Dr. Li Ern Chen was training as a surgical resident at Washington University in St. Louis when she saw a peer humiliated in the operating room. It wasn't the first time.
A well-known surgeon was the teaching physician in the room. He would interrupt a resident's work if he or she made the slightest move he didn't like. The surgeon would instruct the doctor to stop working and go stand in the corner.
"Put your instruments down and step away from the table," Chen recalls him saying to his trainees in the middle of a surgery. If the doctor being reprimanded was engrossed in treating the patient, the surgeon would rap his or her knuckles with a metal instrument before sending the doctor to the corner, she said.
"It was awful," Chen said. "People would come out of the OR crying."
The doctor's behavior was legendary and tolerated for years, she said. Hundreds of people had witnessed it, but no one ever spoke up or challenged him. He has since left the institution. Even though Chen was never personally targeted by him, it made a lasting impression on her.
"In academic medicine, there is very much a hierarchy," she said. "The people at the top have the power. They also have the ability to abuse the power."
Chen made it her mission to flatten that hierarchy.
Chen said she didn't feel she could make a difference by speaking up as a resident, because she was in a culture that tolerated that doctor's abusive behavior. She has now made it part of her life's work to create a different culture -- on a much larger scale.
She now oversees surgery departments in 19 hospitals in Texas. She has instituted a standard of mutual respect among surgeons, nurses, residents and students in the operating rooms.
"They will treat all people with respect," she said. Otherwise, she takes corrective action. "People are not allowed to get away with it."
Challenging highly trained colleagues is not without personal risk. The norms and routines of a clinical practice, like any ingrained or habitual behaviors, are difficult to alter, according to a commentary by Dr. David Shearn in the Western Journal of Medicine. That would appear to be especially true for the high-pressure stakes of an operating room, where the surgeon literally holds a patient's life in her hands. Attempting to change years of tradition on top of years of training could cause a revolt by those invested in an older system.
It was for this stand that Chen was honored recently, along with four other groups and individuals at the HateBraker Hero Awards in St. Louis.
Susan Balk, the founding director of HateBrakers, said the goal of the nonprofit is to encourage ordinary people to "hit the brakes" on bullying and hatred. At this year's awards, the organization honored individuals and groups from around the country, including a group of students from Old Bonhomme Elementary School near St. Louis. The kids demonstrated outside of their school after learning that a driver had shouted racial slurs at an African-American crossing guard at the school.
"I believe we learn from role models," Balk said. She described the honorees, including Chen, as heroes who showed moral courage. They disrupted a cycle of abusive behavior or violence by educating and leading.
"We should be celebrating that kind of triumph publicly," Balk said. The awards program noted that Chen confronted bullying and hazing, and these reforms have reduced errors and benefited patients, as well as the health professionals.
As a pediatric specialist, Chen has worked with hundreds of children and their families. She hopes parents also impart the same idea to their kids as she pushes in the OR: Everyone is different, and everyone brings something valuable to the table.
"It's not about how old you are or how smart you are or who your parents are," she said. There are some individuals who cannot feel good about themselves unless they are putting people down, she explained.
Along with repairing broken bodies, she set out to fix a broken system.
She had taken an oath to heal, and is keeping that promise in more ways than one.