July 1, 2022
Clockwise from top left: Drs. Ariane Abcarian and Herand Abcarian after a case at John H. Stroger Jr. Hospital of Cook County. Dr. Megan Lundgren on her surgical rotation as a medical student, with Dr. Eric Lundgren. Drs. Zewditu Asfaw and Ingida Asfaw performing open-heart surgery at Detroit Medical Center. Dr. Richards and Dr. Worrest at Community Medical Center.
Editor’s note: This is one of several feature stories in the Bulletin series on surgeon families. If you are interested in sharing stories about your dual-surgeon family or know of colleagues who have two or more surgeons in the family, contact Diane Schneidman, Editor-in-Chief, at email@example.com.
Somewhere in the back of her mind, Ariane Abcarian, MD, FACS, always knew she would probably become a surgeon like her father—Herand Abcarian, MD, FACS, former chair of colon and rectal surgery, John H. Stroger Jr. Hospital of Cook County (formerly Cook County Hospital), past-chairman, department of surgery, University of Illinois-Chicago (UIC), and professor emeritus at UIC.
“I would accompany my dad on rounds and sometimes hang out at the nurses’ station or the lounge, but every now and then, I would get to go into a patient’s room, and I just thought that was the coolest thing,” she said. She particularly valued how appreciative her father’s patients were of his work.
Nonetheless, “I really didn’t decide on surgery until I was in medical school. I went to Eastern Virginia Medical School [Norfolk, VA], and ACS Past-President L.D. Britt, MD, MPH, FACS, was my advisor, so I probably didn’t have much choice,” Dr. Ariane Abcarian said.
“I told her, ‘If you pick L.D. Britt as your advisor, you have one path only, and that’s surgery,’” added Dr. Herand Abcarian. “He and I go back a long way. He was my resident at Cook County Hospital.”
Because Ariane had a range of interests and talents, including art and history, Dr. Herand Abcarian cautiously advised her on pursuing a career in medicine and particularly surgery. “I told her, ‘It is a calling. You have to love medicine with your heart and soul,’” he said.
“Once she got to medical school, she would call me during her rotations, and say, ‘I can’t stand medicine,’” Dr. Herand Abcarian said. “I would tell her, ‘I do a lot of things during the day, but the one place I truly enjoy myself is in the operating room (OR). If you’re not going to enjoy being in the OR, then you are going into the wrong business.’ You have to love surgery, and that’s what she agreed to commit to.”
Dr. Ariane Abcarian said she and her father operated together several times when she was in training at UIC and Stroger Hospital.
“It’s been lucky that he maintained his privileges and volunteered his time. I got to learn a lot,” Dr. Ariane Abcarian said.
“In reality, I’ve always tried to stay out her way. I did not want to be overbearing and interfere with her judgment or decision-making by injecting my ideas. Even in the OR, she was the surgeon, and I was the assistant. She made the decisions, and I helped her do the case,” Dr. Herand Abcarian said.
Both Drs. Abcarian share an affinity for certain cases. “I love anal fistulas. I don’t know if that’s because of nature or nurture,” Dr. Ariana Abcarian said.
Throughout his career, Dr. Herand Abcarian has been involved in developing educational programs for the American College of Surgeons and always was selected to lead courses on anal-rectal fistulas. In fact, he edited a book on the topic, Anal Fistula: Principles and Management.
“People started to refer their most difficult anal fistula cases to me—ones where the patient had undergone five or six operations without success,” he said. “I still did colon cases, but I enjoyed complex fistulas the most, and I think Ariane has somewhat inherited that.”
Dr. Ariane Abcarian still sees her parents often and continues to seek their advice. “My husband is not in medicine, so just having my dad available to be a sounding board and understand what it’s like to be a surgeon and what I’m going through is really great,” she said.
One generational shift that both Drs. Abcarian have observed is the emphasis on work-life equilibrium. “I don’t think my parents had the benefits of work-life balance at all. He had so many accomplishments that came at a tremendous personal cost,” Dr. Ariane Abcarian said. Her father and mother (a nurse at Stroger) “sacrificed a lot for their training and their patients. I think that now, surgeons have a little more ability to create that balance.”
“Things have changed, and I believe they have changed for the better. My life was not all fun. It was very hard, and it was hard for my wife to raise our kids while I was away building a career or building a name internationally,” added Dr. Herand Abcarian.
Like Dr. Herand Abcarian, Timothy B. Richards, MD, FACS, a general surgeon who recently stopped operating but continues to serve as director of growth and outreach at Community Medical Center, Missoula, MT, tried to avoid pushing his daughter into surgery.
“First, you have to know my daughter. She was going to make her decision no matter what I said,” Dr. Richards explained.
“There was a while when my parents tried to convince me to be a lawyer. When I decided to go to medical school, they tried to steer me to go into interventional radiology,” said Tarin Worrest, MD, a minimally invasive and robotic surgeon at Community Medical Center.
Her father’s advice was based on experience. “I’ve had a good run for the past 37 years, but it’s not always been easy. There are certain sacrifices that you have to make when you decide to become a surgeon,” Dr. Richards said.
“When you go into general surgery residency, you know it’s probably one of the more unpleasant residencies that people go through—at least it was for me. One of the things we tried to instill in all our kids is that the job doesn’t define me,” added Dr. Richards, who was a US Army surgeon for 11 years before moving into private practice.
Dr. Worrest said what drew her to surgery was a love of anatomy and the joy of seeing patients get well quickly. “I liked knowing where the different structures are, and I really liked fixing things,” Dr. Worrest said. “I tell people surgery can give you very immediate gratification. You have a bad gallbladder, a surgeon takes out the gallbladder, and you feel much better. I am doing something directly for the patient—putting my hands on them and working with them directly.”
Her father offered a similar explanation for choosing surgery, adding that like his daughter, he continues to appreciate the changes in technology.
“I loved the innovations in surgery. We have all the cool gadgets and are always coming up with new procedures that can be done in less time,” Dr. Richards said. For example, he started doing laparoscopy soon after its introduction and doing robotic-assisted operations before he retired from operating.
Having a surgeon parent does have its challenges, though. “When I was in medical school, he had this bad habit of drilling me over the phone,” Dr. Worrest said. “My mom had to tell him to stop.”
Even so, she said, “I still call him when I have done a really interesting case. He actually gave me my first consult when I first started in Missoula and had a complex patient.”
“Now we talk a lot about the business side of medicine, which is something they don’t really teach you in medical school or in residency,” Dr. Worrest said. “Nobody teaches you how to build a referral base, for example. So, that’s something he’s helped me with.”
“It’s nice to have someone you can talk to who understands what you’re going through. Even if you have a really understanding spouse, they are never going to fully understand what you do, especially if they aren’t in medicine,” Dr. Worrest said. “My husband, who is in sales, isn’t really going to understand what I’m going through if I had a really difficult case or a patient had a poor outcome. It’s nice to have someone who knows what that’s like.”
In addition, Drs. Worrest and Richards believe in, and are committed to, helping patients far from Missoula. “We’ve done some mission work in Guinea, West Africa. I fixed hernias in the middle of the jungle. Tarin went over there before she was a surgeon. It would be kind of cool to see her go back because that is the greatest place to operate on people who really need it and don’t have healthcare,” Dr. Richards said.
“I was still in high school at the time, and my job was to sterilize the instruments. That was my first time working adjacent to an OR, so I got to see a lot of patients with large hernias,” Dr. Worrest said.
Ingida Asfaw, MD, FACS, a cardiothoracic surgeon at the Detroit Medical Center, MI, and its affiliate hospitals in the city, is no stranger to mission work. He is a past-recipient of the ACS Volunteerism Award for his work in his native Ethiopia and other developing nations.
Dr. Ingida Asfaw and his wife instilled in their daughters—Sofya Asfaw, MD, FACS, a trauma and critical care surgeon at the Cleveland Clinic, OH, and Zewditu Asfaw, MD, a cardiothoracic and critical care surgeon in Detroit—a commitment to serving others, regardless of the profession they chose.
“First and foremost, I’m extremely proud of my daughters and that they are in the specialty of surgery. They are serving humanity and the community. That alone is a wonderful position to have,” Dr. Ingida Asfaw said. “In my effort to help them grow and choose the profession they liked I would tell them, ‘Medicine is a noble profession. If that is what you want to do, I’ll help you in any way possible to achieve your wishes and your goals and purpose in life.’”
Dr. Sofya Asfaw can’t recall a time when she wanted to be in any other profession. “For as long as I can remember, I always wanted to be a surgeon—actually a cardiothoracic surgeon like my father. That ended up being my sister, and I ended up being a trauma surgeon,” she said. “I can say without a shadow of a doubt it was because of the big role model I had in front of me.”
In contrast, Dr. Zewditu Asfaw said she originally wanted to be a lawyer, but “I joke that I inherited his bad genes. I did everything I could to fight the urge to go into cardiothoracic surgery. A lot of it was because I saw how hard my dad worked. When we were younger, he wasn’t home as much as he or we would have wanted him to be.”
“It wasn’t just about him not being home as much as we would have liked, but also seeing what surgery entails—knowing what the lifestyle is like,” added Dr. Sofya Asfaw. “I had questions about whether I could be present as a surgeon, as a mother, and do it all. That’s definitely something we had to keep in mind, knowing how hard our father worked and knowing that he tried to make it to as much as he could, but there were certainly times when he couldn’t make it to ballet recitals and other events. Balancing that with being a woman in surgery was definitely a consideration.”
“He was very realistic with us,” Dr. Zewditu Asfaw noted. “He would say, ‘You know, as a female, going into surgery, it’s going to be harder. You’re going to be away from your family. If you’re going to have children, you’re going to have to juggle motherhood and surgery. So, make sure that is absolutely what you want to do.’”
Both sisters say one challenge they have faced in residency and practice as the daughters of a highly regarded surgeon is that patients and colleagues often ask if they are related to Dr. Ingida Asfaw.
“When I moved back home to Detroit, I started residency at the hospital where my dad was a very beloved attending,” Dr. Zewditu Asfaw said. “I think every time I stepped into an elevator, people would ask me if I knew Dr. Asfaw because they saw my badge. By my chief year, I would say, ‘I am Dr. Asfaw. Are you asking about my dad?’”
“People at the Cleveland Clinic will stop me and ask, ‘Do you know Dr. Asfaw? He trained me,’ or ‘I worked with him.’ I can’t escape it, and I’m in another state,” Dr. Sofya Asfaw added.
Dr. Zewditu Asfaw said she felt particular pressure to live up to her father’s reputation when she was a cardiothoracic fellow at The University of Chicago, IL. “I felt like I always had to be ‘on’ because I didn’t want to disappoint him. I still feel that way—like if I don’t do things exactly the same way he does, it will disappoint him. But I’ve learned that as long as I’m happy, he’s happy,” she said.
“When your father is a surgeon and chief of staff of a hospital, it’s a lot to live up to and some big shoes to fill, so sometimes you start to feel inadequate. You’re always supposed to do better than your parents, but when your parents are the best, it’s hard to do better than that,” Dr. Sofya Asfaw added.
However, the sisters agree that the advantages of being descendants of an esteemed surgeon far outweigh the occasional disadvantages.
“When I was pregnant with my son, I couldn’t stand for long periods of time. If it wasn’t for my dad, my son probably would not be here. My dad would come into the hospital and OR before me and might open the patient. I would take a break to go sit down, and he would start the case. It was like I was the attending, and he was the fellow,” Dr. Zewditu Asfaw said.
“He’s very open to learning, which is sort of unique,” she added. “Some of the little spats we would have in the OR were about me wanting to do certain things a certain way, but he would let me take the lead and show him how I learned to do things in the fellowship. For an older surgeon, that’s amazing.”
“That’s all a dad could want—for his children to do better, to do great things, to be innovators.” Dr. Ingida Asfaw said. “I was very open to learning. I was in my early 80s and having her by my side helping to provide service to an urban and indigent population was a great joy to me.”
Drs. Sofya and Zewditu Asfaw said their father is just one role model they have had. “This article is about us and our dad, but our mom [Elizabeth Asfaw, PhD] ran her own clinical lab in a time when it was the only Black, female-run laboratory in Detroit, if not the entire state of Michigan. She was a working mother and was on boards working with domestic violence victims, and she and my dad are both very passionate about giving back to Ethiopia,” Dr. Zewditu Asfaw said.
“We have to give credit where credit is due, and that is to my mother who keeps us all together. There is absolutely no way my sister, my brother [who leads an affiliate of United Healthcare], and my dad could do what we do without her,” Dr. Sofya Asfaw said. “She runs back and forth between states to take care of our children, so we can be surgeons and be sure the children are growing and thriving. There’s no way we’d even be having this conversation if she didn’t exist.”
Like other daughters in this article, Megan Lundgren, MD, a minimally invasive and bariatric surgeon at Penn Highlands Healthcare, DuBois, PA, said she did not always plan to go into surgery. She considered a few other options in college but decided to go to medical school. “In medical school, I got to watch my dad operate while on my surgery rotation my fourth year,” Dr. Megan Lundgren said. “It was probably my favorite rotation that I did during medical school.”
Her father, Eric Lundgren, MD, FACS, a general surgeon at Penn Highlands Healthcare, also wasn’t sure he wanted to be a surgeon when he went to college, both because of and despite the fact that his father was a respected general surgeon in DuBois.
“My dad [Wilbert Lundgren, MD] was a general surgeon, and I realized what a hard life it is, but I also realized how much he enjoyed what he did. Ultimately, I was fortunate enough to get into medical school, and I’ve never looked back. I think my kids saw how much I loved what I did and still love it. That’s the influence we placed on our kids,” said Dr. Eric Lundgren, whose wife is a nurse. “We just wanted them to work hard and have a productive life no matter what they chose.”
DuBois is a small, rural town where most people know each other. “For the first 10 or 15 years of my practice, I felt compelled to fill the shoes of my dad. I can’t tell you how many times I had patients tell me, ‘I would have let your dad cut off my head and sew it back on.’ I could have only hoped to glean the respect that my dad had in this community,” he said.
“There were certainly times when I was growing up and I’d be at the baseball park or the grocery store, and someone would lift up their shirt and say, ‘Oh, your dad took my gallbladder out,’ or ‘Your grandfather operated on me. These scars are from him,’” added Dr. Megan Lundgren.
“A lot of times, I’d see that my dad was one the heroes of our town because he really was the busiest and one of the only surgeons in town. As a community-based general surgeon, he feels a very strong commitment to the community as a whole,” she added.
“I didn’t know that I would be coming back to my hometown to practice surgery, but it certainly has a different feel” from training at a large academic medical center, said Dr. Megan Lundgren, a graduate of Thomas Jefferson University Medical School, Philadelphia, PA—her father’s and grandfather’s alma mater—who did her residency at Thomas Jefferson and her fellowship at the Cleveland Clinic.
Dr. Megan Lundgren’s husband is a colon-rectal surgeon at Penn Highlands Healthcare, so family dinners, which occur almost nightly, tend to center on surgery. “It might be a little annoying for my mom and 4-year-old daughter because we do talk about surgery whenever we’re together,” she said.
Both Drs. Lundgren say they lean on each other and respect each other’s opinions. “My first big case here, I called my dad over to come help me, and we frequently will even step in to get cases done faster.”
“For us, being a family of surgeons, I think it’s a legacy, and I’m particularly proud of the legacy,” Dr. Eric Lundgren said. “It’s just a very busy life, and in order to do it right, you have to obsess over it and totally delve into it to be what the community needs.”
Dr. Megan Lundgren said keeping her family name and upholding its legacy worked to her advantage. “When I came back here, I was just starting a bariatric surgery program, and I think one reason I got so busy and got so many referrals was because of the last name Lundgren, because there are so many generations of surgeons here. I’ve actually had patients say, ‘I trust you because I trust your dad.’
“It’s sort of a relief to have my dad around. He has 31 years of experience, and it’s good to have someone you can call who you can trust,” she added.
Despite her admiration for her family’s heritage, “I still don’t want the lifestyle that my dad had. He’s still busier than I am. He has 4 days a week of two ORs a day. My block times and cases are much more limited than that just because he does so many different types of operations,” Dr. Megan Lundgren said.
For example, if her daughter’s daycare center schedules an event, she can block out time on her schedule to attend because she’s an employed surgeon. “I will never be as busy as he’s been, and that will be on purpose,” she said.
“Most people of my kids’ generation are subspecializing, so they have a limited scope. Now that doesn’t mean they won’t get horribly busy, but a lot of people look for niches now—not only to excel in that niche, but also so they can have a life outside of their practice, and that’s being smart,” Dr. Eric Lundgren added.
“I’m learning so much from Megan and my son-in-law. The camaraderie is great because I really didn’t have that once my dad retired. It’s nice to have another surgeon to talk to. I’ve been missing that for many years here. It’s really nice when I’m between cases and I look up and either Megan or my son-in-law is there. It brightens my day.”
Diane Schneidman is Editor-in-Chief, Bulletin of the American College of Surgeons, Division of Integrated Communications, Chicago, IL.