I was in high school and I took my first biology class and it clicked. What I really liked about biology was that you could learn about all of these small changes, like one small change in DNA for example, and then you could watch how everything in the body was different because of that one change. It just seemed so logical and it explained a lot of things that I had seen in life, and I think that was what most interested me. Up until that time I was always good at school, I could do the assignments and focus on learning, but I was never somebody who was digging deeper into the material - until I got to biology. My biology teacher gave me some extra books over the summer to read because I was so interested, and that was the first time I thought, this is a subject that even without the assignments, without anything else, I really wanted to know more about.

My parents always wanted me to pursue science. When I was very small, I thought I’d be a writer, and so I read a lot and I wrote little stories on my free time. I remember telling my parents that maybe I’d be a writer, and they kind of freaked out and told me that that wasn’t a real job. Of course, being a writer is a real job, but my parents had struggled when I was young, and so were always very concerned about whether things were practical. I was born in China, and my dad, who had always wanted to immigrate to America and go to school himself, moved here first. My mom and I joined him two years later, once he finished school and got a job so he could sponsor us. I’ve lived in the U.S. since I was five years old, and when I was in elementary school we took these tests for placement in specialized programs. While I wanted to go to the humanities program, I had scored much higher in the science and math portions. I ended up going to the science program and finding something I liked, so it worked out. And my parents certainly were happy that I found something in science that I enjoyed.

I didn’t decide that until college. I really liked biology, and in particular neuroscience, and I had worked in a neuroscience lab in high school. I was interested in how the brain functioned. In thinking about my primary interest of how small things could affect large things inside a person - when I thought about how the brain worked, how it was so logical, how one tiny part of the brain can affect one’s biology throughout the body - that was what was most interesting to me. I went into college thinking I was going to do research, and I worked in a lab for three years during college and during that time I found that I wanted to see more immediate results of the work I was doing. I liked what I was doing in the lab, but when I thought about the future, how it’s going to take ten or more years for what we’re doing in the lab to start affecting people, it just wasn’t immediate enough for me. That’s when I started thinking about medical school.

When I expressed an interest in wanting to go into medicine my family felt like that was a very stable profession, and they were happy about that. But I’m the one that resisted neurosurgery for a very long time. In my mind, I had a stereotype of what a neurosurgeon was like and I felt like I wasn’t that person. The stereotype was of somebody who had a large ego and needed to prove themselves. Someone who would say “I can stay up all night, and I can do x amount of surgeries, because I don’t need to eat or sleep.” I’d met some people who were very intense in that way and before I started working in neurosurgery, that’s what I thought this field was like. Also, where I went to medical school at the time, there were no female neurosurgery attendings or residents, so it was very intimidating to show up as a medical school student to a room full of these guys. I still remember how the residents’ call room had all these pictures of girls on the wall, and the way they talked about partying together. All I could think was how I didn’t fit in with these people. I liked the work they were doing, but I’m not an intense person, I like sleep and I don’t feel the need to prove all this stuff to others. I thought that since I liked studying the brain I’d like neurology, but the pace and the immediacy of the results just weren’t what I was looking for. Then I thought maybe I just want to be a surgeon and I don’t have to have the brain science be a part of that, so I explored a lot of other surgical sub-specialties. I rotated through vascular, general surgery, ENT, urology, plastic surgery; I tried everything that people in medical school call “lifestyle surgery,” something where you could have a more reasonable work-life balance. But when I tried those things I found that I wasn’t particularly interested in those diseases. If you’re going to wake me up at three in the morning and tell me that somebody’s bleeding in their brain and they might die and I need to come in right away, I have no hesitation, I want to be there. But I didn’t find that same passion for other types of medical problems. I waited until pretty late in the process, I was already in third year doing all of these rotations trying desperately to find something else that I would like, but it turned out that I liked nothing, except neurosurgery. I liked the type of work neurosurgeons were doing, I liked the patients, I liked the fast pace of it. So, I finally conceded to the fact that this was what I was going to do, even though I didn’t fit the stereotype of what a neurosurgeon was.

Part of my choice was wanting something new. I had lived in Maryland for over 20 years, and I thought it would be fun living in California. I didn’t come from a program that emphasized neurosurgery a lot in medical school so I didn’t know a lot about the different programs around the country, and I still distinctly remember looking at the Stanford website trying to learn more about who worked here. The first picture on the resident site that I saw, included Dr. Melanie Hayden Gephart, and she was holding a baby in the picture. I remember thinking ‘that must be a stunt baby’ because no residents have babies, how could you have a baby during residency? That was the first clue that this place was a little bit different than what I had seen before. I came from a place where it was all men, a few were married and none had children. When I came here it felt like people acknowledged that you could be a normal person, and do neurosurgery. There was no trying to one-up each other, there was an acknowledgment that people have human needs, and that you can have something you enjoy outside of this field. People were kind and nice to me as a student, and I got to do things here as a student that I didn’t get to do anywhere else. It’s all left a very positive impression on me.  

What still amazes me, is when patients wake up from surgery and already there’s something noticeably different. Throughout seven years of doing this, I’m still blown away every time something we did worked. I mean, that’s the reason we’re doing it, but when a patient wakes up from surgery and says right away “hey doc, my arm doesn’t hurt anymore” or “that lightening sensation in my face is gone,” or when you do an emergency decompression for a trauma and they wake up and can talk when they were comatose before, I mean, every single time I always think, wow, the surgery worked! A win like that isn’t every day, but the fact that it happens often enough really keeps me going. It’s pretty neat to think, I just moved some things around and all-of-a-sudden this person has a totally different experience. It’s the simple little things - the first time I did a surgery for facial pain, and I got to do the part where I moved the vessel away from the nerve and put in this cotton ball, and then the patient woke up and said “my face doesn’t hurt!” I remember telling my boyfriend, “oh my god, it was an amazing surgery and the patient woke up and had no pain!” and he said “well don’t you save people’s lives, why are you so amazed by this?” To me it was amazing because it was just the smallest little thing and all-of-a-sudden their symptom just totally went away, as soon as they woke up. Every single time that happens it’s a surprise, and I think to myself about how I haven’t seen my family in months, or slept well, but to be able to do cool things like this, to change someone’s quality of life for the better, then all the sacrifices were worth it.

I feel lucky in many respects that at least among my peers and with my attendings, the gender issue is non-existent. My attendings trust me and respect me as a physician. However, those good experiences highlight the bad ones; when you leave that setting then it’s odd when people treat you differently. I remember a lecture I attended at a conference, and the entire time the guy who was giving the lecture kept asking me to refresh the coffee and change the thermostat. I told him that I didn’t work at the conference center and he just couldn’t get that. At one point, he asked for introductions around the room, and he just passed the microphone over me to the next person. The experience actually made me feel very lucky that at Stanford I’d never been made to feel like that by my colleagues. With patients, things are different, they often assume I’m the nurse, or will only call me by my first name. I try not to take it personally, but I am conscious of it. I’ve tried changing the way I present myself, I always make sure to introduce myself as Dr. Xu instead of Linda, and have my badge visible. I also never wear a white coat, so maybe that’s another reason patients don’t see me as their surgeon. I’m very short, and the coats are far too big and long, and they’re also all men’s cuts, so when I wear the coat I think it looks worse than not wearing it. I do wonder if all this will become far more important when I’m an attending and I’m trying to convince people to trust me to do their surgery. I do look very young and I’m female, does that make a difference? Will patients trust me, or prefer an older male colleague, who looks like what people think a surgeon looks like?

I think that a lot of women, even when they’re good at their job, question themselves a lot and never feel like they’re the best one in the room. This is true for me and other physicians in other fields that I talk to. It affects the conversations we have with our bosses and the way we may minimize great things we’re doing by saying they aren’t all that big of a deal. I sometimes tell my physician friends to put themselves in a male colleague’s shoes and ask themselves, how would they talk about the work they’re doing then? Would they still say it’s not a big deal? During my job search this year, I pushed myself to negotiate. Even though it felt uncomfortable, I wanted to be able to say that I asked for the things I wanted. Even so, while asking for them I still had thoughts like I’m a new grad, what do I have to show for my career? or I’m not going to be as good as others competing for this job. That voice in the back of your head plagues a lot of people, but it definitely plagues a lot of women. So, when an opportunity comes up there’s a hesitation. There’s hesitation to take those leadership positions. When women I know say they want to step down from some of their responsibilities I always feel a little disappointed, I just think, but you’re doing so well, don’t give that up! I personally know quite a few women in my year who quit at other programs and that’s unfortunate. I don’t think that it’s because those women didn’t like the field or didn’t want to do neurosurgery, but because there are some environments that make it more challenging for women to stay. I wish every program could be more welcoming to different types of people and people having lives outside of work, and being okay with that.

You can be a leader and can be great at what you do in a different way than what already exists. Looking at women taking on roles in science and medicine today, they’re not necessarily doing it in the exact same way it’s always been done. I think to myself, I’m not so aggressive, I don’t fit the stereotype, but I really enjoy this work, so maybe I can do it my way and it will still work. Leadership in science, research, surgery and medicine is going to change a bit because the people coming into it are going to be different than they were before, and that’s okay. It’s great to have diversity and not everybody has to fit the exact same model. The great thing about having more women take on these roles, is that others seeing them do it think they too can do it in a new way instead of the way they’ve already seen it done. I’ve met several female medical students who want to do neurosurgery, and I can only hope that them seeing us doing this, while still living our lives, makes them feel like there’s at least mentally a way that this could happen; you can be a normal person and do surgery, it’s feasible.

I was more interested in math rather than science, because when I was in grade school I’m not sure I understood science as a concept rather than as an integrated component to mathematics. In high school I had an interest in science and did well in science. I went to an all-girls school and was taught science by a woman, and really quite enjoyed it –all those clichés about girl schools and empowering girls and women, I think they’re true. It was then, at this all-girls high school, that I developed a huge love for the physical sciences and chemistry. I don’t know that I ever had a concrete voicing of “I want to pursue science,” I wanted to become a doctor, and these were the necessary things. I had an interest in biology and was quite good in biology and knew I was going to major in the sciences in order to meet that interest.

Race and gender are inextricably linked, and I think Dartmouth had a lot of issues with race at the time when I entered as a freshman, so I would say that my focus was more on that then on gender per say, and for me it’s hard to tease out which is which. I took and excelled in the sciences and was a presidential scholar in chemistry and ended up doing much more in the sciences then even I had expected. I can’t say it was a thought-out plan or path per say, like “despite all the odds I’m going to pursue science,” it was more an encouragement to follow what you’re interested in. But in full disclosure, I was also very interested in literature and writing, and creative writing, and I pursued that as well at Dartmouth. I also was lucky in that I didn’t feel like I had to give up anything to be a science major. I surrounded myself with a lot of strong women in college, and I was in a sorority, and so I never had that “a-ha” moment in college.

Medical school was probably the turning point both in terms of gender, and race. In my class I was the only black woman and so that was a turning point, but I didn’t feel singled out, per say. There were disparities in terms of gender, and there were disparities in terms of race. It wasn’t all smooth sailing. Residency was probably the biggest gender difference; at that time there was only one other woman in residency, and she was the year ahead of me. So, when she left the program I was the only woman in the program for a while. It was still an excellent experience, and I have overwhelmingly positive memories of medical school and residency. I also have very positive memories of mentors that I had at Stanford, and of the encouragement that I got to go into Neurosurgery from people at Stanford. My mentor was a white man who is blond and as East Coast as can be, and he owns that perspective, and I couldn’t have had a better mentor. I don’t think I needed a black woman mentor to know that I could be who I am. Society may look at him and assume, well, he’s just a white male, what does he have to add to this picture? But, in fact, he’s mentored me in a way that no one else could have because of the depth of his compassion, and care, and drive. I don’t know that I could get that from anyone else, and his skin color was irrelevant, as was mine to his experience of mentoring me. On the face of it, he’d be the least likely candidate to resonate with my experience, but he was the best candidate for it in the end. So, I hope that I too stand as a mentor for women of all colors, for students of all colors. One of the best parts of my job is that the people who come to work with me are all different, men and women, black students, white students, Indian students. I mentor a whole spectrum of people, and I love that.

You’re black, you’re a woman, you’re in an all-white hospital - patients are constantly reminding you of that. I could list probably a hundred different experiences where I was asked to empty the garbage, or take out the trays, or clean out the toilets, when I was just there to use the bathroom myself. My existence is not one where race and gender can be teased, and everything I do, every day, every experience, that’s a part of who I am. I don’t think that many women will say to you that they walk around feeling stressed by being a woman, in fact, I think many would be hard-pressed to kind of pin-point a specific issue. But we know from experience that the stress is there. When I talk to my other colleagues, people don’t question their accomplishments or ask them for their CV, or say “are you here to take out the trays”, or talk around them, or above them. It’s only when you see it in that context that it resonates. Sometimes it’s other people that will point it out to you, like my co-resident used to always say to the patient, “actually, she’s our chief,” and I used to think it was funny, but now I think it was a real moment of their acknowledging that they’re not going to stand for it, as men.

I do, but I also think that everybody has something. In answering the question, well, should I say, I do think women have more to offer? I think we’re then discounting the male perspective. My answer is that I feel like we all have that little slither, that unique thing that we bring, regardless of what we look like, regardless of what gender we are. We need to be bringing that diverse perspective and owning that, and I think far too often we’re just part of an echo chamber, and we’re just resounding what the majority is saying. You could only win by increasing the diversity, be it women, be it religious minorities, be it from the standpoint of race, whatever, I just feel like that’s a win, cause you’re seeing it from a different place. I don’t think I do it better than men, I think I do it differently, and I don’t think they do it better than me either. I think they’re each valid and need to be owned and celebrated, and I think that’s where society is going, hopefully. I think, at least at the medical school, what I can gather from my own experience, is that people are open to the fact that all these voices should be part of the conversation, and I think that’s a win.

If you look across the University, and not just Stanford, there is a problem with women in leadership, in terms of the numbers. People used to argue there was a problem with the pipeline, but we are now at 50/50 or in some places more than 50/50. If you look at university chairs and deans, the imbalances persist. If you look at CEOs and business, same thing. When we turn in on ourselves and look at the problem in medicine, or neurosurgery for that matter, I think we’re discounting history, we’re discounting society, and we’re discounting politics. As a society, we’ve got a lot of work to do. The problem exists across the spectrum, so we can’t say that STEM is what’s causing it. The statistics for presidents of universities, deans of universities, chairs of departments - we’re not seeing women represented at those levels. I don’t think it’s rocket science, I mean we have a president who, well, women aren’t being valued in that context. Those bigger societal issues bleed into the schooling of girls, the schooling of boys, and then how that translates into adulthood and career advancement. I don’t think it’s access at this point. I do think there are some access issues, for sure, and that contributes, but I think it’s contributing to a bigger problem.

I think that my children are somewhat luckier, in the sense that the barriers that they face in many ways are not comparable to the barriers that their mother faced, and that gives me hope. I don’t think it’s a paved path for them, or any girl, quite honestly, but I think that to see us, they know that if we could do it, if they choose to do it, there’s a way to do it. I think they have more choice, and I love that. I love that science for them doesn’t have to necessarily be doctor or PhD, they can do so much more with that thirst. I recently took my daughters to a book signing of two college sophomores who met in “Girls who Code” Camp. They created an online game together that went viral and then wrote a book about that experience. Their love of science translated in a way that my growing up could never had foreseen. Yet, you know they’re scientists, they’re both computer science majors. And there’s Debbie Sterling, for example, she founded Goldie Blox. She was an engineering major and she talks about how hard that was, and you know, she took science and translated that into games and toys. I feel like our girls are going to have so many more options and choices, and I think that’s awesome. 

When I was a little kid I really liked a lot of projects that involved problem solving. I took a biology course in high school and I became very quickly interested in how the brain works, and how we can figure out different ways of understanding the transition between what is a cellular process and what is a higher order of cognition and awareness - that transition was always very interesting to me. When I was in college I majored in neuroscience. I really liked math and science, and that challenge of having a question that no one really knows the answer to, and trying to prove yourself either right or wrong. 

I had a lot of encouragement from my family from the beginning. I’m a very motivated and enthusiastic person, and I think in the same way that I work with my kids to direct their powers for good, my family also made sure that I could put my enthusiasm into a productive stream. But encouragement on a professional level, well, there wasn’t very much of that. Particularly in medical school when I was thinking about doing neurosurgery, the first dozen people I talked to about it said, “absolutely not!” There was no filter or concern to be politically sensitive about it, they basically just said “well, women can’t do neurosurgery, so you should do something else.” I haven’t listened to that voice, that societal voice on what women can or can’t do, and I wasn’t about to then either. That said, I wanted to make sure that this was something that I really intrinsically liked, because I knew it was going to be very challenging, but I also wasn’t going to let other people tell me how to balance my life. During those first few years in medical school I had no real role models, at least not for women in neurosurgery. Once I committed to the specialty, many faculty were very supportive, and Stanford has been as well. 

People would also say, “well, you can’t do neurosurgery because you can’t do it part time,” as if by being a woman I only wanted to work part time. When I was a medical student, a female neurosurgeon I met, who was no longer practicing, said “well, you can do neurosurgery, but then you definitely can’t have kids,” and she didn’t know, but at the time that conversation took place, I was actually three months pregnant with my first child. I think that as with all points in your life and your career, you must filter the advice that you get. I would think, ‘well, I’ve done a good job of maintaining balance in my life while doing all these other productive things, so I think I can also manage this and fulfill my other goals.’ If there’s something that you want to do, you do it. You know that there are going to be sacrifices and compromises, but ultimately this was the correct decision for me. I think about the things that people have said or done to try to prevent me from getting where I am now, and all I can do is make sure that I’m doing the best job that I can every day, and try to set an example for the next generation of scientists and physicians.

I think that the experience is different but not disadvantageous, particularly the experience of being a physician or scientist when you have little kids. Juggling neurosurgery and kids has been helped by my incredibly supportive partner, who has watched all of this develop from undergraduate studies to faculty position. Neurosurgery and science are challenging careers, requiring leadership and resiliency. There are unique experiences to women in child rearing, and I think that gives an opportunity for perspective, and to recognize holistically the different types of support that patients, trainees, or employees may need. 

Yes. I am still very frequently asked by patients if I’m the physician or the surgeon, and people are still taken aback when they meet me and realize that I’m a woman. I’m still regularly referred to as the nurse or social worker by patients, hospital staff, and sometimes even by other physicians. In a sense this is a societal reflex. I’ll tell you an interesting story; I was reading a book about a doctor to my kid back when he was about kindergarten age and we were talking about the book and he said, “well, that person can’t be a doctor, cause it’s a girl.” I found that comment so interesting, because here’s a child who knows that his dad is a teacher and his mom is a doctor, and yet, somehow, all the rest of the input that he gets from life tells him that women aren’t doctors. So, then I asked him, well “what do I do?” and he said “you fix people’s brains” and he recognized that conflict within himself. These ideas are culturally hard-wired from an early age. 

I have three children, two boys and a girl. I try to be reflective and cognizant of my inherent biases – to teach my sons as much as I teach my daughter about what women can accomplish. Girls very early on receive the message they’re not good at math and science. It has to be a conscious reinforcing of your kids’ strengths. Be reflective and thoughtful about how you may be perpetuating inherent biases, or how the same behavior will be perceived. Listen to how people talk, interrupt, or remain silent. When it comes to our kids, I focus on encouragement, awareness, persistence, open conversation, and building confidence. 

Yes, I’ve had assumptions about my role on the medical team, as I’ve mentioned. I’ve also had assumptions about my career goals, like if I was interested in basic science research or not, without asking me. These are not malicious, but ingrained, and need conscious correction.

I’ve traveled to, and lived in, lots of places around the world, and very frequently I’ve thought to myself ‘I’m very glad that I grew up a woman in the United States.’ I know for sure I would not have had even the smallest bit of opportunities that I’ve had in my life if I had been living most other places in the world. The challenges I faced do not compare to women who have to fight for their right to speak, vote, have access to healthcare, and control over the number of and timing of having children, education, and other basic human rights. In the US, I think it would be helpful to remove the stigma around needing to take a leave for your child by implementing policies where men and women have equal time off to take care of their families. People have things that happen in their lives that have nothing to do with having children, and they take the same or more time off then someone else took off to have a child, but for some reason the choice to take time off to have a child is looked down upon. 

I think there would be more women pursuing leadership positions in science or medicine careers if they had more female mentors that they see living and working as role models. We’ve got hard-wired societal biases, and most of us are oblivious to them. You need to make a concerted effort to have women trained and elevated to leadership positions, and to be thoughtful negotiators. I think that Stanford does a good job of that in that they have female faculty mentorship and leadership training. I’ll tell you another story. One day as a resident I ran into a female Stanford medical student who I hadn’t seen in some time, so I asked her what type of specialty she decided to pursue. She answered that she chose orthopaedic surgery. She then said to me, “you know, I’ve never told you this, but you were a big reason I decided I could do surgery. I saw you once, operating in the middle of the night, eight months pregnant, and I just thought to myself, if Melanie can do this, I can do this.” I didn’t have a formal mentoring relationship with this student, but just by the fact that I was there, it was enough for her to say ‘I can also do surgery and be a mom. I can meet all of my goals’. 

I had a very doting father who pushed me to excel, but this was Karachi, Pakistan -in those days there was an understanding that girls should learn how to cook and sew, look pretty, and there was a clear sexual division of labor. I enjoyed studying and I was especially drawn to biology. But I always balanced it out with poetry and literature, and dancing and music. There was never much talk about what I would pursue, law, medicine. I guess it was understood that I would choose something. As I watched my two older brothers travel and study abroad I decided to do the same. Some of my girlfriends whose families were more liberal than mine were sending applications out to schools in the UK and USA. The idea was met with much discontent. I struggled with my parents for about a year, until finally my father agreed. I was allowed to move to California to live with one of my brothers, and attend a community college literally down the street. I think my father felt that if he let me do this I would get it out of my system, and then I would return to Pakistan. That was my first exposure to US education and there was no turning back.

There were several reasons. The most important one was that I did not know what else to do or what else I was good at. I transferred to UC Irvine from the community college where I took chemistry and biology classes and I enjoyed the science courses because of the hands-on interactive approaches. Within my first six months at UC Irvine I applied to be a student researcher in a lab where I became a lab assistant and performed animal research for about three years. It was there that I was exposed to histology, physiology, auditory physiology, electrophysiology, and that was also the very first time I looked at a brain. I was working with post-docs on behavioral training, and we would run 16-hour experiments on rats where we would so single-cell recordings. The first time I saw the brain move under the microscope, I remember I completely freaked out. The first brain structure I fell in love with was the hippocampus, and I spent many hours working with it on a variety of projects on learning and memory.

Another reason that played in my decision to continue my education was the knowledge, strength and confidence it gave me. During my first year in America I met my future husband. He was a white, American ex-Navy choosing to return to school. When my parents found out that I, a Pakistani Muslim girl, was dating a white boy, things got complicated. It took two years to convince my parents to allow me to stay in the U.S. and marry him, on the condition that he convert to Islam. It was important to me to have my parents’ blessing, but the experience also reinforced my determination to continue my education.

It was the duality of working in the lab on these high-level science projects while simultaneously needing to convince my parents to let me marry the man I loved, that I chose to continue my education further and pursue two undergraduate degrees; one in neurobiology, and one in women’s studies.

UC Irvine provided me with the foundation I needed in both science and feminism. I took feminism courses and met smart progressive women whom I’m friends with to this day. Coming from the East, one of my key takeaways was that you can’t apply Western feminism ideas to the East without some major modifications. I found that not all women, but I think a lot of them, particularly women who come from a deep patriarchal culture like mine, were very afraid of change. These women were so rooted in their culture that they forgot to see the alternatives, and instead of improving and expanding opportunities for other women, they victimize women and hold them back. My understanding of emotional neuroscience helped me understand how women have different resources to achieve the same outcomes as men in every-day life. But because there are not enough of us in academia or other fields, these tools are generalized as weak, ineffective and ridiculous. Women are not from Venus, they are from Earth – we just need more representation. So, I have become a huge proponent of mentoring South Asian women get to leadership positions. When I say South Asian, I particularly mean those from Muslim countries, because there are a lot of Indian women in leadership roles, but you don’t see nearly as many Pakistani women in leadership roles. I think this creates a huge deficit for all of society, and I spend a lot of my time giving talks on these issues and mentoring young women in STEM careers.

It was when I completed my undergraduate work that things became difficult. One of my undergraduate advisors would berate me and tell me I would never get into grad school, that my work wasn’t good enough, and he became emotionally abusive. I don’t think he treated the male undergrads in this way, but I did hear that other females had similar issues with him. It was difficult to overcome and affected my confidence. However, I was accepted to the Neuroscience PhD program at USC and UCLA which helped me rise from the ashes – so to speak. My PhD in neuroscience at USC was a gloriously nurturing experience. It was then that I got into structural and functional brain imaging, and where I was lucky to have Dr. Joseph Hellige as my PhD advisor. Hellige probably is one of the most feminist men I’ve ever met and really helped me understand the biopsychological basis of behavior. While completing my PhD, I became particularly interested in the impact of neuro-linguistics on Alzheimer’s Disease and aging, and decided to pursue this field for my post-doctoral fellowship.

It was shortly after I completed my PhD thesis that I gave birth to my son. One of the things that I quickly learned was that as a woman researcher or doctor, it’s nearly impossible to take more than 6 weeks off. Everyone says you can, but even many of the women I’m mentoring who’ve had a child, found it extremely difficult to return to work in anything longer than that. Some of this has to do with our maternity leave but also what you put on your CV if you take a year off. When I was trying to find a post-doc position, I felt a lot of pressure not to take time off to be with the baby. So, when my son was 6 weeks old, I put him in daycare. I took a job at UCLA, which was a significant distance from my home, which was incredibly stressful. I would race across town exhausted, and pump milk during the commute, and overall it was a traumatic experience. Putting my son in daycare so early is probably my life’s biggest regret, even now when I think about it, it just breaks my heart. At that time it was unheard of in my community for a mother to do this to her child so the support was non-existent.

When I got to Stanford for my post-doc, I discovered that gender issues went beyond my own career development, but also impacted the results of much of the research work I was doing. For example, one of the first projects I worked on was assessing the expertise effect on flight simulator performance by studying the brain activity in pilots. The project brought together a variety of disciplines I was particularly interested in – psychology, computer science and neuroscience. One of the biggest problems we ran into was that we didn’t have enough female pilots to study, so we were only getting information on a segment of the population. As it turns out, not having enough females for our studies at the VA is a problem we run into often as well.

There are still, to this day, many stereotypes about women scientists; like that they are absent minded, or will not marry, or that they have short hair or don’t wear make-up. I see articles regularly on my news feeds with headlines such as “Why Women in Science Don’t Cut Their Hair Right,” or “How Women Should Dress at Work.” These stereotypes persist and they negatively affect both women who fit into them and those who don’t. I’m very feminine, and I make a point of wearing dresses, wearing my hair down, wearing high heels. Looking feminine is my strength, it gives me a lot of confidence, and yes, people notice it, but I refuse to be any other way. I firmly believe that a woman doesn’t have to look or act like a man to be successful. It seems to me that women can’t win, we’re either put down for not being feminine enough or for being too feminine. Beyond the physical aspect, there are other ways that can be used to make one feel singled out. Being cut off repeatedly in conversation is a big one. I’ve also been called a variety of things that I know a man who behaved in the same way, would not be. Words such as aggressive, emotional, hysterical, manipulative, blindly ambitious and tempting. It’s offensive and hurtful, but I must continue to do my work and do the best job I can, but above all - be myself.

There’s this attitude that women can now do whatever we want, but I don’t think it’s true for most women. I’ve certainly had to fight to get to where I am, and I still fight. And despite being in the U.S., and being an accomplished career woman, there’s a sense by others that if I’m successful at my career that automatically means I can’t also be a good mother. I used to think that men and women were equal, but they’re not. They are equal in their outcomes, but they use different strategies to get there. We should all be given the same opportunities so that we can employ our individual strengths and strategies to reach our goals – which can be one and the same. I also think it’s critical for us as a society to find a way to support and provide for new mothers, so that they don’t have to sacrifice their careers to spend time with their baby. This is of course a relative opinion based on the pressures of patriarchal society where being a mother makes you a complete woman. There are highly successful women who have broken the glass ceiling and motherhood is not important to them. One day, our society may accept all women for who they are despite their fertilized egg counts.  There are things that I did when I was growing up that I did without question, and I accepted them. But when I look at my eight-year-old daughter she has a confidence at a very young age that I did not have. She doesn’t feel the need to have everyone like her, and she’s not so worried about what others think she should or shouldn’t do because she’s a girl. Perhaps that’s a good sign for the future.

I’ve been teaching my own daughter to say no to social norms she doesn’t agree with or that allow her to reduce her functionality in society. I think we should question things and try to pave the way for others. If there is unfair treatment one must protest and voice their opinion. I would say to young girls the same things I tell my daughter: question everything, don’t get married early, don’t ever settle intellectually – always keep learning and pursuing knowledge – enjoy your life, and never regress to the mean.

I always loved science and math, they were always my favorite subjects in school. I always loved thinking about how things work. I’m the kind of person that looks around at the world and thinks “I wonder how that works” and I want to figure it out. For as long as I can remember I’ve had an excitement about science and how things work.

I don’t think I really talked about what field I wanted to go into until I was in college. But I had classes in high school - I went to a magnet high school, a public school in New York - where I had great teachers for organic chemistry and biochemistry who got me really excited about studying the molecular structure of how things worked and I really liked that. When I was in college I worked in a lab, and there I learned a lot about science too.

When I a went to apply for a doctorate, I applied for MD/PhD programs and that was the first time where I feel like there was a lot of push back. Pretty much everywhere I interviewed somebody asked “well, have you thought about having a family?” or “do you know how long this will take?” It took me by surprise. I knew they weren’t asking this of my male counterparts because they would say things like “well, have you thought about being home with a child and how much time that would take?” I had conversations about this with other women who were applying for MD/PhD programs, and they all had the same experiences.

I bring my own perspective, and I guess some of my perspective may come from being a woman, but a lot of it comes from my training and what I think about every day and the kinds of questions I’m interested in. I’d much rather think of myself as a scientist then as a woman scientist. Women might ask different questions, there’s some data that women may do research differently than men, in a more cooperative fashion, but that also makes me uncomfortable because it’s another way of saying women are not equal to men. In general, I think that at Stanford there’s a lot of cooperation because the University actively encourages it. I also think mentors that are supportive of women are very, very important for women to advance; so that doesn’t necessarily mean female mentors, but people who recognize the importance of advancing equality in the workplace.

At the faculty level, we do a poor job with both ethnic diversity and gender diversity. To address this, as head of admissions for our neurosciences PhD program, I try very hard to recruit a diverse class. Our Biosciences graduate program, as well as Neurosciences, believes that when your group is made up of people with different perspectives you learn different things. It enriches us all to engage in scientific discourse with people who bring something of their own to the table.

For many years, the pipeline has been such that an equal number of women and men, or even more women than men, have enrolled and gotten PhDs. Where they drop out is between the PhD and the post-doc, and between the post-doc and the faculty positions. I think it’s because of sexism. Inherent sexism in the system, mostly. Usually not conscious sexism where someone says “you’re a woman and you don’t belong here,” but people saying “well, have you thought about work-life balance?” and inferring that you can’t have it if you’re a woman in science. I don't have kids. I do have friends who are women who are successful who have children, and uniformly they all have partners who help take care of the children and do equal or more then equal work in the home. The default model was always that the woman makes the [career] sacrifices, and in medicine you see that all the time. There's nothing wrong with that, just like there's nothing wrong with a man staying home with the kids, it's just that it's unequal, and that's what bothers me.

In the 1960’s people were protesting the exact same issues we are today; people wanted equal pay for equal work, they wanted women not to be sexually assaulted, and women wanted to be respected for their voice. As a society, we still need to work on these issues for all women. The scientific community is just a reflection of the larger culture and in many ways, I think it’s more advanced. So it’s not that science is a particularly bad place for women, it’s just when you look at high powered jobs overall, there are fewer women in them. If you look at the number of women in neuroscience or science at Stanford who are faculty, especially more senior faculty, it’s quite low. But it’s still probably higher than women who are CEOs of companies or lawyers who are partners in law firms, or women in politics, or you-name-that high work commitment, high profile, high status job, and you look around and there aren’t that many women. To get to a 50:50 distribution of men and women scientists we must affect change in overall attitudes about women with power and influence.

I would tell them to go and make a difference the way they want to make a difference. Tell them that we believe that they can contribute to the world, and that that contribution will be valuable and important to society.

Even as a young student I was always drawn to biology and studying behavior. The neurosciences was just burgeoning as a science field at that point and so I just tended to be attracted to projects in that area, even as young as middle school. When I went to college I focused on neurosciences and did a bit of benchwork research. But I saw that dealing with people and dealing with patients was a better fit for my personality, and so at that point I decided to pursue medicine.

As a child I was encouraged to pursue science. I didn’t have any family members as role models in the field, but I think it was my eighth grade biology teacher who sent me to a “girls in science” camp at a local university. For a week, I went to this university and did things that had to do with science and it was for girls in science, and I really liked it. I would say I was supported in terms of becoming a scientist and a doctor, absolutely.

I was definitely encouraged to do science and to become a doctor, but I was not encouraged to become a neurosurgeon. I was definitely discouraged in terms of becoming a neurosurgeon – by other neurosurgeons and by physicians that I worked with in medical school. I believe that it came from a good place, in that they were concerned that the lifestyle would be punishing, and that it would mean sacrifices to me in terms of other things I might like to have, like a family. I think that as a woman, part of it was the child bearing, and the time off during a surgical training program, even the small amount of time off required to have a baby. Things have changed since then, when I was in my residency program there was no chance of being pregnant, that was never going to be allowed, that was never going to be tolerated, nor did I ever even think I could have done it because the hours we were working were so crazy. But they’ve tried to make it a bit less draconian, and work hour restrictions and programs have changed, and it’s now routine for residents in the Stanford program to have babies. That means not deferring having children as long as I had to defer it, which was until I was finished with the program. So, I think that the reasons people discouraged me were valid, the road is a little bit bumpier for women in neurosurgery, but I think that a lot of it can be overcome by changing the culture.

I do think in terms of medicine as a science, that as a woman there’s definitely a component of nurturing and forming relationships that I think can really positively affect patient outcomes. I guess it’s not a science per say, but in terms of taking care of patients, not to generalize, but I think that sometimes for my male colleagues, relationships with their patients may not be as much of a priority, and so I think that is something that women bring to medicine that is unique.

I think that diversity is a big thing. It’s only going to hurt the field, the fact that it’s not diverse. Diversity is going to improve neurosurgery, and having more women and more people of different backgrounds is going to make it a better specialty, it’s going to bring innovation and change. I think forward thinkers get that, someone like Dr. Steinberg gets that, but there are a lot of people that still just want things to stay as they are. I think that our big organizations need to try to represent neurosurgery better. I think that will allow these organizations and allow these specialties to evolve and change a little bit. Neurosurgery is probably not going to be, any time soon, a specialty where it’s going to be fifty-fifty men and women. It is a very demanding specialty in terms of time commitment, and it is physically demanding. And it’s not that women can’t do it, but a lot of women don’t want to do it because the facts of the matter are that most women end up doing the bulk of the child care and the housework, even if they are working. The women that I know that have made it work in neurosurgery have like me, more unique situations; my husband stayed home. It’s changing, my friends here, out of a group of say 10 women, three of us are the breadwinners and the husbands stay home. I don’t think that neurosurgery will ever be a fifty-fifty thing, and that’s okay. But I do think that we then miss out on getting the best and brightest medical students and residents, because of the way the specialty is, it’s not a specialty that’s very conducive to clocking in and out.

One thing I noticed throughout my training with women, is that we were all often second-guessing ourselves – 'are we good enough, are we smart enough, do we know enough, have we prepared enough, do I practice this surgery enough to do it on my own, maybe not, maybe I should have somebody with me?' - I just don’t feel that our male colleagues, just from a societal point of view of how they are trained, dealt themselves in that same kind of way; to question their right to do it. I think that process of self-doubt actually isn’t all bad, it can make you a better doctor and a better surgeon because you are always questioning – do I know enough, am I good enough – versus assuming you are. And so, I think that you kind of have to be aware of that, and have insight into that, and realize that those forces are at work in society. As much as we try to protect our little girls and raise them to think that they can do whatever they want to do there’s a lot of societal pressures that are out of our control that change how they view women, you know, in terms of media, politics, and we can’t completely control what they feel and hear. That’s the reason we must continue to tell them to not be discouraged by people that say “you can’t” or “you shouldn’t” or that it will mean giving up other things. There’s always a way to make it work for you, there’s always a way to figure out how you can make it work for you, and I think that a lot of people in neurosurgery didn’t really do that with me. No matter what anyone says to you, you can be just as good at science, you might learn things differently, or at a different pace, but you can get there. 

I wanted to be a doctor, for as long as I can remember. However, when I was in the 5th grade I was fascinated by a TV program about surgery, and thought to myself that “it was very cool,”  which further narrowed my aspiration from becoming a doctor to becoming a surgeon. I guess at that age you don’t think deeply about these things; I just knew that’s what I wanted to do. By 9th grade I was already an eager and more hands-on student, and I’d readily volunteer to help our biology teacher with the frog dissections - in my mind I was already a surgeon. I remember when we got to the nervous system of the frog, my teacher was hesitant to let me dissect, as it was a more delicate and challenging procedure, but I insisted on taking on the challenge and performing the dissection myself.  When we started learning about the different organ systems I was extremely curious about how the brain controls and impacts various functions. I was always disappointed with the limited information there was about the brain versus the extensive and detailed responses I would get about the heart, kidney, etc. In my naiveté, I felt the mystery of the brain needed to be cracked, and that’s when I decided – I want to be a neurosurgeon.

My parents have always encouraged me. My father is a civil engineer, but he was passionate about medicine. Had it not been for social circumstances when my parents first started out, he would have become a doctor. The partition between Pakistan and India had just happened and he needed to find the quickest way to get a degree and start supporting himself and the family, and the path to medicine was much longer, thus he ended up opting to be an engineer. My parents never stopped me from dreaming big, in fact, they encouraged it. My mother is a homemaker, and she is an extremely strong woman who is a staunch advocate of women pursuing whichever path they want to or are capable of. However, I think their mindset and encouragement is a bit unusual in Pakistan, which I didn’t realize at the time because of the environment they created for me. Things changed when I got older. When I went to medical school there wasn’t a single woman neurosurgeon in Pakistan, so a lot of people shared unsolicited advice for me to go into Obstetrics & Gynecology or Pediatrics, which were thought to be more favorable fields for women in medicine. But this was definitely not in line with my passion for neurosurgery and I continued to get pushback throughout. When I’d talk to colleagues and friends, and more distant relatives, I’d start hearing things like “Oh, you’re going to waste so much time, when are you going to start your family?” or, “oh, you’ll become too aggressive to be a family person.”

I believe I’m very focused on my goals, and I had that rock at home - my parents and my siblings– they always said “let people say whatever they want, if you want to do something, of course you can.” I am fortunate to have had that kind of support, and consider myself to this day very blessed. I think my school was fairly progressive growing up, and I have also had a circle of amazing teachers, friends, and mentors. My father would always say that “if you do something you love, then you’ll never have to go to work again for the rest of your life.” I truly believe and now live that.

People don’t see your goals as being realistic, and in turn don’t bother to respond to you seriously, which can be a blessing of sorts. If someone asked me “what do you want to do?” I would say “well, I want to be a neurosurgeon,” and they would just smile and walk away. They were dismissive, but I wouldn’t fight them.  You have to choose your battles, and that was not a battle worth spending my energy on. I think it’s also about how much you let peer pressure get to you. I never thought I had to look a certain way, or talk a certain way, or think a certain way, just because that’s what was demanded of me, or expected of me by others.

If I think that “if I made it, shouldn’t everyone else make it?” that would be an ignorant statement on my part. It would also demean the fact that there are extremely smart, and extremely motivated people out there, but they don’t have the same opportunities to succeed. I was raised in a supportive home, with good opportunities, and I’m grateful and aware of that, but what if I hadn’t been that lucky? What if I was not born to parents who could financially support me in those endeavors?  My parents raised seven kids in a 2-bedroom house, so I think it’s not just about class but more about the mindset that education provides. Back in Pakistan I interacted with women from less financially privileged families, who were working as house help. According to them, if it was just about putting food on the table then their husband’s pay would be enough, but they were working hard to ensure that their kids could also get an education so that one day they’d be able to sit on my side of the table. I really respect those women and I would want to do everything for them, because I support that mindset. Not everybody has an opportunity, but these women, they are the real inspiration.

Well, I think some of it is inertia, it’s always easy to continue what’s already in place. Change requires a lot of bravado by both sides - the side that is waiting for and wanting change and progress, and the side of those who need to relinquish the power and/or allow it to happen. I think it’s important to remember that both parties are essential to change. The other thing, in my experience, is that we don’t realize that in a lot of ways women must work harder, even just to be acknowledged, to be taken seriously. I graduated from medical school in 1999, and didn’t get into a neurosurgery program until 2008, and during that time you can imagine how many people told me “this is not going to happen, you’re wasting your life away, you’re wasting your time, you’re not going to do this…” However, most likely my male counterpart with a similar experience would be approached differently. Society would be more empathetic to his struggle and would take his ambition more seriously to help him out or encourage him to keep trying. I’m not saying I didn’t have some of that help, I did, but I think that because women aren’t normally seen as the breadwinners, there’s no perceived urgency for them to get to a certain point or level in their careers, the way it is for men.

Hopefully yes, but there is a lot of progress to be made. I do think that if we see a problem, we should acknowledge it, otherwise it won’t be corrected. I don’t want to paint with a broad brush, it would be unfair to my male and female mentors, and would be a disservice to the people that believed in me. While the problem is not perpetuated by everyone, there are definitely societal norms which can cause challenges. I wouldn’t be where I am today if somebody did not give me the chance, or believed in me. It starts off with your parents but it also continues with your teachers and mentors throughout school, college, residency, fellowship(s) and even as faculty. In residency, I had a female mentor, Dr. Abosch, who was my rock and go-to person, not everybody is lucky enough to have that. My chair at West Virginia University, Dr. Rosen, and Dr. Steinberg, here at Stanford, both believed that I could make it work by pursuing my cerebrovascular fellowship while taking faculty call on opposite coasts, and they accommodated. At the same time, my spouse has been extremely supportive, as we have lived as a split family for the past year, so that I may pursue my passion. However, on a macro level and as a society we need to invest in better education. I have been disappointed in the sense that I expected the sciences to be embraced a lot more in the U.S., and it’s a little disheartening and disappointing that they aren’t. Our current society dismisses reading, dismisses books, we are demonizing intellectualism, and that’s extremely concerning, because this mindset won’t help us solve these societal issues and in fact, we risk undoing the progress we have made thus far.

Based on my experiences, I would say that you should differentiate between what your goals are and what society’s goals are for you. You should not let peer pressure define you, and it’s important to choose your battles wisely. If you have a goal, then everything else should fade. I wouldn’t suggest that you should let reaching your goals come at the cost of your values, but I do think as women we need to learn how to phase some things out - if you let negative voices get to you, then you will lose your focus. For me, the most important things are maintaining focus and perseverance; you can never, never, never quit.