University of California San Francisco

Muriel Steele Profile

Muriel Steele Profile

Excerpted from “One Tough Surgeon” by William Blaisdell, MD  

Muriel Steele MdThe surgical pathway has not been and is still not entirely smooth for women entering the profession.  Despite these obstacles, women are now heading major departments of surgery and have become regents and presidents of the American College of Surgeons (ACS) and directors and presidents of the American Board of Surgery.  Women, for the most part, are fully accepted as part of the profession.  They constitute 25-30% of all surgical residents and this percentage is increasing by approximately 1% yearly. However, this wave of change would not have been possible if not for the audacity of women pioneers, like Muriel Steele MD, who herself had to overcome significant prejudice on her way to an illustrious surgical career. 

Muriel Agnes Reay was born on July 28, 1930, in Glendale, California (Figure). She grew up on a ranch near Santa Barbara, where she loved to work with cattle and horses and made the decision to become a veterinarian. 

Muriel attended Stanford University, graduating in 1952 as a member of Iota Sigma Pi (the women’s honorary chemical society). She was accepted for admission to the University of California–Davis School of Veterinary Medicine. However, that fall when she appeared for registration, her acceptance was revoked because the admissions office discovered that she had recently married a fellow Stanford student, Rod Steele. At this point she did not know what to do, so she returned to Stanford to pursue a degree in bacteriology. With the encouragement of her husband, she gained entrance to Stanford Medical School, which did not have the same prejudices against married students that the veterinary school did. She received her MD degree in 1957, graduating Alpha Omega Alpha at the top of her class, which contained only 4 women. At this point, she and her husband amicably parted ways, he to pursue a career in electronic engineering, and she to continue post- graduate medical training. 

She had been delighted by her exposure to surgery at Stanford, which then had a dynamic surgical department led by a young chairman, Victor Richards. Despite the discouragement she received from friends and classmates, she opted to apply for surgical training. And in 1957, Muriel became the first woman accepted for Stanford’s surgical residency (when its hospitals and training programs were still located in San Francisco, California). She performed exceptionally well and as she entered her next to last year of training as the top resident, she was awarded a US Public Health Service fellowship to study at St Thomas Hospital in London, England, starting in July 1959.  Unfortunately, while she was abroad, Stanford was undergoing a massive upheaval.  A new dean was selected for the medical school in anticipation of the school’s move from San Francisco into new buildings on the Stanford campus.  Richards, who initially fought the move of the school, then tendered his resignation.  He was subsequently replaced by a new chairman of surgery who refused to have women in his training program.  As a result, Muriel was left high and dry in England. 

As luck would have it, most of Stanford’s surgical faculty remained in San Francisco and did not move to the new medical school. Richards advised her to return home under his preceptorship at Presbyterian Medical Center (the former Stanford Hospital in San Francisco). He assured her that he would organize and obtain approval for a new training program that would qualify her to take the surgery board examination. This he was able to accomplish, and she received retrospective approval for her final years of training.  She went on to pass her specialty examination handily and entered private practice in San Francisco. 

After completion of her training in July 1962, Steele’s practice was slow to develop.She recognized that, as the only woman surgeon in San Francisco, she anticipated that she’d have difficulty obtaining referrals from male physicians. But she expected that her female colleagues, who had taken parallel training in the medical specialties, would welcome her. Wrong! When she visited women internists, they politely informed her that they could not refer their female patients to her because both they and their patients felt that only a man was appropriate as a surgeon.

She was barely making a living covering her former professor’s patients and running the Surgical Outpatient Department at Presbyterian Hospital. However, that latter experience served her well when it came time to organize the SFGH clinics.  Also, during this period she met a hospital administrator, Norman Thompson, and they were married in 1967. He was fully supportive of her demanding surgical career. Both liked to entertain. Norman loved to cook, and the couple hosted many lively parties for their friends, most of whom were fellow physicians or surgeons.  

In 1968, after 7 difficult years in private practice, Muriel received an invitation from William Blaisdell, the new chief of surgery at SFGH, to help him start a surgical clinic.  Until that time there had not been any formal outpatient clinics at SFGH because the city and county of San Francisco had opted to let the 2 medical schools that ran services at SFGH provide indigent outpatient care in their own clinics. However, when Stanford moved from San Francisco, the University of California–San Francisco’s clinics were overwhelmed, and the University of California–San Francisco demanded that SFGH provide outpatient care. It took several years to get the reluctant city and county to provide funds, but finally this was accomplished under the leadership of the surgical service.  Muriel threw herself into the tremendous task of organizing, staffing, and running both the medical and surgical outpatient clinics.  She did such a good job administering these clinics that when a permanent outpatient director was finally recruited, he insisted that she continue in her administrative role as director of the Adult Health Center. 

Muriel became the conscience of the department and ensured that her world-traveling associates met their clinical responsibilities. It was acknowledged that she was the only one who could intimidate Blaisdell and Trunkey, the 2 surgical chiefs she served under.   Because of her administrative responsibilities, she was the stay-at- home faculty member, and Blaisdell came to rely on her to ensure service stability. In this responsibility she assumed the mantle of assistant chief of surgery in 1973 and was promoted to associate clinical professor of surgery the same year.  

Muriel was not actively engaged in bench research, but she contributed clinical articles to the literature on a regular basis. When it came time to nominate her for membership in the San Francisco Surgical Society, she was imminently well qualified. However, her application for membership was denied. The justification was that during its entire history the organization had met in a prestigious men’s club, and no women were allowed inside its doors. However, her numerous friends kept pressing her cause, and finally the organization had no choice but to admit her and move its meeting site. Needless to say, this resulted in many disgruntled Bay Area surgeons who had not yet accepted the concept of women in surgery and resented the need to move their meeting elsewhere. 

The next barrier was gaining entry to the Pacific Coast Surgical Association. The Northern California caucus of that organization strongly endorsed her application, but membership was denied. Although her ACS credentials documented her clinical involvement, the rationale for denial was that she was an outpatient department administrator, not a true surgeon. Needless to say, this argument was met with documentation that her surgical practice exceeded that of her colleagues at SFGH, and the uproar over her membership denial shook the organization at its roots. Thus it was that in 1977 she was admitted as the first woman in the Pacific Coast Surgical Association. 

In contrast to these 2 organizations, she was readily admitted to the American Association for the Surgery of Trauma. She was the second woman to join that organization, Anna Ledgerwood, MD, being the first. 

She proved to be an outstanding administrator, and during her tenure at SFGH she chaired nearly every major committee, including the Operating Room Committee, the Credentials Committee, the Budget and Contracts Committee, and the Professional Services Committee. She served 4 terms as chair of the Executive Committee. After SFGH’s loss of accreditation as the result of a review by the Joint Commission on Accreditation of Healthcare Organizations, which was especially critical of the medical records, she assumed the chair of the Medical Records Committee, saw the recruitment of a competent department director, and initiated discipline of recalcitrant medical staff. After this achievement, she was elected chief of staff in 1977, an office she held through 2 terms, ending only when she died. 

She carried an extensive medical student and postgraduate teaching load, documenting more than 2000 teaching hours in her annual university teaching review. Besides her administrative responsibilities, she spent many hours running her colorectal clinic. In addition to her extensive elective operative schedule, she took a regular full share of trauma and emergency calls. She manifested unbelievable endurance and stamina, and she out-worked her colleagues. She rarely missed a day of work, despite such problems as severe anemia and episodes of partial bowel obstruction, which were subsequently diagnosed as secondary to uterine sarcoma. 

In the fall of 1978, Muriel acknowledged that she felt tired and was found to have profound anemia secondary to an advanced uterine sarcoma. Nonetheless, she was back at work 4 days after her hysterectomy. 

In the fall of 1979, she was operated on in an attempt to relieve bowel obstruction, but the procedure was unsuccessful. For the last 4 months of her life, despite extensive abdominal metastatic disease, she worked full-time until she was too weak to walk. One week later she died at home on October 26, 1979, at the age of 49 years.  She was survived by her sister, Eleanor Johnson, and 2 stepdaughters, the children of her husband, Norman Thompson. 

Muriel Steele was an extraordinary woman and surgeon. She clearly demonstrated that women could compete effectively with men, not only in technical and intellectual ability but also in endurance and stamina. For those who worked with her, she demonstrated not only that she could hold her own with “the boys,” but that she could outdo them all. 

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