Rochester Woman Online had the pleasure to be able to talk with Dr. Rachel Farkas for a little Question & Answer session. These are some of the answere she gave us. Dr. Farkas is a truly, remarkable woman and we are excited to announce that she will be joining us as a regular columnist with “Ask The Doctor”.

Tell us a little bit about yourself, your background, your family and who Dr Rachel Farkas is…

This is such a difficult question to answer, but I suppose that who I am really boils down to the things that matter most to me: family, compassion, community, and faith. I grew up in NYC in a family where hospitality, charity, and caring for others were the core principles that permeated the house. Although there had never been any physicians in my family, I think that these values were the reason why all three of my siblings and I found a passion for medicine, and why we all still gravitate to colleagues who share in our commitment to serve and care for others.

Together with my husband, who is also a surgeon, we moved to Rochester 13 years ago. Here, we have been so fortunate and blessed to build our own home with three children, and to become very deeply engaged in both the medical and non-medical community. We were also privileged to establish thriving professional practices where we continually strive to substantially and very positively impact the lives of patients and their families who entrust us with their care at a time when they are most vulnerable.

How did you decide to become a surgical oncologist and how many years of schooling did you have to go through before becoming a specialist in your field?

I knew early on that I was meant to be a physician, but my specific career path became clear when I helped my mother through her breast cancer treatment during my second year of medical school. I was by her side at every doctor visit and treatment session, and was very personally affected by all of the great things that she experienced, and by the things that I wished were done better. My mother has been disease – free for more than ten years now, but since then I have felt a deep responsibility, an obligation, to treat every patient in the way that I wish she had been treated all those years ago.

To do this, I completed a six-year residency in general surgery, followed by one -year fellowship program that was dedicated entirely to the various aspects of diagnosis and treatment that patients with breast cancer require. This gave me a very broad understanding of imaging, chemotherapy options, radiation treatment protocols, and reconstructive options that pertain specifically to patients with breast cancer. Over the past seven years, I have continually worked to refine my surgical technique so as to achieve the best possible oncologic outcomes while also ensuring that the cosmetic result is as good as it can be, which is why joining a private practice, and teaming up with Dr. Vega seemed like a natural choice for me so that I can best serve my patients.

Where were you prior to joining Vega Plastic Surgery?

Before starting my own practice at Vega plastic surgery, I was privileged to work at the Pluta Cancer Center. There, I worked with an amazing team of colleagues across all professional disciplines. I am excited to continue collaborating with many of these experts and friends so that my patients can continue to derive benefit from a multidisciplinary treatment model that has been repeatedly shown to result in superior outcomes for patients with breast cancer.

What are you most passionate about personally and professionally?

For better or worse, I am an “all in” kind of a person. I don’t do anything halfway, and work very hard to ensure that every task that I sign up for is completed with no skipped or missed steps. This is particularly important in the care of patients with breast cancer who often require all sorts of laboratory testing, imaging, treatment modalities, and follow-ups. It is also really important during operations, where meticulousness and attention to seemingly minor details can make the difference between a great outcome and a regrettable result. I also believe that this kind of attention to detail is very helpful in most tasks, so as you might imagine, I run my house very much like my OR – everything has its place, and I don’t consider the day complete until everything that needs to be done is finished.

That said, I do everything that I can to balance this meticulousness with a very positive and optimistic approach to life. I do my best to help people find silver linings in otherwise awful times, and see beauty in previously unimaginable situations. My true passion, then, lies in finding the balance between my uncompromising nature as it comes to results and effort, and my very positive, outgoing, and sometimes spicy disposition.

What is your favorite thing about being a doctor and working with breast cancer patients?

My favorite thing, of course, is giving news of complete pathologic responses and excellent surgical outcomes to my patients. That is the goal, always. Sadly, that cannot always the case, and I take enormous pride in the relationships that I’ve formed with some patients and families in cases where the cancer just could not be cured. Those are actually some of the interactions that I most clearly remember, and am most proud of. There is a great privilege in offering comfort and when even smiling seems impossible. The beautiful thing about my job is that even though my interactions with patients and families are relatively brief, the connection that is formed, and the trust and openness is incredibly profound and gratifying.

What has been your most challenging procedure to date?

The most challenging operation I have done so far was on a very close personal friend, and the hard part was actually not the procedure itself, but everything around it. This patient and I are of a similar age, our kids have been good friends since birth, and she is a busy, elite professional who is widely known and respected throughout Rochester. I vividly remember a late Friday night when she and her husband came to our house, only days after her diagnosis. They asked me and my husband to serve as a sounding boards for their worries which spanned the gamut from “how long will my wife live” and “who will take care of our Child”, and to answer many very specific questions about surgical technique and options.

That conversation lasted for many hours, and one of the challenges, even then, when I had no expectation of being her surgeon, was to find the right balance. On the one hand, when seeing a patient with breast cancer, I always picture myself as if I were the patient and do my best to create a deep personal connection, and share my opinion on what would be the best combination of medical and surgical interventions. On the other hand, it is really important to remain objective and to present all of the alternative approaches, recognizing that what would be preferable to me might not be for someone with different priorities or values. In this case, there was no balance. The two of us are so close, that even in that first conversation, a big part of me became her, and I think that our husbands also related in ways that they never imagined before. We discussed a few details which were not revealed to her by her other doctors, and these actually caused her to think a bit differently on how she wanted to be treated, and by whom.

Shortly thereafter, Dr. Vega and I collaborated to treat her. You can imagine how hard it is to put a scalpel to the chest of a dear friend. Thankfully, she had an amazing result from her preoperative chemotherapy, and an excellent oncologic and cosmetic operation – but not without bumps in the road. Complications from chemotherapy, reactions from radiation, etc. Through it all, she has done very well, and has been disease-free ever since her surgery.

In medicine as a whole, we are taught that we should not treat close friends and relatives, because these relationships can cloud our judgement and reduce our objectivity. In surgery in particular, this effect is even more dramatic because results are so direct, and so immediate. This case exemplified all of that. What if she did not respond well to the chemotherapy? What if there was a surgical complication? What if I advised her wrong? What if she has incurable disease? On the other hand, how could I say no to anyone in need, especially such a close friend, in such a difficult time? While this was the most challenging and emotionally draining of all of my patient relationships, there are no words to describe the privilege of being part of a team that treats anyone with breast cancer – a merciless, cold disease that does not discriminate. When the patient is a friend, that privilege is magnified even more, and despite the greater challenges, I would be honored to go through this journey with anyone who requested my help.

Who has been your biggest influence and why?

Having already discussed the early influence of my parents, I think that there are two other individuals who I think most directly influence my approach to patients. The first is Dr. Marilyn Ling. Marilyn is the senior radiation oncologist for breast cancer care at Pluta, and is always impeccably dressed, composed in her appearance and demeanor, and is the most organized person I know. Her attention to detail and level of preparation and knowledge is so inspiring – she somehow always seems to know more about patients than anyone else – even about patients for whom she is not primarily responsible. What she exemplifies for me is that by doing more work upfront, Marilyn is able to use all of her time with patients and colleagues so efficiently, to guide them through complex decision algorithms in a clear, compassionate, and amazingly articulate way. She is always smiling, completely engaged, and is beloved by her patients and admired by her colleagues and students. As I am, she is married to a physician, and has three children, and her amazing organizational skills allow her to juggle numerous competing tasks better than anyone I know.

The other person who inspires me every day is my husband. His love for me and for our children, and his demeanor with patients is unlike anything I’ve seen. He sets incredibly high standards and expectations for everything – ethics, effort, and outcomes – but holds himself to an even higher bar. He serves on executive boards of multiple local and national community and professional organizations, where he leads by example, does not accept mediocrity or complacency, and works harder than anyone I know. He is also a highly specialized surgeon, and despite being at the forefront of his field, is always challenging himself to improve the care that he gives his patients, and their experience.

Did you ever see yourself as doing anything else, or did you always know you wanted to be a doctor?

My earliest childhood memories, for as far as I can remember, involved caring for other people. As I mentioned, there is no legacy of physicians in my family, but somehow, I always knew that this was what I wanted to do. My other major passion while growing up was for art. I was constantly drawing, creating, and beautifying everyday objects. This passion still expresses itself in my work in the OR, where I do everything possible to reduce tissue damage and mitigate the disfigurement of women who require partial or total mastectomy. I never leave the OR until everything looks perfect. Additionally, this appreciation for the beauty of the female form manifests itself even more in women who undergo skin or nipple – sparing mastectomy as a gateway for reconstruction. There is such deep satisfaction in helping women conquer cancer AND have their natural beauty restored or even enhanced in the process. This is also a major reason why I am so thrilled to join Dr. Vega, whose appreciation for beauty and artistry at work perfectly align with mine.

Have you had to overcome any obstacles in your field? If so, what were they?

Yes. While I would change nothing about the last seven years, leading to my current position as an independent breast cancer specialist, the last several years have not been easy. Over that time, I have endured the loss of some patients who unfortunately died from breast cancer despite great effort. Additionally, while my work is incredibly rewarding, it does have the potential to encroach to varying degrees on my personal and home life. My kids have had to put up with me talking to patients at all hours of the day but have been great about understanding that sometimes such conversations cannot wait. Finally, my vision for offering highly personalized, attentive care to all of my patients, in the way that I would want to be treated, did not seem achievable within the confines of a large system. It was because of this commitment that I felt the need to start my own practice so that I can personally direct the management of patients who entrust me with their care.

Do you have any advice for young women who want to be surgeons?

I would just recommend that they learn as much as they can about medicine and surgery in particular, and spend some time shadowing physicians whenever possible, to personally experience life as it might be. There is no doubt that this is an incredibly gratifying profession where we get to make very significant and direct impact on patients’ lives every day. On the other hand, the commitment to this profession is nearly absolute. It requires very long training, which often extends into the mid 30s, and this has obvious implications on starting a family, which women in medicine commonly delay. They should also be aware that while payment for medical services has been consistently decreasing, the average debt coming out of medical school is now over $250,000 in this country. Finally, they should realize and accept the fact that being a physician is not a 9-to-5 job. There is a ton written and discussed about “work- life balance”, but the reality is that there is no such thing. You have to be “present” to do either one well, and accept that “life” will sometimes be significantly compromised on behalf of patients in need, but also for continued education. That said, there’s no other job that I would ever want to have, and despite all of the challenges that doctors and surgeons have to overcome in order to do their jobs today, there is nothing else that I can imagine doing.

What are your plans for the future?

Unlike many surgeons out there, I don’t have any major career aspirations that relate to advancement. My main focus is, and has always been, to simply provide the best care that I can to as many patients as I can. In my new job, my goal is to work hard to make sure that access, communication, and care as good as it can be, while continuing to embrace advancements in the field.

I see you are on the physician’s advisory board for the Breast Cancer Coalition of Rochester. Why did you decide this was a good fit for you, and what is something you have taken away from this experience?

In my opinion, the BCCR is an absolutely incredible organization. It is entirely run by volunteers who donate their time, ideas, and money to find and implement new and innovative ways to improve the lives of patients and families who are combating breast and gynecological cancers. This is a place where gender, race, socio-economic background, religion, and age make no difference. The only thing that matters is that we work together to help a group of patients who need support, listening, camaraderie, and a sense of hope and belonging that is nearly impossible to obtain in a purely medical or surgical context. Patients who are newly diagnosed with breast cancer, and those who were recently found to have a recurrence or metastasis of their tumor, are a particularly vulnerable group of individuals, and the BCCR does a phenomenal job helping these patients navigate an incredibly difficult time in their lives.

I have gotten so much more from my involvement with the BCCR than I have given. I cannot describe how rewarding it is to see so many of my patients and their families at the annual breast Cancer walk on Mother’s Day, and that other BCCR events. Beyond that, the satisfaction of knowing that I can contribute to an organization that rounds out the care that my patients receive related to this terrible diagnosis is difficult to describe in words.