Dr. Elizabeth Morgan was in the operating room "when they landed on the moon. I hadn't realized anybody was even about to land on the moon.," she says. "I didn't read a newspaper for 10 years . . . They weren't out yet when it was time for me to go to work."
Dr. Morgan is a plastic surgeon, and the training for plastic surgery is long and bitterly grueling. The survivors are to the medical profession what hot-shot fighter pilots are to the flying profession. She was 20 when she began medical school and 30 when she opened her own office -- in Fairfax, Va., her home.
That was two years ago, but she still feels the culture shock. In a way she feels born again.
"It really takes a while to get resocialized," she says. "You forget how to talk to people. You forget that not everybody is a doctor. For that matter you forget that not everybody is a surgeon. You forget that people aren't necessarily interested in how you did the appendix last night. They couldn't," and here her wide brown eyes open in mock astonishment, "care less."
By and large, she says, "when you finish your residency you are physically and emotionally exhausted. It took me about a year to recover psychologically and six months to recover physically. Though I just realized today that I don't yawn all morning."
Elizabeth Morgan is delighted at the idea that there is a whole new world out there. She has written a book about how a woman gets to be a surgeon: "The Making of a Woman Surgeon," and she regards a forthcoming promotion tour as "like having a deb party . . ." She has written a medical column for Cosmopolitan magazine for some six years now, and this month her book is headlined on the cover of Reader's Digest.
Plastic surgeons are the demigods of the knife, and to be a woman in such a traditionally male training is to have a special perspective on the world of blood, beauty and the needle.
By the time Morgan was a surgical resident, she had developed an unyielding hatred for the androgynous white coat. "It was asking for touble not to wear a white coat," she wrote, ". . . I spent most of my spare money on clothes, and I wore low heels, not flat shoes to work. I needed to feel feminine and different from the male surgeons. And besides, those long white coats were always too big. When I wore a white coat I felt ugly and unfeminine."
Morgan is tall, slim and attractive. She has a wide smile. Her hairstyle and dress are, perhaps, a trace younger than one might expect of a female surgeon. And of course, her refusal to dress with sexless anonymity got her into trouble at once -- inviting stern disapproval from old guard nursing supervisors and advances from (usually married) medical supervisors.
The first she weathered and the second she managed to sidestep. "The trouble was," she said, "the ones who had affairs became known as so-and-so's girl, not Dr. Somebody."
On the other hand, she had only scorn for a female colleague who "would burst into tears when she was criticized, and complain bitterly when she had to work late on her nights off . . . A woman had to demand just as much from herself and the team as a man, and I felt betrayed when another woman surgeon, just as capable as I was, wept and complained when things got tough."
But being a woman did not seem a basic obstable to her accomplishing her goal. Aside from the occasional carless assumption that she was a nurse or a secretary by either a doctor or a patient, most of her experiences, remarkable or not, happened without regard to sex.
Take garlic bullets, for example. Something every big-city surgical resident apparently needs to discover, one way or another.
It was because she and a colleague were depressed about an emergency patient of theirs, an 18-year-old boy full of bullets. They'd sewn him up, but an eventual fatal infection seemed inevitable. "At least," soothed another colleague, "it wasn't garlic."
"The Mafia," he explained cheerfully, "rub their bullets in garlic. We have a victim in I.C.U. who was hit with a garlic bullet. He was shot in the stomach and we sewed it up and he looked fine, but he kept saying it was a garlic bullet. The bullet had lodged in his spine, and we couldn't remove it. Ten days after surgery he had a seizure, then an abcess in the spinal cord, and then abcesses in his brain. We asked the neurosurgeon to see him and he said there's something in garlic that causes a delayed, but fatal infection that spreads to the brain . . .
Morgan never had time to get married -- "You either do it before you start of after you finish . . . it's hard to do it in between." And now, although she concedes that it might be fun to have someone special around, her current social life "is just like having all the fun I didn't have time to have in my 20s."
For the time being, Elizabeth Morgan has closed her office. Not that she doesn't love her profession and not that her practice hasn't caught on, "but I think it's a little bit false to advertise yourself through the papers and a book and everything and expect yourself to be detached from the ensuing large number of patients who come to you.
"I object to seeing any kind of doctor who is rich from his patients. I don't think that is right. I think that doctors should live well. I think that's fine, but there are some doctors of every kind who become very rich people -- and not off their business investments. And I think it makes a lot of patients -- as I would feel as a patient -- very bitter.
"I think medicine is going through a very difficult time," she says, "and although doctors would like to think it's not their fault, and we've been unjustly used, I think doctors haven't looked after their public image, and they haven't psychologically looked after their patients.
"I had a friend who had terrible back pain and he went to an orthopedic surgeon in New York who, for $100, payable in advance, gave him 10 minutes in which he told my friend that he didn't sit up straight and goodbye.
"Now this was a very normal person before he went to see this orthopedic surgeon and now," she sighs, "he's one of those rabid national health people."
She also feels strongly that specialists in one medical genre should stay in close contact with those in others. In her own practice she works especially closely with pediatricians because she does a lot of plastic surgery for children -- repairing birth defects or disfigurement from accidents. But she stays close to the psychologists too.
She recalls one patient she had whose leg had been smashed in a motorcycle accident: "He was doing beautifully, but he just kept getting more and more depressed. I asked a psychologist friend about it and he said, 'Maybe he thinks you're going to cut off his leg and just aren't telling him about it.' So I went to him and I said, 'Look, are you really afraid that we're going to chop your leg off?' And he said, 'Well, yes.' So I said, 'Well we're really not going to,' and he brightened up and said, 'Really? I just thought you weren't talking about it but that's what you were planning to do.' Of course he changed completely and walked out of the hospital just fine.
"Doctors have to be aware that people are afraid the doctor won't tell them if things are going wrong, so they expect the worst. Sometimes a doctor doesn't even think what it is that they think that you think that they have!"
There is a distinct look of the preppie about Elizabeth Morgan, as well there might be. New England prep school. Radcliffe. Yale Medical School. Research at Oxford . . . Her glossy brown hair is worn long and loose. She is slim and long-legged and chic. Her speech is slightly clipped and very proper, much more representative of her English mother and her New England schooling than her Virginia country roots.
She laughs a lot -- at herself, often as not. She is the very embodiment of the Puritan Ethic, has given up cigarettes, tries to keep fit and used to have a weight problem.
"I'm the girl who used to win food-eating contests at boarding school . . . but when I was a resident on heart surgery we worked so hard I lost weight for the first time in my life without thinking about it. We were run off our feet, and somehow it never came back.That's the easy way to lose weight -- stay up all night and work 24 hours a day."
Nevertheless, she says the words "Baskin-Robbins," with reverence and love.
"But," she says, "I really try to live up to all the things I tell my patients to do because I think it's not fair to tell a patient not to smoke, drink too much and get exercise when you sit there, 100 pounds overweight with a cigar or cigarette giving this Delphic oracle kind of advice."
Fitness comes from swimming a few other sports played "very badly. I play tennis and miss the ball. And I play squash and I get hit by the racquet. I played golf once and got an 80. In the first three holes."
Sometimes, she says, she looks back and wonders "how I ever made it. And why." But if the Harvard Med School (where she had originally applied) admissions interviewers couldn't stop her, nor an explosion she set off in a summer-school organic chemistry lab, nor the frightening eye of a grasshopper staring up at her through the microscope . . . well, nothing else would.
She remembers good medicine and bad. She resents the mistreatment of nurses who are, she feels, the unsung, overworked and underpaid heroines of American medicine. She remembers patients she lost and patients she saved. She remembers the fatigue: "I never hallucinated from fatigue. My way of adapting was to collapse. But some of the others, the room would move around them, or they'd see things or hear things . . . Whenever I think of the people I worked with I always remember all of us lined up against a hallway, everybody leaning against the wall trying to make morning rounds. It must have been frightening for the patients, seeing these five doctors staggering around. We leaned on walls, other people, nurses, operating tables, patients, anything.
"One of the things you have to remember when you're not an intern anymore is that you can stand up straight."