At the end of a recent medical school department meeting, a male surgeon turned to Stanford University neurosurgeon Frances K. Conley.
"Even through that (medical) coat, I can still see the contour of your breast," he told her.
"It was ugly, demeaning--and such incidents occurred regularly," recalls Conley now, referring to two years of "a hostile and sexist environment" that led to her abrupt resignation last week from the prestigious medical school.
In throwing in her scalpel at Stanford, Conley, a 50-year-old leading neurosurgeon and tenured professor, has created a national furor. Her resignation was particularly startling, some say, because she had spent more than a quarter-century trailblazing a medical career at the university.
And, according to a number of medical professionals, it may reflect a more widespread pattern of sexism nationwide, ranging from uninvited fondling to unequal pay and limited opportunities for promotion.
"I was shocked," says Dr. Jane Weston, a plastic surgeon who studied at Stanford and practices nearby. "Frances Conley contributed a great deal to the medical school. For those of us coming up through the ranks, we saw her up ahead as a wonderful role model."
In an interview this week, Conley emphasized that she was not charging sexual harassment, although she acknowledges that male colleagues have sometimes run their hands up her legs in the operating room. Rather, she pointed to what she described as a sexist climate in which women feel undermined on a daily basis.
Her decision to quit, she says, "took about 30 seconds" after Stanford Medical Dean David Korn told her that, because of financial constraints, he was terminating a national search for a neurosurgery chief and instead appointing the acting chairman of the past two years, Dr. Gerald D. Silverberg, 53.
Conley and Silverberg, colleagues since their residencies, apparently have a longstanding difficult relationship. She charges that he regularly refers to women in the department as "honey," even in the operating room. And, she adds: "If I expressed any deviation from the majority view, my colleague (Silverberg) announced prominently that I was suffering from premenstrual syndrome."
No one, including Conley, questions the professional skills of the new chief, of whom one colleague says: "If a surgeon needed to have surgery, he would likely request Dr. Silverberg."
Conley describes Silverberg, whom she does not cite by name, as "a wonderful physician--that has to be emphasized--but he is an old-style surgeon in terms of his attitude about women."
She adds: "Once you put a person into a high executive position, you simply validate his behavior about sexual differences in the workplace, providing for another generation of male chauvinistic surgeons."
Silverberg did not respond to requests to be interviewed for this article.
Asked if she might change her mind about the resignation, Conley is adamant. "I'm dog meat here," she declares. Having spoken out, "I think my chances of being reassimilated into this environment are zero."
Conley's charges prompted Korn to acknowledge that some men in the profession and at Stanford are "insensitive" to women. "We still have much work to do in changing attitudes, beliefs and behaviors within our profession to eliminate bigotry and bias. . . ," he said in a statement, but he noted that only two complaints of sexual harassment have been filed at the medical school in the seven years he has been dean.
Korn, who was out of town, could not be reached for independent comment.
The Conley case encapsulates the latest in a series of major social issues that have arisen at Stanford. In recent years, the university has attempted to combat racism on campus and has revised its undergraduate curriculum to be more sensitive to different cultures.
When drafting her resignation letter late last month, Conley cited a "hostile environment" at the medical school but struck references to sexism. A day later, however, while chairing a Medical Faculty Senate meeting, she listened as female students related sexist incidents--ranging from one student being discouraged from pursuing a specialty because she allegedly "didn't have the required male genes" to the use of "girlie" slides during a lecture.
"I was absolutely floored. I came away feeling very guilty because I realized I had been a facilitator, perpetuating the environment students were still complaining about," Conley says.
"In all these years, I wanted to be 'one of the boys.' Had I yelled and screamed aboutthese things 25 years ago, I undoubtedly would not have been taken into training programs because I would have been labeled 'difficult.' "
At that point, Conley drafted a strongly written opinion newspaper piece, taking her sexism charges public. (The Times will publish Conley's piece in Sunday's Opinion section.)
Fran Conley, a woman who seems to relish challenge and competition, would seem an unlikely candidate to quit anything. In 1971, when the annual Bay to Breakers race allowed women to compete on a nearly eight-mile course for the first time, Conley was the first woman across the finish line.
A trim woman with a silver-blond pageboy hairdo, she radiates health and enthusiasm. She literally was born at Stanford, where her father was a professor. She graduated from her hometown university in 1962 and married Phil Conley, a javelin thrower who had represented the United States in the 1956 Olympic Games. (Both Conley and her husband, now a financial planner, continue to throw javelins, entering masters competitions.)
Mindful of Fran Conley's career ambitions, the couple opted not to have children. They will celebrate their 29th wedding anniversary this summer.
After a grueling residency, in 1975 Conley became one of two board-certified women neurosurgeons in the United States and was appointed assistant professor at Stanford Medical School. A decade later, she took a year's leave to enter Stanford Business School, receiving a master's of science degree in management in 1986. Returning to the medical school to do research, publish and perform surgery, she rose through the ranks, becoming a tenured professor in 1988.
To Conley, neurosurgery and the world of brains, spinal cords and backs hold great appeal. "It's a remarkably satisfying profession. You take people who are maimed or dying in front of you, and you return them to functioning life," she says with a smile.
Surgery remains male-dominated, with women making up just 6% of the nation's 38,000 surgeons; in neurosurgery, the figure is only 3%. But overall, medicine has changed dramatically in the past 20 years, from a largely male profession to one in which men and women are entering in almost equal numbers. About 16% of the 600,000 physicians in the United States are women, compared with 8% in 1970. Nearly 40% of medical school students are female.
But the numbers don't tell the whole story, says Eileen McGrath, executive director of the 11,000-member American Medical Women's Assn. in Alexandria, Va.
"In medical schools generally, women are a critical mass, so (for the most part) they are not experiencing so much overt discrimination," McGrath says. "But what we are seeing is the 'glass ceiling' (on promotions) and a lot more subtle discrimination, such as put-downs."
Several experts say many of Conley's complaints are experienced by women in medical settings throughout the United States, although to varying degrees.
On the one hand, Dr. Leslie Kohman, a thoracic surgeon at State University of New York's Upstate Medical Center in Syracuse, recalls that in the middle of a presentation at a recent professional meeting in Denver, a male colleague slipped in a picture of a topless woman skier.
On the other, "things are generally tolerable and can be fought on a day-to-day basis when your department chairman is supportive," says Dr. Linda Shortliffe, a Stanford Medical School associate professor of urology.
But issues still to be addressed, she believes, include promotions, salary and office space. "I have heard people reason that you can offer a woman without a family a lower salary because she doesn't have a family to support--but the same principle doesn't hold true for a (single) male candidate," Shortliffe says. "On the other hand, if a male (job-seeker) is married and his wife (has) decided not to work, there is a perception that you have to offer him more money."
And the point is not that sexism is rampant systemwide at Stanford Medical School. "For the most part, interactions for women and minorities are fine and perfectly respectful. It's that you have a few people in positions of power that create problems," says fourth-year Stanford medical student Katherine Weilbaecher.
Moreover, observes McGrath, the question of whether to speak out is a "Catch-22" because of possible reprisals. "Whistle-blowers do not fare well in our society," she says.
Apparently, some Stanford women are fearful. Midway through an interview, one female medical student declares: "I am getting very uncomfortable about saying these things in print. I'm going to have to think about this."
Shortliffe, who has known Conley for 20 years, describes her as "one of the more reasonable people" and says she was surprised that Korn, knowing of Conley's feelings, promoted Silverberg.
But a spokesman for Korn points out that Conley, in openly applying for and receiving job offers over the past few years, had asked Korn for several letters of recommendation.
"I think (Korn) probably reasoned Dr. Conley would be heading for greener pastures in any case, so the appointment wasn't an issue," the spokesman says.
Once Conley's resignation takes effect in early September, she will leave both Stanford and her joint assignment as chief of neurosurgery at the Palo Alto Veterans Administration Medical Center. Of her decision, she says: "It is a matter of integrity. I'm an honest person, and that's what role models should be."
She says she and her husband are rooted in the area and that she will not entertain a bicoastal marriage. For now, she says, she has no career plans: "It's like being in the middle of a divorce. You don't plan the next few years during the first few days."