The Brain Surgeon Who Hit a Nerve: Insensitivity Cuts Both Ways in Stanford’s Operating Room
A Fair Article on Gender Published by The Washington Post
In doing some research for another Letter to The Washington Post (i.e., the main purpose of this Substack publication) I discovered an article from 1991 about the sexism of Dr. Frances Conley, the first woman to pursue a surgical internship at Stanford Hospital who, in 1991 resigned in protest to a “sexist” environment at the hospital. The article gives a full and fair accounting of what really happened that caused Dr. Conley to resign and then to write a gender-biased book, Walking Out on the Boys.
Because the article is no longer available on the Post website, it is republished here to show that the Post can occasionally be fair in its coverage of gender issues.
Martha Sherrill, “The Brain Surgeon Who Hit a Nerve: Insensitivity Cuts Both Ways in Stanford’s Operating Room,” The Washington Post, November 6, 1991
The naked men are draped and draped - in blue and green unfolding sheets - until they're not bodies but long, smooth, breathing beds of fabric. They're unconscious, but neurosurgeon Frances Conley refers to them in lowered tones as Mr. This or Mr. That.
The three nurses have chosen purple butterfly-print smocks to wear, from a bin of sterile garb outside the OR. But not Conley. She's gone for classic surgical green ... pants, shirt, gown, hairnet, shoe bags, mask wrapped around her face like a Saudi woman's veil. Her eyes are the same color.
She's diminished by the huge operating room and a very tall male resident she's teaching across the table. But she makes herself known, seen, felt, heard.
The put-downs begin.
"You were much fatter when I met you," she says to the anesthesiologist.
"No, I wasn't," he says.
"Oh, yes you were," she says.
"Then your eyes are a better gauge than my scale," he says.
"Maybe all your fat," she quips, "was redistributed between your ears."
Frances Conley says she's endured 25 years of "gender insensitivity" in academic neurosurgery. She planned to resign from Stanford Medical School this fall - after making a very public announcement last spring that she's been been called "honey" and "dear" while operating, that her male colleagues have propositioned her, slapped their hands on her thighs, discussed the shape of her breasts, predicted the stage of her menstrual cycle. The day before her resignation became effective - Sept. 1 - she called the dean of the medical school. She had changed her mind. She'd stay.
So here she is, braving sexism on the front lines. In the course of 12 hours, she opens up one man's back and digs out a disk. The man is 40 years old, from Hayward, out cold, face down and wearing a hairnet like a woman getting a massage at Elizabeth Arden. She opens up another man. He's an 80-year-old from San Jose whose chart indicates that his emotional state was "anxious" before surgery. His neck is cut. His carotid artery is cleaned out. "Roto-Rooter," she booms, "your standard plumbing job."
Over the years, Conley, 51, has told her young male residents that females make better surgeons. Their stitches are more certain. Over the years, she's joked about testosterone and castration. Two former male residents of the Stanford neurosurgery program say Conley has threatened to "cut off" their "left one" in the OR when they weren't listening to her advice. They both respect and like her, they add, "but comments like that," says one, "are standard Fran."
"Sometimes you have to fight sexism with sexism," Conley explains.
More recently, another young male was sacrificed at the altar of her surgeon's ego. In an article in October's Vogue, Conley described him as "a third-year resident who thinks he knows more than he really does." She made several gender-stereotypic comments too: "The guys come in with a big gust of bravado and have to be watched like hawks or they'll make mistakes. ... Women have to be pushed."
A letter of complaint was sent to the dean of Stanford Medical School faculty, David Korn. The resident claimed he had been "mistreated" by Conley, made "an object of ridicule."
"His feelings were hurt," Korn observes, in the neutral, unsympathetic tone common to doctors. "I guess the article made him look like a dumb ox. I advised that he calm down and go about his business. There's a certain childishness to some of this. I mean, `Hey, somebody's looking at me wrong.' "
"What happened was wrong," Conley says later. "And I apologized."
Today, she and the resident seem very friendly. Their heads fit together over the bodies of their patients - the light on his headlamp helps her see too. Their hands - her size 5 1/2 gloves, his size 8 1/2 - are wet with the same blood. It's a funny intimacy, physical and mental, that most men and women in the workplace could not say they share.
The anesthesiologist babbles on. He's full of ideas - about a new wristwatch that predicts heart attacks, about the "anthropology of the operating room." In the middle of his theorizing - somebody has mentioned Claude Levi-Strauss - blood begins to arc, almost in slow motion, from the San Jose man's neck.
"Did we get you?" Conley asks.
"My shoe," says the anesthesiologist, looking down.
"Well," she cracks, "I certainly tried."
Bad-Mouthing Freud
In her 25 years of hacking through the masculine medical jungle, Frances Krauskopf Conley never cared about women's issues, the Second Sex, the Cinderella Complex, the Mommy Track. She just tried to be "one of the boys," she says. She followed in her father's footsteps - he's a professor emeritus of geochemistry at Stanford. She coached the football team of her medical school class to victory, "which made her happier than graduating," says her sister, Karen Hyde. She met Phil Conley, an Olympic javelin thrower and Harvard MBA, on the Stanford field, and they've enjoyed a long, double-jock marriage. They chose not to have children. They throw javelins together in the park every Sunday afternoon, and compete in masters tournaments.
In a 1985 interview with a local newspaper, she said she didn't run marathons anymore because she "couldn't win." She also said she "did not have any female friends."
She entered neurosurgery because she "just liked the field and I knew I could do it," she says. She hadn't really thought about the other part, the part about being a woman in a profession dominated by men with massive ego strength and limited interpersonal skills. When she finished her seven-year neurosurgery residency in 1975, she was one of four women in the country to have done so. Her career has been a vertical blur.
"I wasn't a woman anyway," she says. "I was a freak."
Now, she can bad-mouth Freud with the best of them, speculate about the height of the glass ceiling in academia, and pronounce that men in medicine are "fascinated by the reproductive system" and "primarily consider" a woman as a "uterus with a shell around it whose brains are dysfunctional one week out of four because our uteri are also dysfunctional."
The Stanford department of neurosurgery may never be the same. And, all things considered, that may not be such a bad thing. Of the four other neurosurgeons in her department - all men - only one is sympathetic about her aborted resignation. Even their secretaries, Conley says, are mad at her.
"It's hostile," she says, "just picking up my mail. They don't understand."
Secretaries aren't the only ones. "I'm angry with her," says a female assistant professor at the medical school. "She's caused a lot of pain, and she's taken advantage of the women's movement. It's like using the phrase `date rape' too lightly."
Battle of the Brain Surgeons
The media had blown it over and over. It was much more complicated than it appeared, people kept saying. The Frances Conley Story was not about sexism. Unless gender had something to do with everything. It was about a bitter struggle for power, about ulterior motives and private investigations, about inbreeding and contempt.
Last spring, when Conley announced her resignation, she had in fact offered another reason. It was hidden, though, under layers of explanations and stories like a main artery - harder to locate, more dangerous to work on, and yet seeming to feed all other reasons.
A neurosurgeon named Gerald Silverberg had been promoted to department chair. This made the workplace "unbearable," according to Conley. He did not have the qualities, she said, "of a good leader." Without uttering Silverberg's name at first, she told the press that her new boss "treated women as inferiors" and had propositioned her repeatedly. She said he had made references to her being "on the rag." The rest of the details - that they'd worked together for more than two decades, for instance - were muddy.
"A leader of a group sets the tone," says Conley, "and if my boss doesn't like me, or thinks I'm inferior, then everybody else will soon treat me that way."
Gerald Silverberg, since May, has been stunned by Conley's public remarks. He was advised by the medical school not to comment. A shouting match in the press was feared, since he denies all but one of her allegations - calling her "honey." (Imagined headline: "BATTLE OF THE BRAIN SURGEONS.") It was hoped, early on, that the controversy would blow away. It was hoped that private departmental matters would stay private, that Conley would leave or stay (and just be quiet about it), that Silverberg (if cleared of the allegations) would remain as chair and not sue Conley for slander.
And it was hoped, finally, that Stanford would be spared any more of the bad publicity that has haunted the university since federal auditors claimed a year ago that it had overcharged the government $200 million, which resulted in President Donald Kennedy's resignation July 30.
But things careened beyond control.
After Conley sent her letter of resignation to the media, TV cameras turned up in the hallways. She was asked to write editorials for local newspapers. She was asked to write "Why I Quit" for Glamour. She was interviewed by the New York Times, The Washington Post, Time and Newsweek. Every time, she underscored the unfortunate "shift in leadership" within her department.
Hundreds of women wrote to her. Female physicians at Stanford stopped by her office to introduce themselves. A banner - "BRAVO CONLEY" - was hung outside a student dorm. People were happy this stuff was being aired. There was lots of head-nodding. Lots of story-sharing. Medicine - neurosurgery in particular - had a reputation for being a conservative field, a prehistoric bastion, a 19th-century stronghold of male dominance and insensitivity. Conley was courageous. She became a heroine, a spokeswoman. During the Clarence Thomas hearings, she commented on sexual harassment in the workplace for "CBS Evening News." Last week, she made the cover of People, below a photograph of Anita Hill.
"Look at her - she's from an accomplished academic family, she's educated, WASP-y, thin, tan, well-spoken. It's disheartening," says Denise Johnson, a 36-year-old general surgeon at Stanford. "Even she can't succeed against a man who is clearly not chairmanship material."
"We in the medical community," says Sheila Moore, a Stanford radiologist, "like to think of ourselves as intellectuals, and somehow above sexism. But in fact, we are way behind. And since Fran has raised all these issues, I'm worrying less about making tenure."
The Deep End
Had Conley raised the issues?
"I spent 14 years in the OR with her," says former neurosurgery nurse Claire Houston. "And I know that I didn't have my head in the sand all that time. None of this happened. None of it. And I like Fran. She's been a friend, believe me. But I think she's gone off the deep end."
"She's used the media," says Stanford neurosurgeon Larry Shuer, who's worked with Conley for 13 years, "to carry out a carefully planned character assassination of Dr. Silverberg. And so far it's been successful."
"She's hooked her personal feelings to the caboose of feminism," says George Koenig, associate professor of neurosurgery. He's an old friend of Conley's, he'd like you to know - she even operated on his wife.
Some New Blood
The truth is, Fran Conley had been threatening to quit since 1989. This is no big secret - if you ask her, she'll tell you. Somehow, though, it never seeped its way into a single news account of her resignation.
Conley had threatened to quit not because of sexism in medicine - which is a serious problem - or the "gender insensitivity" of Gerald Silverberg - which is still up for grabs. She threatened to quit when Jake Hanberry, the longtime neurosurgery chair, retired and Silverberg was voted acting chair of the department, and then two outside consultants found Silverberg, not Conley, to be the strongest inside candidate for the position.
"Fran's a fierce competitor, and everywhere she's gone in her career, Jerry's been there before," says Koenig. "I personally view all this as a temper tantrum."
"Dr. Silverberg was the overwhelming choice," says Dean Korn. "Why was that the case? Dr. Conley had chosen to spend her career primarily at the veterans hospital, which is affiliated with Stanford. She had also indicated to me that she wanted an academic deanship - not the chair of the neurosurgery department."
Conley concedes that although she feels her research work is superior to Silverberg's, he often handles more complicated neurosurgery cases. She also concedes that her decision to work mostly at the veterans hospital - where she is chief of neurosurgery - and not at Stanford University Medical Center wouldn't be a recommended career move for anyone wishing to chair the department. A good deanship, she admits, would interest her.
When asked if she had wanted to be chair, Conley replies, "Certainly not now." According to her mother, a sister and two former residents, she expressed a desire for that position until a few years ago.
In 1989, when it appeared Silverberg was the front-runner, Conley began lobbying the dean to find an outside candidate, produced by a national search. Since four of five neurosurgeons in the department had gone to Stanford, there was an inbreeding problem, she thought. The outside consultants had arrived at the same conclusion. The dean couldn't disagree.
"We need some infusion of new blood," Conley says. "We know each other too well. From a leadership point of view, we need somebody with a national reputation. The program here should be in the top 10 in the country. It's probably in the middle half."
A search was initiated. But money problems began. In April, as a result of the $200 million in creative accounting, the medical school found itself running a $12 million deficit for the fiscal year ending Aug. 31. Korn canceled two of five ongoing department chair searches in the medical school, which he says can cost from $6 million to $20 million each, as "packages" of lab money, space and staff are used to entice prestigious names.
"I felt," says Korn, "there would be no major compromise of values by promoting the internal candidate."
Korn called Conley - whom he has known since 1967 - the night before he announced the promotion of Silverberg to department chair. She told him that she'd be delivering her resignation letter the next day. He didn't really believe her. "Frances, please sleep on it," he told her. But the next day, her resignation came.
It was the first time she'd mentioned Silverberg's character to Korn, his alleged treatment of women as "inferiors," the alleged propositions, his jokes about her being "on the rag," or that he had called her "honey" in the OR.
"The rest is history," Korn sighs. "She's become a national heroine and cause ce'le`bre. And it's become an international event. Careers are on the line. Judgments have been made - right or wrong. It's all been badly compromised by the spotlight. ... I could reopen the search, but right now that would publicly condemn Dr. Silverberg, and I'm not so sure he deserves it."
An investigation committee of Stanford professors has been formed - two men, two women - to assess Silverberg's professional behavior in light of the allegations made by Conley. None of these allegations, says Robert Cutler, the medical school's faculty affairs dean, constitutes sexual harassment "as defined by the law or the media." But "gender insensitivity," he says, is another matter entirely.
"It's the sort of situation," says Cutler, "people can't easily find answers to, but we have to, don't we?"
Korn is a pathologist. He wants to make sure that you know what he knows about surgeons: "They aren't like other people - or other doctors," he says. "They are very decisive. They don't beat around the bush. They don't tend to intellectualize. They aren't introspective or self-doubting. And I've always thought that Frances had a very typical surgeon's personality - outspoken, decisive, tough... .
"She's hard," he says, "without any gender connotations. Nobody would dare to take her unseriously - me in particular."
The investigation will be completed sometime this month, and Korn won't guess at the outcome. "Except that Jerry does tend to call women `honey' and `dearie,' " he says. "In the current climate, that's unacceptable. But what should we do, flog him?"
Silverberg Speaks
It's all unfair, says Gerald Silverberg, what's happened to him. Even his brother called from the East Coast, to ask if he'd really been grabbing women at work. The media hasn't bothered to look into his side of things - not one article. But then, until recently, he has refused to comment.
In an interview with The Washington Post, Silverberg denied most of the allegations made against him by Conley. He didn't want to be quoted - a continued effort to avoid a shouting match - but allowed his story to be paraphrased.
He has never propositioned Fran Conley, he says, in public or private. He remembers hearing one male physician proposition her - more than 10 years ago - and believes she has remembered the event incorrectly. Conley admits the last proposition was "probably 10 years ago," but maintains it was Silverberg who made it. None of their colleagues interviewed - fellow neurosurgeons, OR nurses, former residents - said they remember hearing Silverberg proposition Conley, although she claims it was always done "in rooms of people, as a public attempt to demean me."
"Were anyone to make comments like those to her," says longtime neurosurgery colleague Larry Shuer, "I'd imagine they'd fear for their life. I know I would."
Silverberg says he never accused her of being "on the rag." He would never use that term, he says, because he is personally offended by it. He doesn't even joke about menstruation, he says, because he finds it a nauseating image. Years ago, he says, he opened a door for Conley and she chewed him out. He never did it again.
He does believe, though, that he might have called her "honey." She never mentioned that it bothered her. Since Conley has said that being "a complainer" would have ruined her career, Silverberg wants to make the point that after she became a tenured professor in 1988, she would have been free to say anything to him, that her job was totally secure. In any case, Silverberg says that he knows better now - that it is unacceptable. He will never call another women "honey" again, except, he says, his wife, who still likes it.
"At first, his manner did bother me - struck me as odd - when we met," says neurologist Martha Morrell, 35. "He does call women `honey.' ... He often takes my hand. Or he hugs me when he sees me. He opens doors. He is very courtly. He treats me like some of my father's friends treat me. But I realized that it was a warm and friendly gesture."
Silverberg feels like he woke up one morning and, like Clarence Thomas, was living his worst nightmare. He mentions Kafka. He has been married to the same woman, Donna Silverberg, for 27 years. They have three sons, ages 22 to 26. It's been an upsetting time for everybody. A Newsweek reporter even came to the door.
It's true, he says, he and Conley have never been friendly. They've been competitors. They have, though, respected each other's work. Conley agrees. As her senior - two years ahead of her in the residency program - he never obstructed the progress of her career, he says. He approved each of her promotions, supported her appointment to the faculty, fought for her research funding, got her office space.
In 1989, when he was appointed acting chair, their relationship became much more antagonistic, he says. It was very strained. Both agree. Conley says it's because "Jerry is not chair material." Silverberg says it's because Conley desperately wants an explanation of why she isn't chair - and she wants to believe it's because she's a woman and he's a man.
He has learned a few things, he says. He never knew women at Stanford were unhappy. He has a female chief resident now. He has helped many women with their careers, he says. So many women in his work life - doctors, residents, medical students, nurses - and not one ever complained to him about sexism, about being demeaned or dismissed. Nobody told him not to say "honey."
"He treats women abominably," Conley says. "It's anybody he considers to be his inferior. A pediatrician is an inferior being to a neurosurgeon, for example. So he will walk on the pediatric ward and say terrible things about the pediatricians, right to their faces. The nurses hearing. Everything. And this is their domain. They don't need an {expletive} neurosurgeon telling them that they are worthless."
Dean Korn describes Silverberg as "very self-confident" and "very arrogant. ... But then, many members of my faculty are like that."
More Weird Things
Conley wrote in Glamour magazine - in "Why I Quit" - that former neurosurgery chair Jake Hanberry had "created a workplace of support" for her. She was able to ignore the "sexist behavior" around her "because it did not seem to impact directly on my day-to-day work world."
Yet in this "workplace of support," according to many women interviewed, the department atmosphere encouraged a disrespectful treatment of women, and there haven't been big changes for the worse. At least one married neurosurgeon carried on a prominent love affair with his secretary, they say. (His office door would close, and they were not to be disturbed during lunchtime.) Perhaps innocently, nurses and technicians were flirted with, propositioned and pawed by male physicians.
"The culture of the place is that you're allowed to have affairs - with nurses, technicians, whomever - and it won't hurt your career," says Conley.
During the Hanberry years, an EEOC suit was filed against another neurosurgeon, charging him with "sexual discrimination" and "sexual harassment which led to a lay-off." The neurosurgeon, who is married, is alleged to have shown up at an employee's apartment one weekend with a six-pack of beer. She showed him the door. She lost the suit; her dismissal several months later was not found to be related to anything but the budget.
Racism prevailed as well. Jokes about minorities were told without hesitation.
"Jewish jokes, black jokes - everybody is fair game," says former OR nurse Claire Houston. "Nobody was picking on Fran specifically."
In April 1989, a woman named Rose Meller, the administrative assistant to Hanberry, was fired by Stanford when it was discovered that she'd pilfered $285,000 in petty cash and false expense reports between 1976 and 1988. She was found guilty of grand theft and sentenced to two years' probation and 150 hours of community service in Santa Clara County. Stanford also settled a civil suit against Meller this year for an undisclosed amount.
Hanberry, who declined an interview, retired one month after Meller left, and set up a private practice near the campus. Meller now works for him.
"The whole hospital knows about the neurosurgery department," says one former employee. "It's certainly a male-dominated place, and weird ones at that."
And weird things continue. A private investigator called former employees of the neurosurgery department, asking them to cooperate with "a Stanford investigation." Since the employees had already been contacted by the university's investigation committee, they refused, suspecting the worst.
"I gave no authority for the private investigators to misrepresent themselves," Silverberg says when asked about this. "I simply retained a lawyer to find out who was accusing me of what."
Welcome to academic medicine.
`Adequately Flawed'
A couple weeks ago, in the dean's office, Silverberg and Conley faced each other - man to woman, woman to man, brain surgeon to brain surgeon. "He was pretty hostile," says Conley, "and with good reason."
She's asked about the investigation. "Outside of finding a videotape of Jerry raping a nurse," she says with some disappointment, "he won't be found to have an adequately flawed character."
And if they decide Silverberg isn't fit to be chair?
"Oh great! I'm in fat city, aren't I?"
And if he becomes chair?
"They will have made a terrible, egregious error," she says, "that will show that they aren't ready to step into the next century."
She says she'll go. Won't she miss neurosurgery?
"Yes, but when I leave here, it will be with a fairly nasty taste in my mouth."
So why not cause as big a fuss as possible?
"What do you think I'm doing?"
Any regrets?
"I wish I were more lovable."