Prof Lydia Cairncross, Reclaiming the Feminine

From growing up among political exiles to advocating for the right to health and shaping national policy, Professor Lydia Cairncross's career traces the edges of the operating table and the front lines of social change.

Voted one of Mail & Guardian's 50 most powerful women in 2022, she is a pioneering researcher in breast and endocrine surgery, and the first female Head of the Department of Surgery at the University of Cape Town and Groote Schuur Hospital. A human rights activist committed to equitable healthcare for all.

In this episode of Awakening Doctor, we reflect on the intersection between the professional and the political in her personal story. Lydia speaks candidly about the importance of self-awareness in leadership, the invisible labour women often carry, and the identity shifts that motherhood demanded of her in a system not designed for breastfeeding or work-life balance.

Together, we explore her ongoing struggle to define the margins of burnout and reflect on her vision for a surgical department where people are seen, gifts are valued, and bureaucracy doesn't suffocate passion. Along the way, we dismantle tired stereotypes of surgeons and consider what it means to remain hopeful in a system stretched by austerity.

Join us for a thought-provoking conversation with a leader who is profoundly practical, fiercely optimistic and unapologetically feminine in her bid to change the world.

Transcript

Introduction to Prof. Lydia Cairncross

Dr Maria Christodoulou 0:00

Welcome. I'm Dr. Maria Christodoulou, and this is the Awakening Doctor Podcast, a space where we discover the personal stories of those who work in the medical and health professions. Join me as I explore the hopes, the fears, the aspirations, and the real life challenges of those who carry the title, responsibility, and privilege of being a doctor. Joining me today is Professor Lydia Cairncross, surgeon, scholar, researcher, and leader whose work bridges the worlds of medicine, policy, human rights activism, and social justice. Voted one of Mail & Guardian's 50 most powerful women in 2022, Professor Cairncross is the Head of the Department of Surgery at the University of Cape Town and Groote Schuur Hospital, where she leads with a vision to make surgical care more equitable, compassionate, and connected, from the community clinic to the operating theater and beyond. A pioneering researcher and leader in her sub-specialist field of breast and endocrine surgery, she has played a key role in shaping national policy guidelines and developing innovative approaches to ensure earlier diagnosis and better outcomes for cancer patients. Throughout her career, she has been a passionate advocate for the right to health, working with movements like the Treatment Action Campaign and the People's Health Movement of South Africa, and partnering with civil society organizations to expand access to surgical care for those who need it most. Professor Lydia Cairncross, welcome to the Awakening Doctor Podcast.

Prof Lydia Cairncross 1:39

Maria, thank you for that very generous and beautiful introduction. I appreciate it. Thank you.

Dr Maria Christodoulou 1:45

You're welcome. It's all accurate. We were talking just before we started recording, and I reminded you that one of my objectives when I do these recordings is to reveal the human side of being a medical professional. What does that mean to you?

Prof Lydia Cairncross 2:02

I think being a medical professional and being a surgeon comes with a lot of historical stereotype and assumption and expectation. And it's very easy to get swept up in that, in its positives and negatives. And because our society is structured so much to focus on our positions and our accolades and not as much on our humanness, when you occupy such a well-known type of profession, it's very easy to lose sight of the person- person you, and the work-person you or the position person you. And we kind of all collude in that forgettingness of the person. So I think that you have to be intentional about remembering that that person across the table is just a person like you are.

Dr Maria Christodoulou 2:50

I love that. So if we were to make sure that this conversation is a reminder that you too are just a person like me and like everyone who might be listening, what is the story that we must tell?

Prof Lydia Cairncross 3:04

I think, I mean, what comes to mind is the incompleteness of our attempts to do things differently. And that it's a constant journeying, trying, experimenting, sometimes arriving and sometimes not. And that spiral of development that happens for all of us as individuals. So, I have done a lot of thinking and reading around time, intentionality, efficiency, mindfulness, but I still get caught up in a lot of over-extension and over-commitment and time pressure. So I'm reflecting a little bit on that, that despite those intentions and intentions to boundary set and to find a way to make my availability fit my true availability rather than my aspirational availability, or what I would love people to experience of me as availability, as my availability. I'm here slightly late for this and it's squashed between something that I might be slightly late for at the end. I suppose it's the humanness of that striving and failing and striving and failing that I think should come through. But everybody is experiencing that, regardless of where they are. Some people have just entered a slipstream where the thing that they love to do is rewarded and seen by the system that we're in, and some people less so. And if we can see everyone's position in that light, I think it helps us to change things.

Dr Maria Christodoulou 4:33

What is it that you think needs to change?

Prof Lydia Cairncross 4:35

Everything must change, Maria. So there's a beautiful youth group that runs a training and course that is called Everything Must Change. So, and I really mean that. I know we were trying to not go... to remain intentional about the personal here and its intersection with the political, but with the gravitational pull towards the personal. But if you ask me what should change, I mean, we are the way we are because of the socialisation that's been baked into us from early childhood, school, university. And as medical doctors, we come into university still with a little bit of breadth and depth in other areas, and that gets squeezed out of us during our medical school career. And as soon as we finish medical school, everyone is like, okay, what are you gonna do next? So there very often isn't a point of arrival. And I see a lot of surgeons in training, and that's the program that I run is for surgeons in training. And so I see a lot of young registrars, they're doing their surgery, they train and they finish their surgical exams. The first meeting they have with me, and I've just had three of them, what am I gonna do next? And what do I need to achieve next? Because there's this constant sense of not having arrived. So I would love to see our complex social systems that govern how humanity runs being centered in a humanness, which it isn't at the moment. So it's centered in profit motive, competitiveness, dominance, militarisation, bureaucracy, not to facilitate people, but to control people. So I would like to see all of that shift and change, which requires very big changes. So one of the learning and thinking journeys for me has been how to start experimenting with some of those changes in our daily work and create little pockets and bubbles of different ways of being and doing so that we can start to remember that there might be another way to run the world.

Dr Maria Christodoulou 6:38

Do you feel like you've arrived?

Prof Lydia Cairncross 6:41

Oh gosh, that's confronting.

Dr Maria Christodoulou 6:54

Well, you spoke about three meetings with students where they're, kind of, what's next, what's next, and I'm wondering at what level of the hierarchy does one feel like one has arrived?

Arrival, Purpose, And Alignment

Prof Lydia Cairncross 6:55

So, no matter where you are on the ladder, you're always like, okay, now what's next? So in the last few years, I have very intentionally tried to, at least at an intellectual level, yes, I think that I have. I'm not striving now for things that I think are expected of me in terms of what a successful career looks like. What I'm striving for is the best overlap I can possibly get between my daily work, my paid employment, and what I think my true reason, purpose, inspiration is that I want to do. And if you can get that overlap to be as close to 100% as possible, first of all, how awesome for the world if everyone did that. So you're bringing that joy to what you're doing. So I have not arrived at that place. So a lot of what I do overlaps a lot with what I want to do and I'm inspired to do in the world, but it's not a perfect overlap. And so I'm always thinking about how do I shift that so that I don't do those other things as an add-on to my daily job.

Dr Maria Christodoulou 7:59

Yeah. When did you know you wanted to do medicine?

Prof Lydia Cairncross 8:03

Probably grade 11. So my mom is a doctor, my dad is a chemical engineer, and we come from a very political family, a left socialist tradition. So we've grown up with a concept of service. So I was always going to do something in that realm of service in some way. And then my mother was quite opposed to me doing medicine.

Dr Maria Christodoulou 8:30

As a doctor herself.

Prof Lydia Cairncross 10:09

Yes. And I remember her saying to me, it's a hard life, and I wish something better for you. So but I was a very rebellious teen, so that didn't help. And what I loved about medicine was the diverse possibility that the degree represented. So, you know, you can be a researcher, you can do education, you can sit in a lab, you can look down a microscope, you can see patients, you can do public policy, you can travel and do frontline. There's so many things you can do with medicine. And I wasn't completely sure how I wanted to see my life unfold. And medicine seemed like this amazing opportunity to still have that choice into the future. And I think, like many people who go into medicine, if you're getting good marks at school, there is a kind of social expectation that you consider something like medicine. So even though I blame my mother for telling me not to do it and therefore I did it. I think that a whole combination of things plays into the decision. So, and then of course, when I started at medical school and as a doctor, I remember thinking back and saying, it's a complete accident that I love this because I had no idea what it was like. I think it's like that for many people, you don't know what it's going to be like when you're practicing medicine. And I just really loved it. I loved the energy and the buzz, I love the on-call, a naturally quite energetic, busy person. So I could engage with that madness of internship and community service, and I enjoyed it a lot. And I enjoy it a lot. So it was a good choice for me. But I can see that as a student, you really wouldn't know.

Dr Maria Christodoulou 10:10

Right. And did I read somewhere that there were some other options on the table initially, things like being an astrophysicist or being a journalist?

Prof Lydia Cairncross 10:19

Yeah, so I think the astrophysics one, to be honest, it would never have worked. There are very few people that I would engage with. But the journalism one, I still have a little bit of an ache for because I love to write and I love this concept of... it wasn't just journalism. I wanted to document like war zones. I wanted to travel and be those journalists in the midst of things happening and document them. So it was that kind of political commentary part of journalism that I was drawn to. I still like that and the concept of writing as an expression of your vision for how you would like to see things change or the world. So there's still a writer in me that I think is there.

Dr Maria Christodoulou 11:04

Does that writer get a chance to express in the writing that you do now in your work?

Prof Lydia Cairncross 11:10

I suppose in some of the advocacy and political work. Quite a lot of writing there. Not so much in my academic research, that I can write and I do, but it's not the same kind of writing.

Dr Maria Christodoulou 11:23

You've spoken in the past about how you came to medicine from a sort of social justice lens. And you talked now about your parents, your mom a doctor, your dad a chemical engineer, growing up in quite a politically aware home and environment. Tell us a little bit about that. What was that like? What were the influences you were exposed to?

Political Roots And Activism

Intersections: Strikes, Fees Must Fall, COVID

Prof Lydia Cairncross 11:47

So both my parents were political, I suppose these days you'd call them political activists, but they were politically involved throughout my childhood and left South Africa in 1981 to live in Zimbabwe, partly because of the political repression that was happening in South Africa at the time. So my mom was part of holding the United Women's Movement, and my dad was part of a number of left formations at the time. And when we were in Zimbabwe, throughout our time there from 1981 to 1989, we had streams of political exiles coming through our home, staying, sleeping there, coming at night, sometimes even before we'd wake up. There was always this discussion, debate, a sense of possibility and what could be done. And I suppose also optimism about change at that time. Zimbabwe was just newly independent, and there was a lot of excitement about it as a new country. I remember that feeling of crossing over the border into Zimbabwe when I was only five or six, and this kind of pride and optimism and excitement of the Zimbabwean people at the time. So I suppose I grew up in that mix of historical change and wanting to see that happen in South Africa. And then we came back in 1990 and I was immediately involved in the student protest movements and the teacher strikes and mobilization around the elections and that very turbulent time. So that was quite formative for me because I'm not as good in peacetime as I am in crisis. So I think that's from the way I grew up. And so, you know, I came into medicine from that political background, and there's a lot of scope within medicine, of course, to do a lot of social change, you know, it's a lot of social justice work. Though it has for a long time been a parallel path for me. So, I had my sort of medicine and surgery as a fairly standard career avenue, and then work with TAC, with People's Health Movement, kind of as a parallel political stream, intersecting now and again. So, for example, in 2007, when there was the austerity and budget cuts and also the big public sector strike at Groote Schuur Hospital and the whole country. It was interesting, because I was involved in the hospital-based strike and connecting with unions and organising marches to protect the health budget and beds that were being closed. So those intersections would come up every five to ten years, which is quite interesting. And the next intersection came around the university #RhodesMustFall, #FeesMustFall in 2015-16. So, you know, here I was just a registrar, then consultant, and then surgeon within the breast and endocrine unit. And at the same time, I suddenly realised I'm also a university employee. I'm actually a member of the university, which I hadn't seen in that way before. But that whole youth uprising of that time kind of swept me back into a crossover between the two parts, which was interesting. The difficulty is that both of them require quite a lot of energy. So when they intersect, both exciting, but also often followed by a period of exhaustion and burnout. So, you know, when I look back at those parallel streams intersecting and separating over time, that's what I see. And then the most recent one, I mean, COVID, while it was a health emergency, was really a socio-political economic crisis. And so that was very political as well. I mean, many of us thought this is it, things are going to change and be completely different after this. So it was a big disappointment when it became clear that that wasn't going to happen. But that was also an opportunity because during the worst of the lockdown, you know, we were working in the wards and surgeons were involved in all of the care. We had a whole of hospital response. I was running one of the high care units. And then I started to do some community mobilisation and awareness workshops with people around understanding what COVID is and vaccines and all of that. And that was really generative for me to see that in-hospital, out-hospital connection. Very exciting, but also like only one person, two jobs. But it was a very interesting intersection. And I suppose now, as head of department, it is also a political role in certain senses. So I know about budget, I know when it comes out. Like, when the budget speech happens, it affects my life directly because it depends how many posts we're going to have, how many nurses, how many theatre lists. And that's a slightly different intersection, because the kind of social mobilisation that's required to shift those things is not as strong now as it was in the past. So that needs to be built. So I suppose what I'm describing is a constant shifting between the two parts of my identity, sometimes aligning perfectly and sometimes separating, but a constant pull. And I love operating. I love being a surgeon. I love being an actual clinical doctor. I think that's the push and pull.

Dr Maria Christodoulou 16:55

Has there ever been a time when those parts collided in a way that was problematic?

Leadership Tensions And Boundaries

Prof Lydia Cairncross 17:00

No, I think just in terms of time and energy. So I mean, here you could say there's some contradictions around being in a very senior position. So, for example, when budget cuts happen, having to decide which services continue, which don't, which posts. I don't really get to decide on posts, even though the hospital managers pretend that we do. So there is some tension there. But I think I haven't crossed the leadership line where I am truly a technocrat of the system. So academic head of department, you are not a resource holder in that way. You're a resource organiser and a training and a coordinator and a team builder and a leader. But if you are kind of at a CEO of a hospital, or if you are even, I would say, like maybe a dean or a vice chancellor in a university, it's a different institutional position. So I think there is a line. I don't think that I'm on the other side of it, but I'm conscious of those contradictions and that possibility.

Dr Maria Christodoulou 18:02

Did you ever imagine yourself as an HOD? Was that something you aspired to?

Prof Lydia Cairncross 18:08

I didn't actually. When I was a surgical registrar, so I mean I must just say how much I love surgery. So I did my first operation as an intern, a caesarean section, because that's the commonest performed operation in the world. I didn't really like some bits of it. I won't go into... like the liquor and.. no, but the whole operation.

Dr Maria Christodoulou 18:28

People can't see your facial expression, but it was an interesting facial expression.

Falling In Love With Surgery

Prof Lydia Cairncross 18:32

Yeah. The baby, of course, very cool, but I really loved the order out of chaos of surgery and watching something happen with your hands and the edge of it where you have to be completely focused and you're leading a team and you have to stay calm, and there are unanticipated things that happen. So there's that edge that I loved. I felt it there in theater. And I remember someone saying, Oh, you know, maybe you should consider surgery. And I kind of thought, like, that's a crazy idea. I loved anaesthesia, I actually loved all the disciplines. But I came back to surgery because I lost faith in a lot of medicine. So when I was an intern, I was like, we are just pushing a sausage machine here. This isn't like management of diabetes, management of hypertension, management of chronic pain. We were not winning at all. And we were not just not winning. I'm not sure that we were actually improving people's quality of life. We were just pushing tablets that maybe worked. And then when the inpatient service rescuing people right at the end of life or deep in crisis with things that could have been prevented. And then, I was a junior doctor during the HIV pandemic. We had no antiretrovirals, people were dying. I didn't feel that I was helping people as a doctor. But I could see the benefit of the surgical intervention. So I could see people live after appendicectomy, after trauma, after gunshots. I could see this has an impact. So I really liked that about surgery. So it wasn't so much the other stuff, it's that sense of making a real difference that's undeniable.

Dr Maria Christodoulou 20:11

Right.

Prof Lydia Cairncross 20:11

Of course it comes with the flip side of the responsibility when something goes wrong. It is also quite heavy on your conscience when you make a mistake or there's a complication. So surgery really restored my faith in medicine as a field because I was really towards the end of my internship. I'm like, I don't know about this. I remember writing to my mom and I'm like, I don't know. I don't think that I don't know. This is not quite what I expected, mainly because this the futility of so much of what we were doing. And she sent me a book by Bernie Siegel called Love, Medicine and Miracles.

Dr Maria Christodoulou 20:45

I remember it was one of my first influences about medicine, too. It's a beautiful book.

Prof Lydia Cairncross 20:50

It's really beautiful. Bernie Siegel is an oncology surgeon. And he talked about the miracle patients, the exceptional patients. He talked about the role of our psychology and our investment in our own health and our agency and all of those things. And I'm like, yeah, that makes sense. And he was expressing what I was feeling or seeing, but didn't have words for. So he was a surgeon. So I suppose seeing a surgical person able to speak in that way about patients in his own journey, when he shaved his head and all that stuff. Very interesting. And I was also very much drawn still to this concept of, you know, if you're dropped in the middle of nowhere and you have people at war, or something has happened, or trauma, violence, whatever that might be, you can know a lot of things, but it's what you're able to do that's important. So this concept of being able to do something with your hands was really there. So I think that's why I ended up doing surgery. And also it was just so counterintuitive and counter-culture to do. So that was also cool. So there were very few women doing surgery. So in my training, I had no sense that I was going to be an academic in surgery. I just wanted to do that work. So I had in my mind becoming a general surgeon in a district hospital and doing clinical service. And Professor Khan was the head of department when I trained. We used to have annual interviews, and he would argue with me at each one. And he'd be like, That's not the right job for you. That's not what you should do. You need to be an academic, you present well, you're articulate, you're clever. And I was like, That's not what I'm into. I'm gonna do a service, and that's it. And I remember in my final year as a registrar, he said to me, You're gonna sit here in my chair in this position. And I said, No.

Dr Maria Christodoulou 22:36

So he was quite a visionary, huh?

Mentorship, Academia, And Motherhood

Prof Lydia Cairncross 22:40

Yeah, he did know. But what I hadn't predicted in all of that was my kids. So I think my first year after I finished my registrarship, I kind of had to make a decision between a generalist job in a peripheral hospital versus an academic job. And Professor Khan actually pushed me very hard. In fact, I'd interviewed for the other job and he told them just hold and made something happen on the other side. And I took the academic job, but I was torn, but it was very clearly the better choice for me. And I could see that within a few years, and mainly because it allowed me a certain predictability over my work schedule that allowed me to be the kind of engaged mother and present mother that I've been. I would never have been able to do that in a smaller hospital with the on-call and everything that went with it, because it would have been hard for me to betray either side, I suppose. And so, in my academic surgical role, much more elective, planned, controlled schedule. So for the first few years, I resisted it and I used to volunteer at some of the smaller hospitals. I volunteered at Jooste and then Mitchell's Plain for some time, and at Somerset, until I was pregnant with my son, my second child, and I had just had a very bad night where I was like eight months pregnant, I had a toddler, I had a 3 a.m. call-out, and I left. The operation was fine, but I came back to like a screaming child, stressed-out husband. Everyone was late. I'm like, what am I doing? So I had to put down that idea of myself as this kind of trauma doctor, middle of the night, like surgeon that's doing everything. And I had to kind of accept my role as a I'm a surgeon in an academic institution, and that certain things come with that, like a lot of teaching and a lot of research, but also greater control and predictability over my after hours time and the weekends. It was hard for me to accept that, but I did move past that I was not a general surgeon anymore. I was now a sub-specialist surgeon in a particular realm, which is quite niche and fairly protected from the wild winds of general surgical practice, actually.

Dr Maria Christodoulou 24:53

Tell us about the story of meeting your husband and becoming a mother, because somewhere along the way you've found a man and you have two children.

Parenting, Breastfeeding, And Work Flexibility

Prof Lydia Cairncross 25:01

Yeah, I um... we met when, as many, many doctors do, we're such boring people sometimes. So we met at work in the ICU rotation, and he's an orthopedic surgeon, and he's originally from the Eastern Cape in Tsomo. So it was a very different cultural and political background, but also something I was drawn to in lots of ways because of the African identity and everything that went with that. And then he's a very, very good orthopedic surgeon, which is also cool, and an academic. So we met and we were together for quite a long time before we had kids. So I waited till I finished my surgical final exams. And even then, I was still kind of waiting. I was like, wait, let me just first. And then my mom and my husband and my gynae was like, if you're going to do this, it's probably now. So I know a lot of women have that. So I had my first child at 35. But I think if I wasn't nudged, I would have probably been like, wait, hang on, I still need to, I've just taken this job. I think I shouldn't just have a baby now. I should at least first settle in, you know, all of that stuff. So when I was 35, I had my daughter, Lanika, and I worked until I was 38 weeks. And beginning of my maternity leave, I finished my MMed and submitted it. So I did that same crazy story that a lot of doctors do. And I remember being very, very pregnant, and you can't get very close to the table, theater table, when you're very pregnant. You have to kind of operate like a little bit sideways so the tummy can go the one way. But I mean, South Africa doesn't have good regulation on this stuff, so we all just worked until the end. They did our on-call till the end. But when I think back on it, this is not a healthy thing to do, and we should actually stop doing on-call at about 30 weeks, and anyway. So I try and bring some of that in for our registrars where I can to ease the load towards the end. And then I had my daughter Lanika, and I took off six months. So we're four months paid, and then two months unpaid, and all my vacation leave, all the things that women have to do. But I negotiated with Prof Khan, the head of department, and he was fine with it. So I knew beforehand that a three and a half month old baby was not what I wanted when I came back to work. So I took the six months. So I think that I can own for myself. The rest of my kind of very grounded being a mom and parent, I just attribute to my daughter who just sorted me out within the first few months. So she was a... we didn't sleep a lot. She was very, very close to me. She wanted to be held all the time. It started off in a cot and that just didn't work out. So from that point on, for the next decade, we've had kids in our bed and so a very physically close relationship for a long time. And then I was gonna come back to work. I was preparing the month before, and the child would not drink a bottle. She would not drink a bottle. She would not drink the bottle. So then I entered in this whole other thing where she was going to starve when I came back to work. And I took a photograph. We tried 14 different types of bottle, from like the Pick 'n Pay cheap, whatever, all the way through to the most expensive thing that says it's gonna replicate breastfeeding. None of them worked, she was just like not having it. So I had to come back and ask for part-time for six months, which was not like on my radar as something I was going to do. We were so close, I couldn't leave her at home to come and have that meeting with the HOD. I brought her with, and she was here in the office with us. In fact, I think the secretaries took her down the corridor and played with her, and I came to have the meeting, and I'm like, I don't know what to do. The child won't drink the bottle. And he's like, Okay, let's see. And so we made a plan that I gave up some of my pay and some of my overtime and structured a half-day job for six months, which made a difference. So some days I would come in the afternoon and some days in the morning, and I would operate, and it seems now like you know, six months is a short time, but at that time it made such a big difference to me because a baby at five and a half months and a baby at 11, 12 months completely.... I feel so for mothers who have to go back to work and leave like this three-month-old baby. I mean, it's too young. I mean, we pretend it's all okay, but it's too young. Crazy society that makes people make that choice. And I remember the day that I had to come back for my half day. I cried. I can completely understand why women give up their day job. Like, I totally and if I didn't love my job, I would not go back. If I had the economic means not to, I would not go back to work, which is weird for me. It's like it completely shifted my thinking. And so I think being a mother has made me a much fuller person. I think I have within my personality kind of the workaholic adrenaline junkie chasing your tail kind of energy. And kids just don't allow that kind of thing. They're kind of like, no, you have to come home, you have to play, you have to go to the park, you have to swim. And if you love them, you want to meet them there where they are, which is this playful, present, happy state. Now, look, I'm not saying that I manage that perfectly. I'm sure my children will tell you how I have not, but there's a counterbalance to the workplace that came for me through having small children, which I think was good for me.

Dr Maria Christodoulou 30:39

I'm impressed that your work environment allowed that. I mean, again, we talked earlier about stereotypes and social perceptions. Certainly, surgery is not a profession that one aligns with this idea of accommodating a young mother to be present for her children and to work part-time. So it feels like you had quite a forward-thinking head of department at the time.

Gender, Careers, And Trade-offs

Prof Lydia Cairncross 31:02

Well, I mean, he didn't verbalise it, but he did it. So he recruited a lot of women into the program intentionally. And in fact, he had phoned me and said, please apply for the job before I was a registrar. And then when I came to tell him at like 20 weeks or whatever, that I was pregnant, he famously, I hope he won't mind me saying, he said to me, Was this a planned pregnancy? And I'm like, You cannot say that. Like, you can't say those things. And then he advised me not to breastfeed and like don't let the kids... all like completely inappropriate. We had a good relationship, so I could say, you do know that according to HR, you cannot say that kind of thing. But he facilitated my career, he facilitated my part-time work, and he made those accommodations in the beginning, which allowed me to be able to work and to be there for my children, which I'm very grateful for because not everyone will get that kind of accommodation. And I'm grateful for my daughter because she, I mean, insisted. And so I had no other option. So by the time I had my son, as a family, my husband and I, we'd been broken in. We knew that we couldn't make the decisions. It took me six months. I arranged the part-time six months. So I did the same thing for him, which was good. And I ended up breastfeeding both of my kids until like three. And there were fun parts to that. Like, I became in that time quite passionate about breastfeeding. I get very intense about things. I became this intensely... like, the fact that mothers and their babies were not getting the support they needed to breastfeed in the early months is really breaking my heart. And I started to pump and donate milk at the nursery here, which was also lovely, and found out where you can express and store milk at work because that wasn't always provided. There was no office, so it would be like in the theater change room and then run upstairs and put it in the fridge. You know, all of those things. I'd never thought about it, ever. If I were planning a workplace, I would never think, oh, we need a breastfeeding room. I would never have thought about it. And that's only because of the experience, that you think, actually, that's part of what we need to provide. A clean, safe, quiet space for that kind of thing. So, yes, in his farewell speech, I said that he was a closet feminist because he promoted and supported women throughout our training, regardless of the strange things that he said. He did also say to me that my academic career was in question when I had my second child.

Dr Maria Christodoulou 33:33

So there's that side of it too.

Prof Lydia Cairncross 33:35

Yeah, but I didn't take it too seriously because he didn't in any way put obstacles in my way. Continued to open up opportunities and let me go to meetings and do my research. And so, I don't think it was really meant, actually. So maybe just very poor sense of humour. But another person could have taken that very personally and been like, okay, I've made my choices. Now I am just going to be something.

Dr Maria Christodoulou 34:03

Do you think that being a woman has in some ways compromised your career path?

Prof Lydia Cairncross 34:10

Yeah, I would say not so much being a woman, but I would say that my choices around being a mother have impacted upon what I could do. So I didn't use my passport for a long time. And my husband traveled a lot from the time the kids were very small. But I made a conscious decision. I remember I had a trip to Morocco. I was supposed to go to an aortic meeting, and I was still breastfeeding. But I was like, it's okay, child is like 18 months. I'm just gonna pump and dump as you do. And as the time came, I just couldn't do it. And I just canceled the whole trip. And of course, you know, you make connections at meetings, you get onto podiums, you add things onto your CV. So when I did my CV application for my ad hominem promotion, I had very little to put under international engagements. I had some online things because of COVID. But then I thought, well, if they don't want me because of that, then well, that's too bad. So those were sacrifices that I ... it's not even a sacrifice, those were choices that I made which have impacted on the kind, the shape, and form of my career. So I have some international footprint, but it's not as big as it could have been. And I have a much bigger leadership and footprint role in my career in the country, which I'm fine with.

Dr Maria Christodoulou 35:35

Are there any regrets at this stage of your career?

Prof Lydia Cairncross 35:35

I feel like I should produce one.

Dr Maria Christodoulou 35:38

How awesome would it be if there aren't any?

Stereotypes And Women In Surgery

Prof Lydia Cairncross 35:45

I think no, in terms of my work career, I don't have regrets. I have some regrets maybe in how I could have relaxed into things more at different times in my career. A person stresses a lot about things that you didn't need to stress about. So there were many things that I could have just been more at ease with at the time that they were happening. And that changes the feel of your life at that time. That I would maybe have changed. But in terms of career path choices, no. I think in the big choice of politics versus medicine, I mean, that one's up for debate. But within medicine, I think I've made the choices that I would have wanted to make. It's a very sort of out-of-character choice for me to be in surgery and for me to be head of surgery because I've got a primary healthcare lens, a lot of public health visioning, public policy.

Dr Maria Christodoulou 36:38

Isn't that part of the problem, that we think it's out-of-character for someone with those interests to be in surgery?

Prof Lydia Cairncross 36:46

It is a problem. And I think some of the stereotypes are true, but I think a lot of surgeons are negatively impacted upon by a lot of those assumptions. So the stereotype of like the arrogant, blustering, doesn't talk to patients, rude surgeon, I think doesn't apply to most of the people in the department that I work in. So I'm not some kind of anomaly within the field. There are many, many, many people who are compassionate surgeons, compassionate, engaged, communicate well, extremely caring, work well with other colleagues. So I do get a little bit tired of it sometimes when I hear the assumption and the stereotype. And it's even within the health system, within the leadership and bureaucracy of the provincial health system, they'll talk about, oh, you know, the surgeons. And I think that's not really fair. And the kind of surgeons and anaesthetist narrative. So I think it's important for us all to stop replicating those stereotypes in the same way that we shouldn't talk. Oh, you know, the physicians are like that, the anaesthetists are like that. Surgeons are decisive, yes. And so where there was not a good regulatory environment that could lead to arrogance and individualism around decision making. But the decisiveness in itself doesn't mean you are those other things as well. So I think things have changed more than people think. And there are a lot of women in surgery. And they are changing things, and things are changing. And often we get a lot of abuse from other people who are coming in with an assumption that I have to speak to the surgeon in this way, otherwise I'm not going to get what I need. And so I hope that that can start to change.

Dr Maria Christodoulou 38:30

You've mentioned that there are a lot more women in surgery, which I know is true. I think there's a lot more women in medicine in general than there was maybe 10 or 15 years ago. Some of the conversations I've had with our young registrars or even interns who are thinking about surgery, there is still the perception that it's a male-dominated career and that it's a very difficult career, and that, more importantly, it's going to come at a cost to personal life, relationships, being a mother. What would you say to that?

Invisible Labour And Leadership Styles

Prof Lydia Cairncross 39:02

So I think it's true. First of all, there are still more men than women in surgery. That is true. I would say if I look at our registrar body in general surgery, it's 50-50, those who are training. The consultant level, we're probably looking at about 30 to 40 percent female amongst the consultants. And then the numbers dwindle down, of course, as you go up. But to give you a sense of how quickly the terrain is changing, when I became head of division of general surgery, I walked into an all-male room. There was no one else. Now, and it was quite a like proper all-male room, but now, the head of paediatric surgery, head of general surgery, head of ENT, are all women. And that's out of 10 people, right? So that's, you know, within the space of three years. And I think if we look at the next head of a couple of other divisions that I'm thinking through, we're probably going to be about half the divisional heads, women, pretty soon, within the next five years. So I mean, UCT, I think, has had more women historically. There has been a drive. So, and it's obviously not the same in orthopaedics where there's still a much, much higher percentage of men than women. Probably looking at more like 20% to 80%. But there is a shift. Now we know from what's happened in the world that that doesn't go all the way and end up at 50% just over time. We know that the barriers, we have the leaky pipeline, people leave the system as they go along. Not everyone has been lucky, in the sense that I can describe my supportive workplace as lucky, to be able to be a parent and be at work and try and perform both. So that is a reality. I think it's a reality of medicine. I don't think it's a reality just of surgery. So if you look at obstetrics and gynaecology, if you look at paediatrics, they have a similar kind of work requirement and hours and after- hours and nights and weekends. So there's something about what is being done in the profession that overlays the stereotype as well. So in paediatrics, paediatricians work extremely hard and they work a lot of nights and a lot of weekends, but there are a lot of women in paediatrics. And obs and gynae, they work very hard and they're up all night, as we are. And there are a lot of women in obs and gynae. So there is something in that story as well, which we need to dismantle. So it's not just about the hours, it's also about what people perceive to be what you look like when you become a surgeon, gynaecologist, paediatrician, which we need to change. So it's not, I think, not a surgery problem. It is a medicine and human problem. And so the workplace overall needs to shift. And now specialist training needs to shift. How it's done, what's expected, the lack of job share, flexible hours, all of those things that are not built into the system. That is true in all the specialties. But surgery has a particular historical reputation of being more difficult because uh... Some of it's funny. Like, we've done some studies on this where young people believe that women's technical competence will not be as good as men's. And actually, quite the opposite is being shown, often better. So that may also be selection bias and who goes into surgery. But I don't think surgery is more difficult for a woman than other specialisations, I suppose to put it that way. So those are the hard things around call rosters and hours. In terms of breaking in as a woman into a male-dominated field, yes, there are probably more barriers, but I do think that they're shifting. So I would encourage young women to make a decision about their specialisation based on what they love to do, and then to look at what that might mean in terms of their work-life balance, when they plan their families, what they can do. But I think go for the thing that you love. Don't allow the if I do this, I'm not gonna be able to, like, I'm never gonna have a partner and be stable, I'm never gonna have kids. I don't think that's true and valid. Or no more true or valid than any other specialisation or any other job in medicine.

Dr Maria Christodoulou 43:17

Or perhaps any job, any choice one makes in life.

Prof Lydia Cairncross 43:21

Law, finance, these are professions which are not people- friendly. The workplace is not set up to be person-friendly, and it's as much a man problem as it is a woman problem. So we're seeing now with a generation of male surgeons whose wives are also professionals. It's hard for them to fulfill the stereotypical work obligations that men of a generation ago did. They also need to swap out who's doing bath time and sleep time and weekends, they have to check in with their spouse. So that imperative to shift is for both men and women.

Dr Maria Christodoulou 43:59

Yeah. When I was preparing for our conversation, I listened to, I think it was maybe your inaugural speech or another interview that you did, and you spoke about this leaking pipeline and the idea that women fall away from the system at some stage. That they don't reach the upper echelons of the profession because of these other demands that society places on them. And you used the phrase something along the lines of the women disappear. And it reminded me of some research that a feminist writer did a few years back, or quite a few years back. She called it Disappearing Acts. And she followed a bunch of women engineers around in an engineering firm and looked at all the ways in which acts and behaviours, and things that they did in the workplace that in the past would have been designated feminine or female. So relationship building, collaboration, all the invisible tasks that contribute enormously to the outcome of a project, but which nobody officially names or recognises. And so I was intrigued by the fact that it's not only the acts of things that are feminine by definition that disappear, but that the women themselves disappear in these spaces. That something about navigating those spaces makes it really hard to stay in that place of relationality, mutuality, interdependence, you know, connection.

Prof Lydia Cairncross 45:28

Yeah. I'm reminded of when you speak about that, of course, is the invisibility of the home labour as well, the emotional and relational building. And so women within our system are grossly exploited in that way, in many ways. And because it's not valued, though it is extremely useful and is useful for the system, women get exhausted. So we get very, very tired. And I see it in our teams, the women stepping up and organising the rosters and making sure that the events happen and sorting out the sort of background... I don't even want to say administration because it drives me crazy, but creating the framework and the template against which things happen and flow with a particular kind of joy and life in them. I mean, those are the gifts that the feminine principle brings. And they've been completely undervalued. So I get very frustrated, and I must say that sometimes a little bit triggered sometimes when some men within the system are just like so disorganised, you know, they like just can't get the things done. And I'm like, this thing is gendered, because you're expecting someone to come and pick it up and sort it out for you. You can be organised and you can be strong. So that does exist. And I think the rehumanising of men and women requires us to recognise those things that have been lost. So the women who've come, I mean, probably two or three generations back, and maybe even now, who've come into the workplace showing I can do the things that men can do as well as they can do, but I have to put down part of myself to do that. That happened for a while. My sense is that that is possibly shifting. But now women are carrying both of those labours, they're doing that kind of traditional masculine decision, those kinds of roles, but they're also bringing in all the other things, the communication styles, the creating of beautiful spaces and social connections that allow the work to flow. They're doing that as well. And it takes energy. And I feel that in my work because as head of department, I do a lot of relational work. A lot. A lot. So I meet with people one-on-one, I meet with people in groups, I do a lot of conflict resolution, I help people with visioning their own personal careers. I do a lot of unacknowledged or unlabeled counseling for people in various parts of the system. And sometimes it's because they haven't done their own personal work. And so, after a few years now, I'm starting to reflect on, actually that needs to be done. If you're in a leadership position, you need to take responsibility for what you bring into that role. You need to understand your weaknesses, your strengths, what motivates you, your blind spots, your own prejudices, and be able to hold that in relation to the people that you have a lot of power over. That failure to do that, not only by men, men and women. Very, very damaging to the space.

Dr Maria Christodoulou 48:38

Absolutely. I guess the challenge is those stereotypes run deep. I mean, again, even as I was preparing, I knew you had children, I wanted to ask you about being a mother and how that has affected your career. And I had to stop and check myself. Like, have I asked every male guest who has children that question? And I haven't. I have asked it sometimes, or we've talked about their children and I've asked them what their children would say about them. But you know, that gendered idea of the type of questions that are appropriate for me to ask you versus the kind of questions that I might ask a male colleague. It runs so deep. It's crazy. Yeah. So do you think that you do a lot more of that relational work than perhaps some of the male HODs are doing?

Prof Lydia Cairncross 49:23

I'm trying to think, not to overgeneralise.

Dr Maria Christodoulou 49:26

I felt like even my question was a generalisation.

Prof Lydia Cairncross 49:29

Yeah, I think people are starting to try to do more of it, though not enough people are doing it. So, I realised into my second year as HOD, we are like firefighting all the time. And actually, I love this. When you get people into a room and they've been too scared to like face the thing and put it on the table. You get them into a room and they put it on the table, look each other in the eye, and actually, okay, it's not so terrible to actually face what we disagree about and to say the thing that is driving me crazy and to watch that resolution. I really love seeing that happen. But I realised that I can't do that all the time for so many people, hundreds of people, literally. And so I've started some proactive work, so leadership training, skills development amongst layers of leadership. So, first of all, our surgical leadership group, and then our registrar leadership group. And some of it lands, some of it doesn't land. And so we've structured our own sort of homemade but quite bespoke or personalised courses with our staff psychologist, to try and work with people where they are. So understanding the self that you bring when you're on a ward round or in theatre, or when something bad happens or when you're under stress. Who is it that you bring in? Is it the same person that you bring on the day when you haven't slept the night before, or you've had an argument with your spouse, or your kid is not well? Is it the same self that you bring when everything is great? So it's not true that something is wrong on the ward round or the registrar didn't check the INR. They didn't check the INR, and that's wrong. But your reaction to that is quite different depending on who you are that morning. So that kind of self-awareness is kind of what I'd love to see being built into... And actually, when you're in a leadership role, it is your responsibility to have that self-awareness. So I think slowly I'm hoping to see that change. And that's not about women in power, women in positions of leadership and authority. It's about re-centering and understanding and honouring the feminine principle in everything that we do, which has been so suppressed for so long. And men have that in them, that needs to be brought forward. So we have women in our system that are very destructive in their leadership styles. Very, very destructive, very command- and- control, very traditionally masculine in the way that they do things, and that's not what we want to see. So it's not just about whether you are female or male.

Surgeons and Surgical Errors

Dr Maria Christodoulou 52:02

Yeah. Well, you know, the internalised misogyny affects us all. Maybe let's talk about some of the challenges. What has perhaps been one of the hardest moments of your career, whether that be a loss or a surgical error, a mistake, something that kind of stays with you? A moral dilemma?

Prof Lydia Cairncross 52:24

I mean, I think on table deaths in surgery never really leave you. Those are really hard. Fortunately, very rare, actually. Usually trauma related, and you always feel like there's something else that you should have or could have done. I mean, there are one or two patients that stand out for that. There have been some complications where, like the surgeon I am now, would probably not have done that thing that I did 10 years ago because I've more experience and I do it better now. Like that's hard, right? I often say that our patients carry the burden of our learning curve, and that's quite hard. And to confront something that you've done that you could have done better, and now this is the consequence for the person. And the only way that I've managed to kind of deal with that is to, okay, how do I make that a meaningful thing that's happened by getting better for the next person, either the system or me or something? And I think that's a hard thing. I don't think there's an answer to make that pain better. And I think you want your surgeon to experience that pain. You don't want a surgeon that doesn't stay up at night because of something awful that happened in theater that's affected someone's life. That's actually the important humanity to hold. So I do have those, like other surgeons do. We've tried to set up some spaces with registrars where we can share our complications. Not what happened and why, but how did I respond to it? How did it feel? What does it make me think about now? That kind of thing, to surface the fact that this is happening to everybody. So it's not that if you have a complication, you have to hide it because it makes you a bad surgeon. But that it's only by owning up to them and learning from them that we can find a way to deal with that guilt and distress that comes with it and to be better every time. So one of the difficult things with surgery is it's a very intimate thing. You know, I try to say to the students, this person's going to be completely asleep and at your mercy, and then you're going to do something to their body. I mean, it's extremely personal. And so you really need to have a relationship with the person. Like you need to have looked them in the eye, understood a little bit about the person. So even now I don't have as much time for the clinical work as I used to. I will not operate on a patient if I haven't met them properly, spoken to them and been part of the consent. It's very important to me. I think it's happened once and it was like unavoidable and it was a minor op because they changed the list. I think it's a very important principle because you get to a point in an operation where you're trying to decide should we do this or should we do that? And sometimes, from a clinical point of view, the decisions are... there's some gray area. But if you know the person, you have a sense of what might be right for this person. So I think those are some of the things that are difficult to hold, but we need to do. And it's always hard for people out there in the public to hear about surgeons making mistakes.

Dr Maria Christodoulou 55:28

Yeah. It's rare for surgeons to openly talk about making mistakes.

Prof Lydia Cairncross 55:33

And of course, we need to balance it because there are complications that happen regardless of how well you do it. But all surgeons do learn and they make mistakes. So everything that we set up is to try and hold that safety threshold as high as possible. But what you don't want is someone to make a mistake and then to hide it.

Dr Maria Christodoulou 55:50

Are there any specific anecdotes that stand out in terms of your experience? Any patients that stay with you?

Prof Lydia Cairncross 55:56

I suppose one that just popped into my head. It's not actually a very serious event. I did a lot of breast surgery earlier in my surgical career, now I mainly do endocrine surgery. Like both, but now only endocrine. And there was a patient who had a... was it actually, no, she had a soft tissue tumour. Anyway, so we removed the soft tissue tumour, but the wounds just fell apart. I don't know. And we just couldn't get it to heal. And so, you know, the problem with complications sometimes is that it might have only been one patient in one event, but you see the person over and over again, so it looms large in your consciousness. And I felt so bad about this woman, you know, I wondered what we had done or the way we'd sutured it, or something that had gone wrong, but I wasn't sure. And we spent a long time with her, coming in week after week for dressings and irrigation, and had this like terrible guilt about it all the time. And after the whole process and everything had healed up, she appeared one day in the ward with gifts. Chocolate, card, a little bracelet, all these things to thank us. Thank you so much. Like, oh my goodness, we actually didn't do a really good job here and this person, and it's not an uncommon experience that sometimes patients who've actually... haven't experienced the best out of the system somehow are very grateful nonetheless, and maybe that's relational. So I suppose that stands out for me that even when things don't go as you wanted them to go, don't go perfectly, it's possible to keep a relationship with that person if you are able to own up to it. I still have the little bracelet somewhere, and yeah, it was interesting, just that connection that you have. And I think that's what I love so much about clinical medicine is the human connections you have with people. And when patients say they're going to pray on your hands. I'm not religious, but I always say, please do, we'll take all the help. So I think, yeah, those stands up, and there's so many examples of that. Patient once in Somerset when I was a reg who had this fight with the clerks actually, because he was not from South Africa and he had appendicitis and he needed to have his operation. And I get very angry about patients being denied care because of the country they were born in. And I mean, older me is thinking that poor clerk, it was not their fault either. They were implementing the rules of the system, but I completely lost it. So I've got a bit of a temper somehow. I didn't shout at him, but I was very insistent that we should treat this man. And I said, I don't care who's gonna pay for it. And you can write my name down and you can bill me if you want to. But this is what's gonna happen with this patient. And I didn't know exactly what I was committing to, but anyway. Afterwards, this patient who was from Angola brought me this incredible carving or wood carving, which I also have at home. So it's like these small things that stand out, I suppose, in that experience. And then there are many patients who I meet afterwards, and I can't remember their full story. It makes me feel bad. Hi, doctor, and how are you? And you know I'm doing so much better. I'm like, my goodness, I can't remember. No, I mean, I don't want you to get the impression like I'm this awesome doctor that remembers all my patients and I'm so amazing. So there are some obviously that stand out more than others, and some experiences that stand out. But each interaction... And I think funny enough, now that I'm in an HOD position and I have two days, one and a half days clinical rather than all five days, I value it a little bit more. So when I take consent, I really take my time, I sit down, I make eye contact. Much better than I did when I was very rushed and flustered before, I think, because I suppose I value it because I don't have it as much as I did before.

Burnout, Boundaries, And Saying No

Dr Maria Christodoulou 1:00:00

You've spoken indirectly at different times about... You mentioned the word burnout earlier, and you know, you talked about getting to a place in the last year or two where you realised just how much you were taking on in terms of the relationship building and that you had to take a step back and put a different strategy in place. Has burnout been a theme for you? How do you navigate this space, these tensions, and stay centered, stay healthy, stay whole?

Burnout and Navigating the Margin

Prof Lydia Cairncross 1:00:30

So work in progress. I mean, burnout is the word we give it, but I think most medical professionals are close to the line, edging away, edge close, and edge away from that at different times in their careers. I know that I have definitely been close to the edge a few times. I can recognise the times I've been close to the edge and the times where I've sustained stress for a long time, which has been unhealthy. I think maybe to give you an example, what does the burnout feel like? I remember after my FCS final examination, I had decided a few months before, in fact, I decided somewhere in my registrarship that like, I'm not sure about this, but if I'm gonna do it, I'm gonna be the best. So I mean, I must just reflect on that because of the insanity of it. Somehow I'd held that thinking all the way through my registrarship without realising I was holding it. And then I studied for my FCS finals and I worked really hard and I did the exam. I remember walking out of it, and I'm thinking I didn't have to do as much as I did. And then I went back to my hotel room, which was far away, and I hadn't asked my family to come over for the graduation, even though they had offered to. And I just had this complete like meltdown. I just wept out of exhaustion and stress and anxiety, and like, what am I doing? And I did well in the exam and I got the medal, and I was like, okay, but does it balance out what I had done to my body in that run-up to all of that? So at the airport on my way home, I bought A New Earth by Eckhart Tolle, and I was like, okay, I don't know why the book just jumped out to me. I've read The Power of Now. And I started reading it, and that I suppose gives you a snapshot of my cycle. I get involved in things, I'm very enthusiastic. I have very poor ability to predict how much energy and time will be required for the things that I want to do, but I do them anyway because I said I'm gonna do them. And then I keep going, keep going, and then I get really, really, really tired and I have to take a break. And I've managed to take a break before I've had a major physical impact so far, which I'm grateful for. But I do realise that I'm skirting close to the line sometimes. And I think an awareness of what that feels like when you're getting close is something I might be getting a bit better at over time. So I'm still approaching the line, but I'm noticing when I'm getting there.

Dr Maria Christodoulou 1:02:58

Right. What does it feel like when you approach the line?

Prof Lydia Cairncross 1:03:02

I get irritable. In the evenings when I get home, I'm unable to engage with small things like did I order dog food, and is there enough stuff for the lunchboxes tomorrow? And whose birthday party is it we're going to on Saturday and have we got a gift? Like really small things. And when my brain can't do that easily, I know I'm approaching that kind of mental exhaustion. Where it's just one more thing, it's like it's too much. So that gives me a sense of it. The irritability is a big one, and then my inability to do fun things because I'm too tired. I think those are probably the markers. And I know that in 2020, in the middle of COVID, I had a big kind of wake-up where I was really exhausted and really tired. And I kind of took a pause and reflected on what I was doing and adjusted some things. And I went into six months of no. So I said, for the next six months, I'm gonna say no to everything that's not absolutely core to my work. It's very liberating, by the way. And if you write it down, it's even better. So I wrote quite a long list. I wrote it down. So these would be, please can you come and do a talk on women in surgery? Please can you come and chat to this group of students? Please can you do another lecture? Do you want to participate in a research study? Will you come to my conference? Can you attend something... like anything. These are never things that are awful. These are fun things. These are things you want to do. You want to love to do. They're interesting. They align with your vision and they're good for your career and for your CV. And then you just think to yourself, no. I mean, like as in, this is not core. My core responsibility is to come to work. I need to do my clinic, I need to do theater, I need to see my patients, I need to teach students. That's my core. I have to do those, but for the next six months, I have to say no to everything. And that took me out of it because the tiredness of today is what you committed to six months ago, not what you committed to yesterday. So it's six months ago. So that kind of taught me some of the skills. And in that time, I went into a deep dive on time, minimalism, efficiency from all the corporate stuff, 4-hour week. I read all of that stuff. Pomodoro - that's crazy. All the way through to the minimalists, how to declutter your life and your inbox, all of that stuff. I read 35 books, actually. I eventually counted them. To try and figure out what is it that you can do to live in a way that you're within your energy bubble and you don't have to keep exceeding it constantly. The term that I found most helpful for that is living with margin. So living with margin is where you predict there will be unpredictable things. And so you have to plan to 80% of your capacity, so you have that margin to extend into. And a concept I've embraced 100% intellectually. I discovered the problem is trying to figure out what the 80% is.

Dr Maria Christodoulou 1:06:14

Right. Or where the margin is.

Prof Lydia Cairncross 1:06:16

Where the margin is. But at least, you know, it's a constant trying and failing and trying and failing. And I think each time I'm getting a little bit better at it, I hope. You'll have to ask my kids. They will be the ones to tell you if I'm right or wrong. So burnout is something that I've thought about a lot. And I can also recognise it in my staff. And the person that you are before you go on your holiday, when you come back from your holiday, it's the same job, same problems, same crazy management, same patient load. How come it looks so different? Because you're rested. It's amazing.

Dr Maria Christodoulou 1:06:48

Yeah.

Motivation and Drivers

Prof Lydia Cairncross 1:06:48

So that's me and the burnout journey.

Dr Maria Christodoulou 1:06:52

As you were talking about all these things, I found myself wondering how you would answer the question, what drives you?

Prof Lydia Cairncross 1:07:00

I think, I can't think of a way to say this that doesn't sound extremely corny and fluffy.

Dr Maria Christodoulou 1:07:07

Let's be corny and fluffy. Let's be human.

Prof Lydia Cairncross 1:07:12

Let's be human. I really feel the things around me that I feel are an injustice. And as I'm getting older, I realise how sensitive I am to them. And I think what drives me is that I think I can do something about them. I think I can do something to change that. I really do. I believe it. It's like part of my DNA. It's been inculcated into me from a child that you can change stuff that you think is not right. And also that things should be changed by people who see the problem. So if you see the problem, you should change it, you should fix it. So I think I'm constantly driven by that. That first of all, I see it, and I'm like, I see it, I can see how it could be different, and I think I can do it. I think I can change that thing and in different ways. So I'll see a problem. And other people can like honestly walk past the thing. And I'm like, what about if we did it this way? And I see other people like that as well. I mean, that's not unique to me. Some people don't, and some people do. And it's great. I think many people should have that. The thing that I wish I'd learned when I was a child is also that you can only do that if you stay whole and centered and energy-filled. And so this, problems should be solved by people who see them, can be problematic if you see a lot of problems. But that is what drives me, and why I can't sit still and why I keep trying and doing things at different levels. I think that's where it is. And I'm very passionate and restless about the state of the world.

Dr Maria Christodoulou 1:08:44

Yeah, there was a moment as you began answering the question, and it's always tricky with Zoom to know for sure, but it felt like some emotion welled up inside of you as you reflected on what drives you. Tell me a bit about that. Tell me about the emotion that wells up.

Prof Lydia Cairncross 1:09:00

I think people who are seeing and sensing what is happening around them, if you're open, I think we're all grieving. I don't know how you cannot be. I think it was not Arundhati Roy, Gabor Mate who said that if you are in grief over the world, you're not crazy, you're awake. And so I think that's what it is. And I suppose part of the emotion comes from a sense that I don't know if I am doing enough of the things that I need to do within the envelope of my influence and whatever gifts I might have. I don't know if I'm doing enough of the right things to change that. So I think that's the questioning, that constant questioning that's there. So I'm dealing with, why can't we fill the nursing posts in theater so we can have more lists and I'm fundraising to do extra theater lists. Should I be fundraising to do extra theater lists, or should I be trying to change the political system so that we don't have economic austerity or that we can change the constitution so that the health and education budget is always protected? Is this the right place to put this passion, which is the translation of what I'm seeing, the grief that I'm feeling? So I think a lot of people have that. So that's that emotion that I think you saw coming through. And I think we don't grieve enough. Sometimes what we see, we transform it straight from hurt into anger and action before going through that. And so it can be quite harmful to our systems.

Legacy: Humanising The Department

Dr Maria Christodoulou 1:10:37

So if there was one concrete change that you could leave behind when your term as HOD is done, whenever that may be, one thing that you could leave that would outlast you, what would it be and why?

Prof Lydia Cairncross 1:10:54

I've got 10, Maria.

Dr Maria Christodoulou 1:10:58

Maybe there'll be 20. Let's pick one.

Prof Lydia Cairncross 1:11:00

I'll name a few and then I'll pick one because I actually have been making this list of things. Either there is the department and how we do the thing we do, which is the surgery that we do, the way we care for patients, what we do in this institution, and then there's how we use that intellectual capacity to discover new knowledge, which is our research and it's how we connect to the community that we're serving. That's one part. And then there's how does it feel to be here, when we walk into this space? And they're deeply interconnected. So how it feels to be here unleashes all the potential of how you can do the service and you can do the technical ability and you can do the research and community connection. So there's some very structural things that I want to do. I want a stable theater list, which is protected. I want all the posts to be full. I want to see kind of the rhythms of how we connect as a surgical community to be better. But I think all of that is probably encapsulated by, I want to change how it feels to work here. So when you're walking into the space, you feel valued, loved, seen, cared for, that your gifts are both visible and appreciated, that the institution is not standing in your way, that you feel there's momentum behind whatever positive energy you're bringing in, because the individuals that work here are phenomenal. They are amazing. And so often that is boxed in and boxed down and reduced or either suppressed or undermined in different ways by very unfeeling, unseeing systems, bureaucratic systems. So it's to kind of humanise that, so that when people come here bringing their heart and their talent, the space is just open for them. Come create and express that gift for our patients. I would love to create that kind of department. I mean, some of it's there. I'm not saying that it's not there, but I want to enhance it. It's the beauty of the space that we work in and the way that we relate to one another. So I'm like getting walls painted and setting up artwork and prize givings and social events and cricket days and runs and also the nuts and bolts of the theater schedule. So it's that combination of things. So I guess it's having a space that really unleashes people's potential in a real way. That's what I'd love to see happen.

Dr Maria Christodoulou 1:13:26

I notice myself as I listen to you have this like range of emotions sort of surging through my own system and like the hope that that could be true. And then my own experience of academic systems, which was totally not that. And yeah, just... there's a sadness about that and a grief, but then there's also this beautiful kind of sense of possibility when I listen to you, and that there are people like yourself in those roles holding that vision. I guess, yeah, it gives me hope. So thank you for that. If I could grant you one minute in front of the entire country, and you could tell them one thing about health that you think they should know, what would you say?

Prof Lydia Cairncross 1:14:14

Health or the health system?

Dr Maria Christodoulou 1:14:14

You decide.

Prof Lydia Cairncross 1:14:16

I think I would say the way that we care for our sick and vulnerable is a barometer of how we are doing as a society. And we have the possibility in South Africa, because we have the talent, we have the infrastructure, we have the skills, we have the hospitals to make available for everyone the miracles of modern medicine. We have not only that possibility and the people to do it and the resources to do it, we have all of those things. What we need is the collective will to make that vision possible. And everyone is responsible for that. From the President to the Minister of Health to every single clerk, every single porter, every single doctor, every single nurse, every single community health worker, every ambulance driver, all of us can come behind that vision and do it. I really believe that.

Dr Maria Christodoulou 1:15:10

So you're reminding me of something you said at the end of your inaugural speech in 2023. And you said, and I quote, the world today is awash with pain and conflict, from Gaza to the gang-ridden streets of the Cape Flats. So it's easy to despair and it's easy to be cynical. It's much harder to hope and harder still to take action. But I urge myself and I urge all of you to take that other route, to find a point of access in the place where you are, the place where you have influence, the place where you can make a difference and act so that the world we leave our children is better than the one into which we were born. How is it for you to hear me say that back to you in this moment?

Prof Lydia Cairncross 1:15:57

Thanks Maria, it's interesting for me because I think I come back to that theme often. There's big picture and there's everything that's wrong, and there's the hope that I really feel, the immense hope and possibility that I see in people. I really love people and I think they're incredible. And so it's interesting to hear that echoing through my different writings and also what you've managed to bring through from me today. So I think that is a talent and a skill to kind of find the places to really bring the person through in all that they are. So I think, yes, that's what I felt like. Oh, yeah, that's connecting to what I've just said.

Dr Maria Christodoulou 1:16:36

Absolutely. What keeps you hopeful?

Prof Lydia Cairncross 1:16:40

I think it's that sometimes when I zoom out, I think about the grands of human history, and I try to position us in that moment. And I think sometimes times of turbulence herald times of change. And I think we've tried and failed a couple of times, and we've learned from that. So I mean, I was brought up on Gramsci and Lenin, you know, it's like pessimism of the intellect, optimism of the world. So, in the impossibility of the scale of what we need to do, there is the unseen, I suppose, life force, energy, collective unconsciousness, however you define that. The part of life that you can't describe but exists. And I think that that is an untapped source that we can go to, and I think more people are going to. So I think it's my sort of political analytical background and analysis is grounded in that almost spiritual understanding of what human potential is. And I think those two things keep me optimistic.

Dr Maria Christodoulou 1:17:49

Is there anything I haven't asked you that you'd like to share?

Prof Lydia Cairncross 1:17:52

I just want to make a comment about young people. And that links to hope. I hear a lot about teenagers and young people, and they're screen addicted and either on social media or gaming, and every generation looks at the younger generation and we like, oh my goodness, what's going to happen to the world? I actually don't have that. When I look at the younger generation, I'm like, wow. So this gives me hope. I mean, I look... my daughter's 14, and not just her, but like the children around her, the way they're thinking, the way they're engaging with the world, reflecting on themselves and others and their parents, it's so mature. It's so much beyond where I was at 14. And I really think that they're going to unlock something about the technological revolution and the AI revolution and this emotional, spiritual transformation that's happening for so many young people. It's got tremendous potential for the next 50 to 100 years. So I'm very excited about what youth are bringing to this world in the next period of history.

Dr Maria Christodoulou 1:19:06

What would you like your children to say about you 50 years from now?

Prof Lydia Cairncross 1:19:11

Oh my goodness, Maria, you're like the art of the difficult question. I would love my children to say that their mom was awesome and she was powerful and inspiring and fun, and she read to them, and they always had a sense that I was present in their lives and I was available for them, and they could talk to me about anything, and I'd be prepared to listen.

Dr Maria Christodoulou 1:19:42

You're making me hope my daughter says that about me one day.

Prof Lydia Cairncross 1:19:45

So we can only hope.

Dr Maria Christodoulou 1:19:46

We can only hope, absolutely. Anything else before we close from your side?

Prof Lydia Cairncross 1:19:52

No, I think how that's it from my side.

Dr Maria Christodoulou 1:19:56

Thank you, Lydia. I'm mindful of how many things we didn't talk about and how much you have done in your career that we didn't even touch on, and what you have contributed to the world. I made about 10 pages of notes in preparation for this. And I, while we've been talking, I've sort of been scrambling to try and make sure I get the key points out. And I feel like at some point in the conversation, I just gave up and I thought, let me just listen and see where the conversation takes us, because to do justice to your story and your career in the time that we have feels almost impossible. But I do find myself at the end of this conversation feeling hopeful and feeling inspired, really, and I think reminded. Because you started quite early on in the conversation with the comments about do what you love, do what you love. And you've spoken in other settings about kind of finding that place where what you love intersects with what the world needs. When I first read that, and I mean I've heard it in different ways in other settings, but when I first heard that, I thought, so every now and again when part of me goes, What difference does a podcast make? You know, and what difference does it make to tell people's stories? And then, yeah, there was something about reading that again and then having you almost reiterate that a couple of times. It's like, I don't know what difference it makes, but it's what I love doing, and I know it does something, so I'm just gonna keep doing it. So thank you. Thank you for that.

Prof Lydia Cairncross 1:21:26

That's beautiful, Maria. And I mean, the world needs people doing things that they love.

Dr Maria Christodoulou 1:21:30

Yeah.

Prof Lydia Cairncross 1:21:31

The compass of what we need to do doesn't reside in our heads, it resides in our hearts, and our hearts know how to show us what we like to do.

Dr Maria Christodoulou 1:21:39

Exactly, even when the head's going, What? No, are you crazy? Do you really want to do that?

Prof Lydia Cairncross 1:21:44

Thank you. And I'm honoured by the time that you've spent reading my things. Thank you so much. And I think that podcasts like the send out ripples that you can't predict. You don't know. One sentence that you've said or I've said may connect with someone somewhere and make some small change. And also it's been fun.

Dr Maria Christodoulou 1:22:04

Great. I'm glad. What's gonna stay with you after this conversation?

Prof Lydia Cairncross 1:22:10

I think what's come forward for me is I feel like I'm approaching another crossroads. It's interesting when someone asks you to reflect on yourself, which you don't always have time to do, how... what sort of bubbles up and comes up. And so that sense of what's excited me, the moments in my career, the different paths, the intersections, that's what's come up for me.

Dr Maria Christodoulou 1:22:33

Excellent. So it feels like we may need to commit to a space for an interview at a different time to explore what that crossroads has facilitated. I look forward to that. And I look forward to witnessing what unfolds for you in your career. And I wish you much joy and I guess the courage to stay present to what matters most, because I think your sensitivity to the suffering in the world, your empathy for that suffering, and your incredible ability to bring not only the scientific rigor, but that sort of place of intersection of the social rights and the social justice activism with the health equity stuff is exactly what we need.

Prof Lydia Cairncross 1:23:20

Thank you so much, Maria, and thank you so much for this time today.

Dr Maria Christodoulou 1:23:26

I'm Dr. Maria Christodoulou, and you've been listening to the Awakening Doctor Podcast. If you enjoyed this conversation, please share it with your friends, follow Awakening Doctor on Instagram, Facebook, and Spotify, and go to Apple Podcasts to subscribe, rate, and give us a good review. Thank you so much for listening.