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Editor鈥檚 note:听This is one of several feature stories in the听Bulletin听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听dschneidman@facs.org.

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Drs. Herand Abcarian and Ariane Abcarian

Somewhere in the back of her mind, Ariane Abcarian, MD, FACS, always knew she would probably become a surgeon like her father鈥擧erand 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.

鈥淚 would accompany my dad on rounds and sometimes hang out at the nurses鈥� station or the lounge, but every now and then, I would get to go into a patient鈥檚 room, and I just thought that was the coolest thing,鈥� she said. She particularly valued how appreciative her father鈥檚 patients were of his work.

Nonetheless, 鈥淚 really didn鈥檛 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鈥檛 have much choice,鈥� Dr. Ariane Abcarian said.

鈥淚 told her, 鈥業f you pick L.D. Britt as your advisor, you have one path only, and that鈥檚 surgery,鈥欌�� added Dr. Herand Abcarian. 鈥淗e and I go back a long way. He was my resident at Cook County Hospital.鈥�

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. 鈥淚 told her, 鈥業t is a calling. You have to love medicine with your heart and soul,鈥欌�� he said.

鈥淥nce she got to medical school, she would call me during her rotations, and say, 鈥業 can鈥檛 stand medicine,鈥欌�� Dr. Herand Abcarian said. 鈥淚 would tell her, 鈥業 do a lot of things during the day, but the one place I truly enjoy myself is in the operating room (OR). If you鈥檙e not going to enjoy being in the OR, then you are going into the wrong business.鈥� You have to love surgery, and that鈥檚 what she agreed to commit to.鈥�

Dr. Ariane Abcarian said she and her father operated together several times when she was in training at UIC and Stroger Hospital.

鈥淚t鈥檚 been lucky that he maintained his privileges and volunteered his time. I got to learn a lot,鈥� Dr. Ariane Abcarian said.

鈥淚n reality, I鈥檝e 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,鈥� Dr. Herand Abcarian said.

Both Drs. Abcarian share an affinity for certain cases. 鈥淚 love anal fistulas. I don鈥檛 know if that鈥檚 because of nature or nurture,鈥� 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.

鈥淧eople started to refer their most difficult anal fistula cases to me鈥攐nes where the patient had undergone five or six operations without success,鈥� he said. 鈥淚 still did colon cases, but I enjoyed complex fistulas the most, and I think Ariane has somewhat inherited that.鈥�

Dr. Ariane Abcarian still sees her parents often and continues to seek their advice. 鈥淢y husband is not in medicine, so just having my dad available to be a sounding board and understand what it鈥檚 like to be a surgeon and what I鈥檓 going through is really great,鈥� she said.

One generational shift that both Drs. Abcarian have observed is the emphasis on work-life equilibrium. 鈥淚 don鈥檛 think my parents had the benefits of work-life balance at all. He had so many accomplishments that came at a tremendous personal cost,鈥� Dr. Ariane Abcarian said. Her father and mother (a nurse at Stroger) 鈥渟acrificed a lot for their training and their patients. I think that now, surgeons have a little more ability to create that balance.鈥�

鈥淭hings 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,鈥� added Dr. Herand Abcarian.

Dr. Richards and Dr. Worrest

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.

鈥淔irst, you have to know my daughter. She was going to make her decision no matter what I said,鈥� Dr. Richards explained.

鈥淭here 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,鈥� said Tarin Worrest, MD, a minimally invasive and robotic surgeon at Community Medical Center.

Her father鈥檚 advice was based on experience. 鈥淚鈥檝e had a good run for the past 37 years, but it鈥檚 not always been easy. There are certain sacrifices that you have to make when you decide to become a surgeon,鈥� Dr. Richards said.

鈥淲hen you go into general surgery residency, you know it鈥檚 probably one of the more unpleasant residencies that people go through鈥攁t least it was for me. One of the things we tried to instill in all our kids is that the job doesn鈥檛 define me,鈥� 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. 鈥淚 liked knowing where the different structures are, and I really liked fixing things,鈥� Dr. Worrest said. 鈥淚 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鈥攑utting my hands on them and working with them directly.鈥�

Her father offered a similar explanation for choosing surgery, adding that like his daughter, he continues to appreciate the changes in technology.

鈥淚 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,鈥� 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. 鈥淲hen I was in medical school, he had this bad habit of drilling me over the phone,鈥� Dr. Worrest said. 鈥淢y mom had to tell him to stop.鈥�

Even so, she said, 鈥淚 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.鈥�

鈥淣ow we talk a lot about the business side of medicine, which is something they don鈥檛 really teach you in medical school or in residency,鈥� Dr. Worrest said. 鈥淣obody teaches you how to build a referral base, for example. So, that鈥檚 something he鈥檚 helped me with.鈥�

鈥淚t鈥檚 nice to have someone you can talk to who understands what you鈥檙e going through. Even if you have a really understanding spouse, they are never going to fully understand what you do, especially if they aren鈥檛 in medicine,鈥� Dr. Worrest said. 鈥淢y husband, who is in sales, isn鈥檛 really going to understand what I鈥檓 going through if I had a really difficult case or a patient had a poor outcome. It鈥檚 nice to have someone who knows what that鈥檚 like.鈥�

In addition, Drs. Worrest and Richards believe in, and are committed to, helping patients far from Missoula. 鈥淲e鈥檝e 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鈥檛 have healthcare,鈥� Dr. Richards said.

鈥淚 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,鈥� Dr. Worrest said.

Drs. Ingida Asfaw, Sofya Asfaw, and Zewditu Asfaw

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鈥擲ofya 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鈥攁 commitment to serving others, regardless of the profession they chose.

鈥淔irst and foremost, I鈥檓 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,鈥� Dr. Ingida Asfaw said. 鈥淚n my effort to help them grow and choose the profession they liked I would tell them, 鈥楳edicine is a noble profession. If that is what you want to do, I鈥檒l help you in any way possible to achieve your wishes and your goals and purpose in life.鈥欌��

Dr. Sofya Asfaw can鈥檛 recall a time when she wanted to be in any other profession. 鈥淔or as long as I can remember, I always wanted to be a surgeon鈥攁ctually a cardiothoracic surgeon like my father. That ended up being my sister, and I ended up being a trauma surgeon,鈥� she said. 鈥淚 can say without a shadow of a doubt it was because of the big role model I had in front of me.鈥�

In contrast, Dr. Zewditu Asfaw said she originally wanted to be a lawyer, but 鈥淚 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鈥檛 home as much as he or we would have wanted him to be.鈥�

鈥淚t wasn鈥檛 just about him not being home as much as we would have liked, but also seeing what surgery entails鈥攌nowing what the lifestyle is like,鈥� added Dr. Sofya Asfaw. 鈥淚 had questions about whether I could be present as a surgeon, as a mother, and do it all. That鈥檚 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鈥檛 make it to ballet recitals and other events. Balancing that with being a woman in surgery was definitely a consideration.鈥�

鈥淗e was very realistic with us,鈥� Dr. Zewditu Asfaw noted. 鈥淗e would say, 鈥榊ou know, as a female, going into surgery, it鈥檚 going to be harder. You鈥檙e going to be away from your family. If you鈥檙e going to have children, you鈥檙e going to have to juggle motherhood and surgery. So, make sure that is absolutely what you want to do.鈥欌��

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.

鈥淲hen I moved back home to Detroit, I started residency at the hospital where my dad was a very beloved attending,鈥� Dr. Zewditu Asfaw said. 鈥淚 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, 鈥業 am Dr. Asfaw. Are you asking about my dad?鈥欌��

鈥淧eople at the Cleveland Clinic will stop me and ask, 鈥楧o you know Dr. Asfaw? He trained me,鈥� or 鈥業 worked with him.鈥� I can鈥檛 escape it, and I鈥檓 in another state,鈥� Dr. Sofya Asfaw added.

Dr. Zewditu Asfaw said she felt particular pressure to live up to her father鈥檚 reputation when she was a cardiothoracic fellow at The University of Chicago, IL. 鈥淚 felt like I always had to be 鈥榦n鈥� because I didn鈥檛 want to disappoint him. I still feel that way鈥攍ike if I don鈥檛 do things exactly the same way he does, it will disappoint him. But I鈥檝e learned that as long as I鈥檓 happy, he鈥檚 happy,鈥� she said.

鈥淲hen your father is a surgeon and chief of staff of a hospital, it鈥檚 a lot to live up to and some big shoes to fill, so sometimes you start to feel inadequate. You鈥檙e always supposed to do better than your parents, but when your parents are the best, it鈥檚 hard to do better than that,鈥� Dr. Sofya Asfaw added.

However, the sisters agree that the advantages of being descendants of an esteemed surgeon far outweigh the occasional disadvantages.

鈥淲hen I was pregnant with my son, I couldn鈥檛 stand for long periods of time. If it wasn鈥檛 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,鈥� Dr. Zewditu Asfaw said.

鈥淗e鈥檚 very open to learning, which is sort of unique,鈥� she added. 鈥淪ome 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鈥檚 amazing.鈥�

鈥淭hat鈥檚 all a dad could want鈥攆or his children to do better, to do great things, to be innovators.鈥� Dr. Ingida Asfaw said. 鈥淚 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.鈥�

Drs. Sofya and Zewditu Asfaw said their father is just one role model they have had. 鈥淭his 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,鈥� Dr. Zewditu Asfaw said.

鈥淲e 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,鈥� Dr. Sofya Asfaw said. 鈥淪he 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鈥檚 no way we鈥檇 even be having this conversation if she didn鈥檛 exist.鈥�

Drs. Eric Lundgren and Megan Lundgren

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. 鈥淚n medical school, I got to watch my dad operate while on my surgery rotation my fourth year,鈥� Dr. Megan Lundgren said. 鈥淚t was probably my favorite rotation that I did during medical school.鈥�

Her father, Eric Lundgren, MD, FACS, a general surgeon at Penn Highlands Healthcare, also wasn鈥檛 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.

鈥淢y 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鈥檝e never looked back. I think my kids saw how much I loved what I did and still love it. That鈥檚 the influence we placed on our kids,鈥� said Dr. Eric Lundgren, whose wife is a nurse. 鈥淲e just wanted them to work hard and have a productive life no matter what they chose.鈥�

DuBois is a small, rural town where most people know each other. 鈥淔or the first 10 or 15 years of my practice, I felt compelled to fill the shoes of my dad. I can鈥檛 tell you how many times I had patients tell me, 鈥業 would have let your dad cut off my head and sew it back on.鈥� I could have only hoped to glean the respect that my dad had in this community,鈥� he said.

鈥淭here were certainly times when I was growing up and I鈥檇 be at the baseball park or the grocery store, and someone would lift up their shirt and say, 鈥極h, your dad took my gallbladder out,鈥� or 鈥榊our grandfather operated on me. These scars are from him,鈥欌�� added Dr. Megan Lundgren.

鈥淎 lot of times, I鈥檇 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,鈥� she added.

鈥淚 didn鈥檛 know that I would be coming back to my hometown to practice surgery, but it certainly has a different feel鈥� from training at a large academic medical center, said Dr. Megan Lundgren, a graduate of Thomas Jefferson University Medical School, Philadelphia, PA鈥攈er father鈥檚 and grandfather鈥檚 alma mater鈥攚ho did her residency at Thomas Jefferson and her fellowship at the Cleveland Clinic.

Dr. Megan Lundgren鈥檚 husband is a colon-rectal surgeon at Penn Highlands Healthcare, so family dinners, which occur almost nightly, tend to center on surgery. 鈥淚t might be a little annoying for my mom and 4-year-old daughter because we do talk about surgery whenever we鈥檙e together,鈥� she said.

Both Drs. Lundgren say they lean on each other and respect each other鈥檚 opinions. 鈥淢y 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.鈥�

鈥淔or us, being a family of surgeons, I think it鈥檚 a legacy, and I鈥檓 particularly proud of the legacy,鈥� Dr. Eric Lundgren said. 鈥淚t鈥檚 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.鈥�

Dr. Megan Lundgren said keeping her family name and upholding its legacy worked to her advantage. 鈥淲hen 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鈥檝e actually had patients say, 鈥業 trust you because I trust your dad.鈥�

鈥淚t鈥檚 sort of a relief to have my dad around. He has 31 years of experience, and it鈥檚 good to have someone you can call who you can trust,鈥� she added.

Despite her admiration for her family鈥檚 heritage, 鈥淚 still don鈥檛 want the lifestyle that my dad had. He鈥檚 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,鈥� Dr. Megan Lundgren said.

For example, if her daughter鈥檚 daycare center schedules an event, she can block out time on her schedule to attend because she鈥檚 an employed surgeon. 鈥淚 will never be as busy as he鈥檚 been, and that will be on purpose,鈥� she said.

鈥淢ost people of my kids鈥� generation are subspecializing, so they have a limited scope. Now that doesn鈥檛 mean they won鈥檛 get horribly busy, but a lot of people look for niches now鈥攏ot only to excel in that niche, but also so they can have a life outside of their practice, and that鈥檚 being smart,鈥� Dr. Eric Lundgren added.

鈥淚鈥檓 learning so much from Megan and my son-in-law. The camaraderie is great because I really didn鈥檛 have that once my dad retired. It鈥檚 nice to have another surgeon to talk to. I鈥檝e been missing that for many years here. It鈥檚 really nice when I鈥檓 between cases and I look up and either Megan or my son-in-law is there. It brightens my day.鈥�

Diane Schneidman is Editor-in-Chief, Bulletin of the American College of Surgeons, Division of Integrated Communications, Chicago, IL.