Pathway to Medicine: Daniela P. Ladner, MD, MPH

Daniela P. Ladner, MD, MPH, Associate Professor of Surgery in the Division of Organ Transplantation and Medical Social Sciences

My mother, an English-speaking Catholic, grew up in Southern India. She followed her sister to Switzerland when she was 20 and while working for an American company, met my dad and became a stay-at-home mom. My mom remains the most energetic, passionate and powerful person I have encountered — a woman whose mindset did not allow for anything to be impossible. My dad grew up in the Swiss Alps and as an adult moved to the big city (Zurich) and worked for IBM – the Google equivalent of that time. He started in sales, worked his way up the proverbial ladder, then retired and studied psychology, a lifelong interest of his. He is the steady rock to my mother’s quicksilver, equally passionate about life and a firm believer in unlimited opportunities and personal independence. This dichotomy of cultural backgrounds and personalities allowed me to be raised in a household free of most societal boundaries that either culture (Swiss or Indian), traditionally impose. I was raised with an emphasis on education and the firm parental doctrine that there was nothing I could not achieve if I worked hard enough.

When I was about seven and in first grade, I decided to become a surgeon. I do not remember what prompted me to want to do this. I did not know any physicians, other than our family doctor, but I knew with absolute certainty that this was what I wanted. I must have been quite outspoken about my professional aspirations, because people in my hometown just outside of Zurich often chuckle when I tell them that I am now a surgeon. ‘That is exactly what you said when you were a little girl.’ I was seven in the 70's. Women in Switzerland had just obtained the right to vote in 1971, but in Switzerland women did not become surgeons. My parents however never questioned my aspirations, so neither did I.

At the age of 11, I took my ‘gymnasium’ (high school/junior college) entry exams and graduated from medical school at 24. I loved anatomy. I loved physiology. I loved my surgical rotations. My enthusiasm was rewarded with stellar clerkship evaluations, especially on all rotations that involved surgery. I remember one urologist who was particularly supportive of me. He showed me an orchiectomy and then left me to do a second orchiectomy skin to skin with the scrub nurse. It was amazing. I am glad to report that the patient survived, and while you could not do this today, it was an amazing experience and was exactly as I had always imagined.

Towards the end of my medical school, I successfully secured my first year of surgical residency. Training in Switzerland is organized differently from the U.S. One year of training at a non-academic center is mandatory, hence those who wish to pursue an academic career usually began with that. It was not until my last year in medical school that I wavered about my future career. I only knew of three female general surgeons in the entire country. None of them had kids and two were single – not by choice was the word on the street. The endless well-meaning advice by many mentors, male and female, was that if I wanted to succeed and have a chance at having a relationship and maybe even kids, I should pursue gynecological oncology. This surgically challenging field, contrary to surgery, was welcoming to women. This was paired with an offer to be educated in obstetrics and gynecology at the University Hospital in Zurich within a gynecological oncology pathway, including research. So I wavered and folded. After all, I did agree with my mentors that I was not the kind of person to live my life as a hermit – just me and my career.

Hence, I started my general surgery year, which in Switzerland is a requirement for any surgical specialty, including obstetrics and gynecology. I loved it. I got to operate constantly. Surgeons liked me, taught me generously, supported me, taught me tricks, let me do things – it was exhilarating. I finished my year, got glowing letters of recommendations and went off to start my first year of obstetrics and gynecology. During my surgery year, I happily rode my bike across a field in the middle of the night to go and assist in a ruptured aortic aneurysm (yes in Switzerland you bike). But now only two weeks into obstetrics and gynecology, I could barely motivate myself to get out of bed to go to work. After the third delivery, soaked with the mother in a delivery tub (that was a thing in the 90’s), I was neither happy with nor exhilarated by this career choice. I called my chief from my surgery internship, and told him I needed to be a surgeon. I distinctly remember our lengthy conversation, his well-meaning, “You’ve got great hands, but you’ll be miserable as a female surgeon,” and “It’s hard for women,” and “Those who make it end up being unhappy.” I called him back every few months, same conversation, same result. I felt stuck.

So I drowned my dilemma in work. With the support of my obstetrics and gynecology chief, I was allowed to design and execute a clinical study (unthinkable today), which earned me two publications and a career development award from the Swiss National Foundation, the Swiss NIH equivalent, to go to Yale and do a postdoctoral research fellowship for two years.

This experience was a game changer. In my lab at Yale, one of the other residents introduced me to a bunch of surgeons. One of them became a dear friend. She had just started on faculty, was operating, good at it, loving it, no boundaries. She was what I had been told I could not be – if I wanted to be happy that is. She was happy. She introduced me to other surgeons, some men, some women. Nobody cared. I thought I must have died and gone to heaven. I was determined to figure out how I could be trained in this amazing country and somehow I talked my way into a preliminary surgery position at Stanford. I worked really, really hard – it was so much fun – and I was offered a categorical position by the end of internship. As a preliminary intern I was assigned to the transplant service a lot. Apparently, this was not one of the favorite rotations for interns, but I loved it. These were the best surgeons I had ever known and they did the most amazing surgery I had never seen before – a liver transplant. I was going to be a transplant surgeon.

During my first year of medical school, while trying to study for my finals, I figured out that I preferred dating women to men. That did not fit with my plans and at first was quite poorly received by my parents. I dated, but not too seriously, and focused on my professional development instead. It was at the concurrence of receiving my categorical spot at Stanford, deciding to become a transplant surgeon, and turning 30 (namely at the end of internship), that I came across a book about women with interesting high-achieving careers. Their individual stories were all fascinating, but the recurrent theme was that many women were so focused on pursuing their professional goals that as they approached 40 they realized that they ‘forgot’ to get married and ‘forgot’ to have children. In an attempt to counteract future regrets, I made myself the promise that I would dedicate significant time and energy to finding and nurturing a strong relationship, just like I did pursuing my career. I found Sara two months later – in a dance club in San Francisco – in deep conversation with her friends – that is, so I found out later, what clinical psychologists like to do. Best find ever. The rest is 14 year-old history. She is the partner I married a few years later, before it was legal and is the mother of our two kids – five year-old Julia and nine year-old Luca. She carried one, I carried the other – in case you were wondering.

I am not sure how I knew that I wanted to be a surgeon when I grew up. But I quite remember how I thought it would feel, and it turned out just like that. I cannot imagine anything I would rather do.