S03E54 The Greatest Surgeon of the Modern Era - Dr. Susan Love

Have you ever wondered how it feels to break barriers, defy odds, and reshape the course of medical history? This episode brings to light the awe-inspiring journey of the late Dr. Susan Love, a pioneering surgeon who transformed the treatment of breast cancer.

This extraordinary physician, despite facing immense challenges and discrimination, revolutionized patient care, heading institutions like the Faulkner Breast Center, UCLA Revlon Breast Center, and Santa Barbara Breast Center Institute, which now bears her name. Not only did Love's relentless dedication improve outcomes for patients, but her groundbreaking book, Dr. Susan Love's Breast Book, has served as an invaluable resource for countless patients around the globe.

We reflect on Dr. Love's unconventional approach to surgery training, advocating for less invasive, more personalized treatments. Her story truly resonates, illuminating the shifting dynamics in gender representation within the medical profession. As we celebrate the rise of women in the field, making up over 50% of medical school students today, we pay homage not only to Dr. Love's contribution but to all surgeons who have shaped the profession.

Join us in this enlightening episode, as we honor Dr. Love's legacy and the indelible mark she left on the medical landscape. Share your thoughts on our Instagram or YouTube page, as we pay tribute to those who, against all odds, have blazed a trail and forever altered the course of medicine.

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00:00:05 The Legacy of Dr. Susan Love

00:04:16 Impact of Dr. Susan Love on Breast Cancer Treatment

00:10:28 Honoring Dr. Susan Love and Mentors

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S03E54 The Greatest Surgeon of the Modern Era - Dr. Susan Love

Sam Rhee: If you Google greatest surgeon ever, you will find names of famous surgeons, including Dr. Michael DeBakey called the father of modern cardiovascular surgery, Dr. Thomas Starzl, father of modern transplantation surgery. I might personally even include Dr. Paul Tessier, father of modern craniofacial surgery. I heard of these surgeons and other well-known surgeons countless times in residency training. However, one surgeon who recently passed away might be one of the greatest modern surgeons ever.

I don't think I ever heard this particular name come up once while I was training. But t o the general public, the surgeon is probably much more famous than any of the other names I've mentioned.

This surgeon was not known for developing groundbreaking surgical techniques or having magical surgical skill, but this physician advanced the surgical field and made as much of an impact on the care and outcome of patients as much as, and [00:01:00] arguably more than any other modern surgeon in history.

This surgeon was able to accomplish this despite encountering constant opposition and discrimination over a lifetime. And yet, like so many of our greatest heroes of our world, this surgeon was able to make the world better, not by burning down the institutions that were unjust, but by changing them from within.

We as a world are better for the surgeon's accomplishments. It is unfortunate that I did not know more about the surgeon before their passing July 2nd, a couple weeks ago, but upon reading an obituary written by Harrison Smith in the Washington Post, and then taking a deeper dive into this surgeon's life, including pieces from NPR and the New York Times, I've come away with an appreciation, admiration and inspiration about what this person was able to accomplish in a lifetime.

This surgeon was the unsinkable Dr. Susan Love, whose groundbreaking work in the field of the treatment of breast cancer and improving patient [00:02:00] care will last as an enduring legacy after her passing. Her story is remarkable and almost overwhelming for me as a surgeon, what she was able to overcome, particularly in the brutal and fossilized surgical training culture, which I also experienced, resonated with me deeply, and I hope it does for you as well.

The oldest of five children, Susan Margaret Love, was born into an Irish Catholic family in Long Branch, New Jersey on February 9th, 1948. Her mother was an artist and a homemaker, and her father sold forklift trucks for Eaton.

Dr. Love started at the College of Notre Dame of Maryland and actually entered a convent for several months joining the Catholic religious order.

But then she left saying that she had a different calling. "I wanted to save the world," she said, but they wanted to save their own souls."

Dr. Love then graduated in 1970 as a pre-med major from Thomas Moore College, which was a [00:03:00] women's affiliate of Fordham University in the Bronx. She then went to SUNY Downstate Medical Center, located in Brooklyn, New York for medical school.

She said that her pre-med advisor discouraged her from going to medical school. She said, in fact, my pre-med advisor said to me that if I went to medical school, I would be killing some boy because he would have to go to Vietnam and then you're going to stay home and have babies and it will be totally wasted.

This is the exact same thing I would hear from many of my senior surgeons during my residency even in the 1990s. Training women was a waste because they felt they would no longer work as surgeons once they had kids. So as a result of this in the 1970s, medical schools were still admitting very few women, maybe 10% of each class.

It did get better. And by the 1980s, about 25% of the graduates were female. And now by last count in 2019, women make up over 50% of medical school [00:04:00] students.

At SUNY Downstate Medical School, Dr. Love was elected AOA, which is known as the Alpha Omega Alpha Honor Society in medical school, which is an elite honor for top medical school graduates. I didn't make AOA, although some of my more distinguished friends and classmates did.

After medical school. Dr. Love did her general surgery residency at Boston's Beth Israel Hospital, which is a Harvard Medical School affiliate.

As few women as there were in medical school, even fewer chose general surgery at that time as a specialty. General surgery residencies were notoriously harsh and brutal, particularly any hospital associated with Harvard Medical School. The work hours were unreal, and a surgeon that I knew that trained at Beth Israel at that time said that as a chief resident, he was excused from surgical cases for one afternoon to see his wife who had just given birth to their first child several floors down in the hospital. But he was expected to come back in the early evening to resume working.

After finishing surgical [00:05:00] training at Beth Israel, Dr. Love said it was pure sexism that led her to focus on breast surgery.

"I was a chief resident in surgery at Harvard, and when I finished, nobody offered me a job, and so I hung up a shingle, and the people that were referred to me were all women with breast problems, but I found I could make a much bigger difference in that arena than I could fixing hernias and doing general surgery."

She said there's always something unique that as a woman you can bring to the table that actually makes it better. And the trick, I think she said, is not just to give in and put up with the garbage, but to make your own path.

Dr. Love became the founding director of the Faulkner Breast Center in Boston, and then went on to become the director of the UCLA Revlon Breast Center in Los Angeles.

Afterwards she became director of the Santa Barbara Breast Center Institute, which is now known as the Dr. Susan Love Foundation for Breast Cancer Research. Dr. Love was one of the early advocates for less invasive and more personalized treatments for breast cancer.

[00:06:00] In the 1970s, the standard of care for breast cancer was as follows. If you found a breast mass, your doctor would schedule you for surgery. At the beginning of surgery, the mass would be biopsied and examined while you were still under anesthesia. If it wasn't cancerous, the surgery would end and they would wake the patient up.

If the mass was cancerous, the patient would then undergo a radical mastectomy, which was an extensive operation where they took not only the entire breast, but the pectoralis muscle, the chest lymph nodes, and sometimes part of the ribs would also be cut out depending on the location of the tumor.

Afterwards, the patient would then be awakened and then find out whether she still had a breast, or was left with a devastatingly large void that had major functional problems afterwards.

It was only after research in Europe, then confirmed in the United States that it was clear that bigger surgery wasn't better surgery. Hormonal therapy, more directed surgeries, targeted radiation treatments, and [00:07:00] sentinel node biopsies.

These are all now standards of care for treatment. One out of eight women in the United States will now develop invasive breast cancer in their lifetime. The fact that Dr. Love did not accept the standard of care at that time and pushed to find more effective treatment outcomes for patients has helped thousands and possibly millions of patients survive and live better lives.

Many patients are well acquainted with her book, Dr. Susan Love's Breast Book. First published in 1990, which is still regularly updated and considered the global bible for patients with breast cancer. The book has been translated into German, Dutch, Chinese, Japanese, Spanish, and Hebrew.

I think the anecdotes that I read in the New York Times article written by Perri Klass about how Dr. Love approached surgical training and helping patients reasonated the most with me as a plastic surgeon who underwent similar surgical training and now works with many women patients.

Dr. Love said she had to suppress many of her [00:08:00] basic values in order to get through surgical residency. "Most women have problems in surgery training unless they can block out their previous socialization. Surgeons don't really like having women, and don't make it comfortable for them."

"Things that women like, such as talking to patients aren't important. It's how many operations you've done, how many hours you've been up, how many notches on your belt."

"If you get through your five or six years of training, you can regain your values, but it's a real if, and most men never get them back."

She ran an operating room by treating the nurses like intelligent people. Talking to them, teaching them. She said, "I'm not the big ruler." She said, "Surgery is a lot of ritual and little science. The boys need high mass, incense and altar boys. They need more boosting up, but the women are much lower church."

Dr. Love offered an example of something she does differently, something no one taught her before. Before a patient is put to sleep, she made it a [00:09:00] practice to hold that person's hand. Quote, "I'm usually the only person in the room that they really know and it's the scariest time," she said. "The boys scrub then come in when the patient's asleep. I got razzed for it, but they're used to it now."

"I spend more time in empathy, talking, explaining, teaching, and it's a much more equal power relationship."

She told the story of a recent patient, an 84 year old woman with breast cancer who was asked by a male surgeon, are you vain?

Embarrassed, the woman said she wasn't. The surgeon advised her in that case, have a mastectomy rather than a more limited procedure. But her niece pointed out, you bought a new bra to come to the doctor and you combed your hair over your hearing aid. The doctor simply assumed that an elderly woman would have no desire for looks or to preserve her breast.

From an NPR article by Michael Levitt and Sarah Handel comes this story about Dr. Love. She was genuinely the most empathic doctor I think I've ever met. She [00:10:00] had a supply of tape recorders and when she went in to see a new patient, she would hand them the tape recorder and say, listen, tape this consultation.

And when you go home and your friends and family start driving you crazy, asking the same questions over and over, give them the tape and go to the movies. And that was her way of saying, you don't have to become the Capital P Patient. You are a woman who has breast cancer and you don't have to live that 24/7, and I think that humanized the whole thing.

Despite Dr. Love's fierce fight against the status quo in medicine, she always brought a deeply human touch to her practice.

For me, being a patient advocate is as simple as having empathy for your patients and doing for them what you believe you would deserve for yourself as a patient.

I have had many wonderful surgical role models and mentors, but none have come close to having the capabilities, compassion and endurance that Dr. Love embodied in her lifetime. I honor her and I [00:11:00] raise her up as an example to myself and others as well as many have and will continue to do.

As her Foundation CEO Christopher Conway said, quote, "The light that Susan shared with the world has touched so many and the world will mourn her loss as an advocate, a researcher, a doctor, a surgeon, a friend, an author, and so much more. Her legacy will live on forever. In the love she showed the world."

God bless Dr. Susan Love. Thank you.

My thankful this week is for all the surgical mentors that I've had over the years. While these surgeons may not have been quite as luminous as Dr. Love, they were all instrumental in many ways shaping me to become the surgeon that I am today.

I think of many of them almost every day that I operate. I hear their voices, sometimes gentle, sometimes very loud in my head. Teachers, taskmasters, friends and advisors, I thank everyone who took the time to teach a young surgeon the craft. Thank you.

I welcome your thoughts and comments every [00:12:00] week, and some of my best interactions have been with you, the listener, about your own experiences.

Please DM me @BotoxAndBurpeesPodcast on Instagram. Or leave a comment on youtube.com/@BotoxAndBurpees. Thank you.