Top Guns: Bobbie J. Rimel, MD & Cholene Espinoza, MD
An OB-GYN resident and her mentor on what it takes to soar into the unknown in the medical field (and sometimes the sky)
Today, Cedars-Sinai medical resident Cholene Espinoza, MD, studies sonograms, looking for the curves of a baby hidden in a mother’s womb. But 25 years ago, her astute eye was used for something different: flying a spy airplane. As the second woman to ever pilot the storied U-2 spy jet, she flew reconnaissance missions over distant landscapes in search of terrorist camps. Later, she searched for stories as an embedded war reporter. Her mentor, Bobbie J. Rimel, MD, associate residency program director for Gynecologic Oncology, maintains that someone like Espinoza only comes around once in a lifetime.
Here, Rimel and Espinoza talk about the hope — and humor — they share in their careers, how flying a plane and medicine have more in common than one might expect, and what it’s like for Espinoza to be old enough to be her fellow residents’ mother.
Dr. Espinoza, you have led a tremendous life so far. What drew you to change careers and choose OB-GYN?
Espinoza: What really led me to it is that I want to practice medicine in South Sudan. I started going there when I was a first-semester medical student. My wife got me interested in the region — she was there as a journalist. I learned the maternal mortality rate in South Sudan is 1 in 7. I don’t have a lot of time in medicine — I didn’t start this at age 25 — so the one thing I’d like to focus on is to improve outcomes for women there through education and training, as well as practicing as an OB-GYN.
What has been one of the biggest challenges for you in your new role as a doctor?
Espinoza: After my final flight, I cried myself to sleep. I was leaving a profession I deeply loved and was good at — one that just came naturally to me. When I flew the U-2 spy plane in the Air Force, our slogan was “toward the unknown.” So the unknown now is what I grapple with: Am I going to be a good enough doctor? Not just in this environment but where I want to deploy my skill set, in South Sudan? There’s the struggle of wanting to be very good, and this painful process of getting there. It’s all about overcoming that self-doubt, and Dr. Rimel helps me remember that.
Rimel: I feel a lot of kinship with Cholene. My dad was in the military, so I understand that mindset a little bit. And I’ve traveled some; I’ve lived in 17 states, so I kind of understand Cho’s experience with moving a lot, too.
Dr. Rimel, how did you choose to specialize in OB-GYN?
Rimel: I thought I would be a pathologist. I did a post-sophomore fellowship at the Yale morgue. Then 9/11 happened, and our morgue assisted with providing supplies. A few months later, I went with my mentor to the Office of the Chief Medical Examiner in New York City and was impressed with the work, but I also realized that I missed working with patients. After that, I started doing more neonatal and fetal autopsies, and I discovered meaning from that experience: understanding grief and what a fetus means to the parents. I became really interested in women’s health and by the end of that year I decided OB-GYN was the direction that I wanted to take.
Dr. Rimel, what’s it like being Dr. Espinoza’s mentor, especially considering that she’s several years older than you are, and has more life experience than your other residents?
Rimel: It’s a great match, even though we were randomly assigned.
Espinoza: Wait a minute, you didn’t pick me?
Rimel: It’s not that I wouldn’t have picked you. I asked heartily for you, but we are not allowed to pick. … It’s been an incredible opportunity working with Cholene. I’ve said “We are Fred and Ginger in the OR. We are moving in tandem together.” But it’s not exactly right: It’s more like we are flying side by side together. Espinoza: Even though she has never been a pilot, Dr. Rimel is very good at incorporating my mindset and how my brain works into making me a better surgeon and a better doctor. To be able to train here with a surgeon of this caliber is a gift. I’m trying to learn as a much as I can from her. I’m already the only person in the program to start OB-GYN residency and menopause at the same time. But, honestly, I don’t think my colleagues see my age. They don’t think of me as being a mom. I’m just Cho, the Cho-bot!
Rimel: You’re also not really maternal. [Both laugh.] You have a lot of great skills. But I think you’re right: We don’t see the age difference.
Cholene Espinoza, MD
The Write Stuff
After Hurricane Katrina hit the Gulf Coast in 2005, Espinoza leapt into action to help with recovery efforts. She wrote the memoir Through the Eyes of the Storm: A Book Dedicated to Rebuilding What Katrina Washed Away about the insights she gained from helping rebuild the storm-ravaged community.
Catch Her if You Can
She owns and flies a private plane she calls “Chuck.” She also cruises around town on a Vespa that she won in a raffle six years ago.
Dr. Rimel, what skills do you try and pass on to your mentees and residents?
Rimel: One of the most valuable skills for being a resident is being able to see the actual diagnosis and the treatment through all of the noise of the other things that we’re doing — through the fatigue, through figuring out which are the relevant labs and physical signs, the relevant imaging studies, how to use all the available evidence without getting distracted. I think that’s a really critical part of medicine. How do we get the right drug to the right patient at the right time and make them better? That’s the sort of skill set that I’m trying to pass on to my residents, including Cholene.
Has the Women’s Guild Simulation Center for Advanced Clinical Skills, which replicates high-pressure hospital situations with pretend patients but real medical devices, helped with training?
Rimel: The simulation center has really helped us bring more pattern and order to what we do. It helps with a stressful situation when your heart is racing and the patient is bleeding and the loved one is screaming at you, and someone nearby is fainting. You know, how do we get through those situations? The airlines have improved emergency situations by putting people in those types of settings, and we are just starting to do those kinds of simulations in a hospital setting. I wish I had access to something like this when I started in medicine.
Espinoza: The sim center is one of the many reasons why I wanted to train here and ranked Cedars-Sinai as my first choice for residency. It was something familiar to me. The simulators are made by the same companies, in some cases, as ones that I trained with in the airline industry. It gives me an opportunity to practice the procedure in a safe environment. I’m not practicing on a patient; I’m practicing on a simulator. Plus, we have access 24 hours a day, so I can go there during my off time.
Dr. Espinoza, how else did being in the Air Force inform your work in medicine?
Espinoza: One of the first things we learn in the military is to take care of each other. The chain is only as strong as the weakest link, and I think that sense of commitment not only to the mission but, in this case, to our patients, is critical.
We have this saying: “I’ll never leave my post until properly relieved.” In medicine, we call it “closing the loop,” and that’s making sure that the patient is taken care of. There’s also a similar sense of respect and hierarchy. But I’ve learned not to say “yes, sir,” or “no, ma’am.” That doesn’t go over so well here!
Dr. Espinoza, what would you say to someone who is considering a career shift into medicine?
Espinoza: Follow your heart. It’s no question that my life is much richer because of this change. There are days where I see a big jumbo jet in the sky and I think I could be there sitting in the left seat getting ready to land and go have coffee. But there is never a day that I don’t come home and say, “I’m glad I did this.” Every day I have the chance to make a difference in someone’s life, and to connect with them and help them navigate through something. I have no regrets.
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