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At the Cutting edge


GROWING UP in Illinois, Julie Freischlag figured she'd teach, like her mother. But when she was shut out of education classes in college, she switched to pre-med. She went on to medical school, hoping to be a pediatrician. Then she discovered she had good hands.

Now Freischlag, the accidental surgeon, is the new director of the surgery department at the Johns Hopkins School of Medicine and surgeon in chief of Hopkins Hospital. "It is totally happenstance that I am where I am," she says.

Chance might have shaped Freischlag's career choice, but it was her surgical and leadership skills - and abundant energy - that impressed Hopkins officials. The school wasn't necessarily looking for an outsider when Freischlag, 48, the former chief of vascular surgery at the University of California, Los Angeles, became a candidate. "We just wanted the best," said Dr. George Dover, director of the Hopkins Children's Center and head of the search committee that chose Freischlag. "She had all the tickets."

At an institution where the top jobs have typically gone to men who have attended elite East Coast schools and worked for years at those citadels, Freischlag stands out. She talks with the flattened vowels of a Midwesterner, attended a state university, never worked east of Milwaukee and is a woman in perhaps the most macho specialty in medicine. She is only the second female department head at Hopkins.

Officials there saw her as someone who could not only lead a department but also help transform what some describe as the overly conservative culture of surgery. "Surgery has a great tradition. But some of these ideas are keeping it from moving forward," says Dover. "Her vision of surgery is that it is constantly changing."

Unbound by the insider's web of obligations and allegiances, Freischlag could find it easier to push through the changes she envisions. Her chief aim: to make surgery more appealing to medical students. The number of medical school grads going into surgery is dropping, a worrisome trend to some observers.

"Over the past few years, a lot of people haven't wanted to become surgeons," she says. "A lot of it is lifestyle issues. It's known as the toughest type of training to go through."

Starting July 1, she says, surgical residents at Hopkins will work an average of no more than 80 hours per week, bringing the school into line with a new national standard. Freischlag also wants to allow surgical residents to specialize earlier, trimming a year off the long apprenticeship.

"We've been training the same way for 100 years," says Freischlag, one of only four female surgery chiefs in the nation. "Can we change training and still get a good product? I think we can."

She also hopes to change the culture so surgeons are less hidebound. They have a reputation as cocky, sure of their skills and not shy about sharing this certainty with nurses, patients and anyone else. The relatively low number of female surgeons - they are outnumbered 5 to 1 by men - has encouraged these attitudes, Freischlag says: "Things sort of worked like a football team."

"You want someone who makes fast decisions, who is aggressive," she points out. "That behavior works very well during the operation. It just doesn't work very well when you're working with others."

Those who have worked with Freischlag praise her ability to listen and engage. "She makes people happy to work for her," says UCLA surgeon Dr. Wesley Moore. Over two decades, he has hired her three times, first as a surgeon, then as head of vascular surgery at Los Angeles' Veterans Affairs hospital, and finally as his boss, chief of vascular surgery at UCLA.

During a recent "Professor's Hour," Freischlag - and 20 third-year Hopkins medical students - listened as an eager young woman began outlining a case, loading her sentences with phrases such as "femoral popliteal dorsal pedis."

After a couple of minutes, Freischlag interrupted. "Does everybody know what that means?" she asked. Darting up to the chalkboard, she drew a goofy diagram that cut through the jargon and had the students giggling. She continued the explanation, keeping the medicalese to a minimum: "It's a composite graft, which is a fancy way to say it's made of lots of stuff."

Since coming to Baltimore two months ago, Freischlag has had ample opportunity to display her energy. Small and trim - she jogs several times a week - she talks quickly and has made a point of introducing herself to everyone from janitors to other department heads. She spends 12 hours a day trying to understand the enormous operation she controls: 80 faculty, 70 residents, 550 nurses, 100 administrators and a $150 million budget. She sleeps five or six hours a night, "a little more on weekends." The only hints of her pace are circles under her eyes.

As the weeks pass, Freischlag is finding her way around Hopkins' sprawling East Baltimore campus and around her new city. "Now, I can't remember not working here," she says. "All of a sudden I'm not getting lost in the hallways. And when someone says, 'Meet me at this restaurant,' you have a clue about where to find it."

She has not decorated her office yet. It is almost bare except for three construction-paper cutouts made by her 7-year-old son, Taylor - a fish, a bear and a heart, all covered with sparkles - taped to the wall behind her desk. To make more time for Taylor and her husband, businessman Philip Roethle, she is trying to shift to weekdays those meetings now scheduled for Saturdays. The family recently moved into a house in Reisterstown.

Besides running the department, Freischlag will continue teaching and doing research; she is running a large nationwide trial for a new way to fix aneurysms, the ballooning arteries that can burst and kill.

Within a few weeks, she will begin seeing patients and performing surgeries, a task she compares to sculpture: "A lot of it is three-dimensional reconstruction. It can be artistic, especially vascular surgery. You have to make the artery lie right; you have to sew it so it doesn't kink or turn."

For this skill, she credits genetic benevolence. Her family has always been good at making things. One of her grandfathers built boilers for a railroad. Her father, a retired newspaper circulation manager, makes furniture as a hobby. "My mother did incredible cross-stitch. My grandmothers made crochets and afghans," says Freischlag, a skilled seamstress. In high school and college, she made her own clothes.

Her parents live in Decatur, Ill. While proud of her, they don't quite comprehend their daughter's success; her mother still thinks she should have become a pediatrician.

But they are coming around. "I think they finally sort of figured out that this job is a little bit bigger deal," she says with a smile, "because of the woman thing."

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