Thriving or Surviving with Dr. Elisa Greco

“You know, the old adage is, “It takes a village” - Dr. Elisa Greco

In this episode, we chat with Dr. Elisa Greco, a vascular surgeon and program director for the Vascular Surgery Program at the University of Toronto. We talk about the need for ancillary support for medical trainees looking to family build, and her own journey navigating motherhood as a staff physician.

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Contact Information

Dr. Elisa Greco, MA, M.D.

Email: Elisa.Greco@unityhealth.to

Twitter: @efgrecolekas

Dr. Greco completed her residency in General Surgery, followed by a residency and fellowship in Vascular Surgery both through the University of Toronto. During this time, she completed a research fellowship at The Wilson Centre for Research Education, while also obtaining a Master’s Degree in Education through the Ontario Institute for Studies in Education, at the University of Toronto. Dr. Greco’s clinical focus is in Renal Access, Wound care and Limb Salvage, open and endovascular intervention for peripheral arterial disease. Dr. Greco’s research interests include vascular enhanced recovery, research in education, and wound management in diabetic foot ulcers.

Transcript

Radha Sharma: Welcome to Season 1 Episode 12 of Family Planning for Docs - Thriving or Surviving. This podcast is an extension of our platform at www.familyplanningfordocs.com, a website created for Canadian medical trainees to highlight useful information about family planning and a medical career. Our group has a mission to inform medical trainees about their options regarding family planning while navigating things like training, career, and a personal life. Our research has demonstrated that personal stories are very impactful, and we hope to provide access to a diverse number of stories, to current trainees. On our podcast we hope to capture the stories of medical professionals who have navigated the process already, and a medical career while planning parenthood parenting, and the supports that they had along the way.

Radha Sharma: In this episode, we have Dr. Elisa Greco. We are thrilled to have you on our podcast today. Thank you on behalf of the entire team for coming on and sharing your story with us.

Elisa Greco: My pleasure. Thank you.

Radha Sharma: So I'm going to start with the first question. We know that you are a vascular surgeon. So what does a day in the life of Dr. Greco look like?

Elisa Greco: So that's the best thing about being a vascular surgeon, at least for me, is that every day looks different. We are able to do so much. For example, a week would look like Monday. I am reporting vascular ultrasound and doing a lot of my administrative and academic work, as I'm also the program director for the vascular surgery residency program. So I do a lot of that stuff on Monday. On Tuesday, I'm actually in the interventional radiology suite, doing my endovascular procedures with the international radiologists. On Wednesday, I'm in the operating room, mostly doing my open cases in the operating room on Wednesday. Thursday is my clinic day, and Fridays, or every other Friday, I have a wound care clinic for half a day, and then the rest of the day is to catch up on all the paperwork, I probably didn't get done during the week.

Radha Sharma: So there's still paperwork is what I'm hearing. 

Elisa Greco: There's never ending paperwork.

Radha Sharma: But it sounds like there's a lot of variety in your practice, which is very cool. 

Elisa Greco: Absolutely. It's always very good. And even with the endovascular and the open cases, there's a variety in the body from neck to toe essentially what we are able to provide treatment and care for. So it keeps things fresh, it keeps things busy and not so mundane.

Radha Sharma: For those of our listeners who may be interested in knowing how you got here - What does the training process look like from start to finish, to kind of get to where you are now? 

Elisa Greco: No, for sure. So the training process has actually changed since I did my training. So what I did actually was I did my medical school in Ottawa, I came back to Toronto for my general surgery residency. During my general surgery residency. I actually did a Master’s of education through the surgeon scientist training program. Once I finished the Master’s, I came back and finished my general surgery training, and then did a 2 year vascular surgery fellowship here in Toronto following that. Then I cam on staff here at St. Michael's Hospital. Now, while that paradigm still exists, we call it the 5 plus 2 program - that still exists. A few programs in Canada, a lot more programs in the US still do it that way. But for a while, now, there's been a direct entry or an integrated program, or a 0 plus 5 program where you can now apply straight from medical school into a 5 year vascular surgery training program. We've been running that program for quite some time now. Some people come to general surgery - sorry to vascular surgery later.
And so the nice thing about still having the fellowship option is that if you're in general surgery and you do an elective in vascular surgery, and you realize that's actually where you want to be, you don't necessarily have to switch mid-training program, you can finish and then become a general surgeon and a vascular surgeon, and some communities, especially in different places in the US as well still do require or like to have, both options in terms of specialties.

Radha Sharma: I see. So there's pros and cons of each is what I'm hearing. 

Elisa Greco: Absolutely. 

Radha Sharma: The goal of our podcast is to chat with you and others that are from a variety of specialties to talk about how they’ve fit family planning and family building while also having this incredible career. What did family planning sort of look like for you? When did you have your children?

Elisa Greco: So I had my children. I was one and a half, 2 years into being as a staff, as faculty. Part of the reason for that was because the person I was dating during my residency is not the person I ended up marrying. So I met my husband at the beginning of my fellowship and we got married at the end of my fellowship. So 2 years later. So that's kind of why we ended up having our children after that and we had started trying to have a family, maybe a year and a half after being married. I was in my early to mid thirties and we had tried naturally for a while, for maybe about 3 months or so, and subsequently referred to a fertility clinic and the rest of the year, and about a year was multiple fertility treatments and medications and injections and tests, etc., on a very regular basis that eventually led to IVF and the success of my first born. And then my subsequent 2 children actually were not. They were not fertility at all. Actually. The first one
we did not time very well, very happy to have them, because we always wanted 3. We didn't plan very well. And then our third one also came naturally

Radha Sharma: Did you always know that you wanted to be a parent? What was kind of your inspiration for having a family?

Elisa Greco: My husband and I are both from European descent. We both have 3 children in our families growing up. It was always something that we both kind of wanted and was a natural move. I have 2 nieces, they're older than my kids, so I helped, you know, sort of raise them, too, which was nice. That was one of the impetuses for me to come back to Toronto, for my residency, was actually the birth of my first niece. So that's always having the how I know how long I've been out of medical school because it's how old she is. 

Radha Sharma: It’s a good reminder. 

Elisa Greco: It's a stark reminder of how long ago it was. So you know, it always just came naturally. You know, it was something you know, that I wanted. If it worked out, if it was meant to be with the right person type of thing, and it did in the end turn out that way. So all things worked out in the end is what I'm hearing

Radha Sharma: And as a staff physician having young children at that time. What were some of the challenges that you had to navigate through? I know some people have spoken about things like breastfeeding during or pumping during shifts. And you know, having those conversations with co-workers. So what was your experience like?

Elisa Greco: It was a tough go in the sense that - for the fertility treatments. It was most mornings almost every morning with blood work and invasive ultrasounds, and having to get to there first to be able to get to work on time which was quite difficult especially if I was on call, and operating the night before and I was still operating into the next morning, and looking at the time, and having to rush out to go to the clinic, or making sure that I had to - you know there was one time I was operating in the evening on call, and after the time out, and the anesthesiologist was putting the patient to sleep I had to run up to my office, give myself an injection, and then run back downstairs because it's very timed. You know the planning and the timing is a bit crucial, and having to remember to bring the medications with me on call. If I had to be called in, for example, because it's home call, otherwise.

Elisa Greco: So that was tough. In terms of, you know, discussing with my colleagues. I actually had really, really great colleagues. We were a group of 5. So there's 4 other colleagues. They're all men. They all have their own families. But they were all extremely supportive. Never a question about anything. Happy to change cover, call, etc. So that was, it was very easy, for from that perspective. I'm very lucky that way. I have you know my family at home. I have my family here at work, and we very much are like that. So that was a blessing, for sure. In terms of struggling. You know you're a female surgeon, so your practice is always going to be harder to start up and keep up. And then, you know, like I said, I was about 2 years into practice when I had my first. So there's always the concern that you're going to lose whatever momentum you had to build up your practice. You're now going to lose it because you're gone for however long you decide to take a leave. Or that your colleagues are gonna sort of steal any cases, or your practice, for example, and finding coverage, and like I said, my colleagues are not like that. So that did not happen. But even finding coverage for your leave is difficult. Again, my colleagues were amazing. I had one colleague who was just starting a couple of months before I was gonna take my first maternity leave. So it worked out really, really well that he was able to just kinda fit right in into my practice and build his practice while maintaining my practice. So it gave him patient load and confidence and experience. So it actually helped him a lot. And then, when I had my other 2 children, he, without a question, just took over my practice seamlessly, and handed it back to me. You know, for the better when I came back. So it was actually very, very nice, and, as I said, without the support of my colleagues, that definitely would have made things a lot more difficult. There was just one less stress that I needed to worry and care about
which was, which was really really nice.

Radha Sharma: That's so nice to hear that you had such a supportive environment, and your coworkers were kind of you know there for you, in a sense, especially the person that was covering for you and took on that load. I can imagine that probably lessened than the burden because you're already balancing so many things at once. So that definitely helps.

Radha Sharma: And you mentioned you took maternity leave. How long did you take that leave for each of your children? How did that work?

Elisa Greco: So I’ll preface it - it wasn’t really a full maternity leave, I only took clinical leave for any of them. I was still reporting vascular ultrasound from home, I was still attending all my academic and administrative meetings. We don't have zoom yet. We didn’t have zoom yet, but we were able to call into meetings, so I called into the meetings. So I was still doing a lot of the non-clinical stuff or not - I shouldn't even say that because I was doing vascular ultrasound as well. So the non-patient facing stuff. But I was still doing a significant amount of work anyways.

Elisa Greco: For my first one, I actually only talk about 6 weeks. And then for the following 6 weeks I came back more part time. So I was here once or twice a week and still doing the rest of the stuff from home and then back full by 3 months.

Elisa Greco: For my second and my third one I took about 4 months and then came back. Yeah, about 3 to 4 months off of the clinical duties, still maintaining all the rest of it. And then came back part time for face to face things at around the 4-5 month mark and was back into things by 5 or 6 months. A little bit different for my third, because she was born during COVID. So it was easier to take time off but still, you know I didn't want to  have too much of the burden. I appreciated my colleagues who were taking my clinical load, and I didn't want to take advantage or take that for granted. So I did want to try to come back as soon as I could, and felt that I was ready to, as well because they were doing call, more call than they would have if I was here.

Radha Sharma: You had a great group of people that were kind of in your corner and allowed you to thrive as a new mom and you know, a new surgeon. What other support systems kind of helped you as you look back to those earlier phases, having your first kid and then now you know, still, being a mom and balancing it all?

Elisa Greco: You know the old adage is “It takes a village”, that is very, very much true. So part of that village is like you, said my colleagues here at work - were a huge help. Obviously my husband, my partner. He's also a physician. So he was also a huge help in all of this. My parents luckily for us, live very close by, and our family. We definitely have a nanny, and we have babysitters also. Because, you know, physicians and surgeons, we all run late and meetings don't usually happen between 9 and 5. They usually happen at 7 am or 7 pm, so it does take a village, and it definitely does and and has for us. So whether it was, you know, family, work colleagues, nannies, babysitters, etc. I was also, you know, I'm of the mind that I'm not gonna shy away of the fact that I have kids and I'm a mom, and I'm a working mom. So I would often bring my kids to work or to meetings if I had to. They come on every single Zoom Meeting if I'm at home, because I can't keep them out of my room anyways, so all my colleagues would know my kids at sort of through the ages. So it's nice because they've also seen them kinda grow up through the years. But I wasn't going to shy away from hey? If I didn't have childcare. Guess what, I'm bringing my child with me. So that was kind of the stand I took. Not that anyone ever questioned it, or anyone ever said anything. It was never an issue. We tried our best to again accommodate child care of some sort. But there were times - the kids actually like it. They like coming to work and seeing where mommy works and meeting all the people and everything like that. So it's kind of nice for them too.

Radha Sharma: It's cool now with Zoom, because I feel like I'm so used to seeing supervisors or people that I work with, and then they'll have their kid in the Zoom call, and it's so normal to me, but I can imagine that maybe that wasn't always normal. Take it to work. But I feel like it's becoming so normalized, which I kind of love, because if you're gonna be on Zoom and they're gonna be knocking at your door, you might as well show them what mom's doing at work.

Elisa Greco: Well, but you know what I think it also normalizes the newer generation like your class, your generation of physicians that it normalizes that you can be a mom and or parent, you know, if that is the dad that had the kids on, you know, a parent and a working parents. My first son - like I said I was still doing all the academic commitments, so I had a teaching commitment. I don't know. He must have been maybe 6 or 7 weeks old. And I had a teaching commitment. It was in person at the time and I brought him, so I brought the nanny along, so she would stroll him in the stroller out in the hallway, and when it was time for him to feed because he was, we were still breastfeeding. She just brought him into the room, and it was, I think, like a CBL type of case. So I wasn't really doing any didactic class, it was sort of a smaller group. But I was able to you know: cover up and feed him while someone else was giving the presentation. I actually had that role modeling for me at one point and it was nice to see. And I think it was important to see again, normalize being a working parent
 
Radha Sharma: As a program director, have you seen sort of changes in the culture of surgery in terms of having a family, but also having a career not just for women but I guess men as well? 

Elisa Greco: I think more and more residents are maybe starting a family in residency, if it's the right time for them. And I think they're not not going to shy away from that which I think is a good thing. And I think the accommodations that are necessary for our, not just the trainees, but even the faculty, like right now at the PGME tables, at least at the Department of Surgery level, is things like, is there a lactation room at all the centers or at all the sites? And it's not just the room. But is there a fridge that we can, that the mum can keep their milk in? And is there a sink that you can wash your pump stuff? So it's not just to have a room with a couch. But it's all the ancillary stuff, too. And now what about childcare and extended childcare, as we know, you know as a faculty, I can kind of control my hours a little bit more, but definitely, as a trainee you can't, and as a surgical trainee, the hours are, you know, extreme sometimes, especially on call days. So the idea is like, is it affordable child care? Is there even childcare? And is it extended hours, childcare? And why don't we have one for our trainees yet? Like, why is there no UofT or hospital specific etc. And so these are the sort of conversations now that are being had at the leadership tables. And definitely things that are concerns that some of my residents have brought forward to me as well, and I fully support and agree with them, and I've already told them that I actually have already started to bring this stuff up, so I'm glad I have your support behind me.

Radha Sharma: So awesome to hear that those discussions are being held at the faculty and department level, because so much of this work is awareness and talking about things and normalizing, you know how do you figure out the things that you need to have a family while also being a medical trainee, at whatever level like, whether that's at staff level or as a resident. So it's very, very cool to hear that those conversations are being made, and hopefully it'll be reflected with systems level change. Because ultimately, like you said, it's not just having a room. It's having those ancillary supports to make sure people have the stuff they need to succeed. 

Elisa Greco: Well, it's important, right? Again. We have to normalize. At least in my field, you want to encourage women to come into surgery. Well, we have to make it   available and approachable and inclusive enough for women to feel like they are welcomed and wanted in the specialty. So I think it's important.

Radha Sharma: Definitely. I'm going to shift gears a little bit and talk about your kids and you being a parent. So you said you have 3 children. I know you said one was born during covid times. How old are the rest of them?

Elisa Greco: So, my oldest is 6 and a half. He'll be 7 at the end of the year. My middle child turned 5 in the spring. So if you do the math, they are only 15 months apart. And my youngest is a girl. She'll be 3 actually in September. So

Radha Sharma: And how has it been parenting? 3 children? And how are you dealing with that right now? 

Elisa Greco: It's it's busy. It's busy for sure. it's a lot like, I said, it takes a village and then some. But it's rewarding just as much as it is challenging. So you kind of take your wins, and I think it kind of humbles you a little bit, and it kind of puts things in perspective a little bit as well. Maybe softens some people to let go of some control especially as type A, you know, physicians or surgeons you're always wanting to be in control, and you always want things a certain way in your way, and you kind of realize, like kids don't care. So it you know they change you as much as you're trying to sort of change and mold them.

Radha Sharma: What were some of the, I guess, unexpected challenges of being a parent that maybe you didn't think of before having kids and then you realized after?

Elisa Greco: Well, so I'll tell you this. Being up on call all night does not prepare you for the months of sleeplessness which I thought might actually prepare me for. But yeah, no, they do not. What I didn't realize is that when you were post-call there was no one bothering you, and you could actually sleep, you know, 10 or 12 hours with rare interruptions until the next time, whereas this was a continuous day in and day out - on call every day kind of one in one 

Radha Sharma: On call one in one!

Elisa Greco: With no, with no break. My first kid, I must say, was a terrible terrible sleeper. Made sure that the second and third one were much better and sleep trained earlier for sure. So that was challenging. Another thing actually, I didn't think I actually ever wanted to breastfeed. To be honest with you, I'd seen my sister breastfeed and as a general surgery resident you see - I had seen a lot of breast abscesses come in, and women who are breastfeeding. I was like, not for me not going to happen. But I must say for the betterment of my kids, if I you know, if I could, I said I would at least try and it did work out and I actually enjoyed it a lot more than I thought I would to be honest. I still stopped at 6 months for all of them, but that was my goal but I was able to achieve that all 3 times. So I was very proud of that, So you know, there's a lot of different challenges. And it's interesting because each one of my kids were very, very different from each other from the start. How they slept or what soothed one didn't work for the other, and it's all sort of a bit of a guessing game for a while until you figure out that child. So they're all very different. And you have to be a little bit creative, and you have to be a little bit more flexible, than maybe I like to be in general. So you know, there again, it's huge learning curve, and even though you've done it once before, let's say for the first child, it's almost like you're starting from scratch again. You might have a little bit more knowledge for the second and the third one. But you know they're so different from each other that what, again, what works for one may not work for the other. 
Elisa Greco: So I was recommended a book. I don't even, thankfully I don't actually remember the name of the book but it was written by a nanny from the UK and it was a very, very structured - this is what you should do, and it was very prescriptive, and this is how much they should sleep, and this is how much they should need, and this is how much this is. And it went through like, I don't know a year of their life in this book, and I stupidly read it before my first child. And then I was basically a failure before I even started. And I kept saying but no, but that's not what the book says. At one point my mom was like I'm gonna throw that book in the garbage. And so, point taken. I don't even know where it is anymore. It was not the right book for me. It was not the right book for my kids and obviously worked for the person who recommended it to me. But it definitely was not for me or my kids, because again it made you feel like a failure if your kids were not on the schedule you know by day. 3 according to this book. Along with all the other emotionally roller, coastery things you were going through this just kind of added to that stress that you really didn't need so definitely. Everyone has their own parenting style. Every kid has their own parenting style, and it's for you to figure that out.

Radha Sharma: What's been the best part of being a mom to your kids? 

 Elisa Greco: You know what, their hugs are the best. Being able to just get all the cuddles in at any time of day or night. And no matter how I feel, it just makes you feel that much better. So that would be the number one, and then, of course, seeing them succeed right. Seeing their wheels turning when they figure things out, and they can start doing things independently and on their own. And when they kind of have these Eureka moments, and it just makes it feel kind of like, oh, good look! I did something. I did something good for them. So, it's nice to see them you know, having acts of kindness towards other kids, for example, or like I said, being proud when they do well on a test. But really, really the best thing for as a to be a mom for me is is the are the those hugs

Radha Sharma: Elisa, if you had a magic wand and could go back and change anything about your life. anything about training, about family planning, really anything? Would you and why?

Elisa Greco: Very good question. I wouldn't actually. I wouldn't, because I wouldn't be here today in the sort of life that and what my husband and I have created for ourselves. And I feel like if I changed one thing that would change multiple things. And I don't know that I would want to do that.

Radha Sharma: It's like the domino effect, or the butterfly effect.

Elisa Greco: I think we created a really great life for ourselves and for the kids that we have. And so I don't think I would want to change any of that. I mean, you can always say, I wish I had my kids in training or during training, but I don't know how that would have been, or if I would have been on the same trajectory that I am now, I don't know. So you know I think I'm pretty happy with how all of that ended up turning out

Radha Sharma: Do you have any advice for medical trainees that might be listening to this podcast?

Elisa Greco: Pieces of advice. No time is a good time. So do it whenever it moves you right. Everyone's trying to look for the best time to have their children again there will always be pros and cons to having it at any time of your training, career, or life. So I'd say, throw timing out the window and just have them when you're able and ready when it's you know the time in terms of the ability, because not everybody has the ability to have children, and some of us had to go through fertility treatments to kick start their body to do that. So I would say, no time is a good time, so just do it would be, would be my first advice and my second words of wisdom, I guess, or what I wish I had done a little bit differently, that after I learned with my first one we just to again be that little bit more flexible. Try to let go of that control when you're trying to raise them when they're newborns and things like that, and really try to. And it’s hard to you know, enjoy the moment, but really try to enjoy maybe not the moment, but the process and the journey that goes along with the parenting because it is really tough, and it's really hard, and there's going to be good times and bad times. But I feel like, you know, if you pick your battles, and you kind of be a little bit more flexible, then maybe there might be a few more good times that you can have.

Radha Sharma: I hope our listeners are paying close attention to some of those things that you mentioned today. and our last question for you in the name of the podcast, Dr. Greco, Elisa, are you currently thriving or surviving?

Elisa Greco: Both? Well, thriving more so than surviving. But definitely there are days when we're just surviving to get by but I think that's the whole concept of this work life balance or work life integration is that it's not going to be a everyday thing, or it's sort of a global gestalt - as long as there's more days of thriving than there are surviving I feel like, you know, that's success and a win.  

Radha Sharma: Thank you so much. This actually concludes our episode, an absolute pleasure chatting with you and learning a little bit about your journey, and you know your perspectives as a program director and a staff physician. You can find our guest’s contact information in the notes from today's show. This is Radha and Elisa signing off.
Elisa Greco: Thank you.