Working Abroad Q&A: Each week, Irish Times Abroad meets an Irish person working in an interesting job overseas. This week, Dr Sidhbh Gallagher from Co Louth on working as a plastic surgeon specialising in gender confirmation surgery in Indianapolis, Indiana.
Tell us about your job.
My career here has been incredibly rewarding. I started the Gender Affirmation Surgery Programme at Indiana University School of Medicine in 2015 and three years later, it’s thriving.
The programme is one of few in the Midwest serving the transgender community. Gender affirmation or gender confirmation surgery is the preferred term for what was previously known as “sex change surgery”. I established the programme in 2015 and since then, I have performed more than 200 surgeries .
We provide a range of different procedures for a patient’s surgical transition, the most common being chest masculinisation (masculoplasty) for female to male patients, and vaginoplasty for transgender women. We have seen a massive growth in requests for surgery with about 90 referrals a month, and many of our patients coming from out of state.
The work itself is gratifying beyond belief; it is really my dream practice. I get to use the artistic part of my brain to help people physically transition into their authentic selves. Patients will have been through so much in order to get to my office. Firstly they will have to come out to themselves, their family and their community. This is not easy, especially in rural parts of the Midwest, and despite all the progress, we regularly hear horror stories of discrimination and violence.
In order to meet the requirements for surgery, the patient will have to undergo rigorous screening, take hormones and, for the genital surgeries, live in their gender continuously for a year.
Access to care is a major problem, with many of the procedures we know to be medically necessary not covered through a patient’s insurance. Living with gender dysphoria, the profound distress a person suffers when their identity and their assigned gender do not align, is associated with a high risk of suicide. Surgery can help a patient to finally live as their authentic self and help relive that pain.
I get to see my work relieve incredible psychological pain for a population that has traditionally been marginalised and underserved in the conservative midwest.
As an academic surgeon working in a university, I get to innovate and come up with new techniques such as “Masculoplasty”. This is a procedure that masculinises the chest for female to male patients, with less morbidity than a traditional mastectomy. The idea that I could positively influence the lives of many more patients than just my own is obviously wonderful. In addition, I get to teach medical students and plastic surgery trainees, and provide education in taking care of the transgender community.
What does you average day look like?
I get up at 4am so I can work on research projects, publications and social media. At 7am I head into the hospital, meet my first patient and start operating at about 7.30am. I usually do about four surgeries a day. Most of the gender surgeries take between two hours and six hours. Gender confirmation surgery is about 70 per cent of my practice, but plastics is so diverse. One day last week I operated on a hand, an eye socket, genitalia and a foot.
In surgery I often get into a “flow state” so don’t notice the time passing - we surgeons love operating. We always listen to music (hip-hop or EDM if I have my way). In plastics, everyone in the room can tell if I’m doing a good job depending on how things are looking - I always welcome feedback from anaesthesia or other non-invested parties.
I usually have a couple of residents or medical students, their enthusiasm (especially for this work) is energising. Usually I’m done on surgery days around 4pm. Clinic days are Fridays, when I trade my scrubs for a suit. We see about 25 patients, a mix of pre and post-ops.
Most nights I run about six miles to clear my head. Indianapolis has gorgeous, warm evenings about six months of the year. I take a call about once every seven weeks where I deal with facial trauma or hand trauma. The most demanding thing I might have to do is replanting fingers in the middle of the night. That’s thankfully rare though.
Where did you train?
I studied medicine at UCD followed by a year in the Mater in Dublin as an intern. I left Ireland in 2006 to pursue a career in surgery. I was worried that back then it was somewhat an "old boys' club". There was, at the time, only one female consultant surgeon in the Mater Hospital. Since coming to the US, I did eight more years of formal training - five years in Philadelphia doing general surgery followed by three years here in Indianapolis doing plastic surgery.
What is it like living in Indianapolis?
The motto here in Indiana is it’s “a state that works”. There’s not much to do when you visit (other than see lots of corn fields), but it’s hassle-free, cheap living and the career opportunities are amazing. I’m the only person doing gender affirmation in a state of six million people, and there’s nobody in many of the neighbouring states doing it.
Do the Irish fit in well there?
There aren’t too many Irish people at all in Indiana, it’s very rare to hear an accen. It’s one of the downsides of living here. When I moved to Philadelphia I very quickly found the Irish community and had a substitute “Irish Mammy” (Alice Carr) who made being away from home (especially at Christmas) a lot easier.
What is it like living there in terms of accommodation, transport, social life and so on? What are the costs like?
Living here is affordable, so I can have a beautiful, spacious apartment right in the centre of things downtown. It also allows me to have hobbies such as flying a plane and kite-surfing which I’m not sure I’d be able to do back home. The winters here are rough with snow and bitterly cold weather from Decemeber to March. On the winter weekends I usually take the two hour flight down to Miami where I can go to the beach year-round. I had an apartment there until recently. Summer weekends, I will often spend in New York or Chicago.
Do you think working abroad has offered you greater opportunities?
There’s no question. I can’t imagine being able to run a gender affirmation surgery programme at the age of 34 back home.
What advice would you give to someone interested in pursuing a career abroad?
It takes a fair amount of resilience, can be lonely (depending on where you are) and you certainly miss out. I missed nine consecutive Christmases with the family. However, if you are career-orientated, moving to the right place, even if only for a while, will certainly pay off.
Is there anything you miss about living and working in Ireland?
I definitely miss the sense of community back home. There is less craic to be had here. I miss the kindness of the Irish. I also miss the food - I’m convinced everything tastes better back home. I do however now have a rule of not missing family events, so I will hop on a plane and come back even if only for a long weekend.
Where do you see your future?
For the moment I'm completely engrossed in this work and living in the United States has been very good to me. Like many emmigrants, I do have a strong desire to reconnect in some way to Ireland. Maybe by providing a service for the transgender community there? I have no doubt that the surgeons in Ireland are well capable and do wonderful work, but it's been my experience that the community overall tends to be underserved everywhere. It was incredibly difficult for me to get training in these techniques, so I'm always keen to pass them on if I can.