My commitment to my husband and my desire to keep our family together gave me the courage I needed to take on this uncertain and potentially risky new position.

In 1996, I began working as an ophthalmic plastic surgeon in private practice in Ann Arbor, Michigan, where my husband held a faculty position at an academic medical center. Like many women in dual-physician marriages, I had mostly allowed my husband's career choices to dictate what professional opportunities I would pursue. In the fall of 1997, changes in my husband's work situation necessitated a move, and once again, we chose the best professional opportunity for him, at The University of Texas MD Anderson Cancer Center. I was offered a faculty position in MD Anderson's Department of Plastic Surgery. MD Anderson had never had full-time ophthalmologists on faculty, and I was concerned that if I accepted the position, I would not have enough work to keep me busy and I might lose my professional skills over time. However, my commitment to my husband and my desire to keep our family together (our son was 3 years old at the time) gave me the courage I needed to take on this uncertain and potentially risky new position.

I faced many obstacles, including some resistance early on to having an ophthalmic plastic surgeon at the institution and limited support for my goal of building a top-notch comprehensive ophthalmic oncology department. As the only ophthalmologist on staff, I was on call nonstop for the first 20 months of my employment. I forged ahead, and within 6 years, I grew our program to include 4 full-time faculty members, a fellowship training program, a residency rotation, and many full-time support staff. We outfitted a busy comprehensive ophthalmology clinic, gained additional clinic space, and purchased major surgical equipment to support ophthalmic surgeons in various subspecialties and ophthalmology residents and fellows. At the same time, I built my own busy surgical practice in ophthalmic plastic surgery and orbital oncology while I rose up the ranks to tenured full professor and gained an international reputation as an expert in my field. Today, my practice attracts patients from all corners of the United States and the world. Our fellowship training program in ophthalmic plastic surgery and orbital oncology is highly sought after and attracts very bright young surgeons. I have contributed significantly to my field as a researcher and an educator, and I may be the only ophthalmic plastic surgeon in the US who is fully based at a comprehensive cancer center and has dedicated her career to multidisciplinary management of tumors of the orbit, eye, and eyelid and complex reconstructive surgery in the orbital area.

However, I still have not achieved one of my goals: to build a comprehensive ophthalmic oncology department. Perhaps I would have achieved this goal by now had I more actively sought mentors who shared my vision and had I worked harder at actively securing political support for my vision. Maybe in the future I will have the opportunity to "lean in" and pursue this vision once again. Perhaps the most important lessons from my experience for younger women colleagues are to recognize that there is a limit to how many simultaneous challenges one individual can address, know the limitations of your environment, and build relationships and harness support at all levels of your organization. Regardless, my journey has been productive and educational and one that I hope future generations of orbital oncologists and oculofacial surgeons, both women and men, will benefit from. Be aware that accepting a risky opportunity may give you the opportunity to grow professionally and the freedom to contribute to something wonderful.