“It’s been very fulfilling,” says Dr. Annette Epp of her nearly 23-year career as a pelvic floor surgeon and physician specializing in obstetrics (childbirth), gynecology (the female reproductive system) and urogynecology (pelvic floor disorders).
“I’ve had many moments of exhilaration, a few moments of terror and some moments of extreme despair. I think that’s a pretty typical physician story,” she says, recalling a surgery in her residency when her surgical mentor, Dr. Stan Valnicek – who she proudly says is now in his 80s and still doing surgical assists – gave her the best advice of her career.
Dr. Annette Epp
"We were in the operating room one night with a difficult case – I was very worried the patient would not survive. My mentor put down all the instruments, and he looked at me and said, ‘We’re done here. Perfection is the enemy of good.’ What he taught me is that you have to know your limits. I don’t think I’ve ever forgotten that,” she says, adding that the patient survived without any complications.
“She was perfectly fine, but that’s the voice of experience,” she says, explaining that her interest in obstetrics snuck up on her in an unexpected way.
“I was interested in many parts of medicine and wasn’t really sure what I wanted to do. My very first night as a JURSI (student doctor) I was on call and delivered a breech baby by myself. At the time, I had no idea how potentially dangerous that could be, but it was exhilarating and I was hooked,” she recalls.
Her interest in urogynecology, a sub-specialty of gynecology that manages pelvic floor disorders affecting the bladder, reproductive organs and bowels, quickly followed.
“Through my residency training and exposure to really good surgical mentors, I saw that urogynecology was an area that was very under-serviced. These disorders are so distressing for women and their self-esteem. It’s a hidden problem – women don’t talk about it, but they live with it,” she says. “It’s a patient population I really enjoy working with because the patients are extremely grateful for any help you can give them.”
When it came time to do her one-year fellowship in urogynecology in Calgary she took her baby daughter with her, so that her husband could continue farming full time in Saskatchewan. She returned to Saskatoon periodically throughout her fellowship to visit her husband and family and perform surgical assists to supplement the grant money she had received.
After her fellowship, she moved back to Saskatoon and has been with the same practice downtown for over two decades. When not at her downtown clinic, where she sees approximately 90 to 100 patients a week, she performs surgeries at Saskatoon City Hospital and outpatient procedures at City Hospital’s Women’s Health Centre. She is also the Clinical Head of Gynecology for Saskatoon Health Region, Medical Director of the Region’s Pelvic Floor Pathway, and a Clinical Associate Professor at the U of S.
The best part of her day, she says, is the diversity of people with whom she gets to interact.
“I really enjoy interacting with people – I find people’s journeys through life fascinating – and now that I do administration, I interact with people who are trying to make the system better,” she says of her role as clinical head of gynecology for the Region. “Gaining an appreciation for the big picture perspective has been really interesting for me. What I’ve come to understand and respect about our administrative leaders is that they have a lot of integrity. They bring a lot of intelligence to the table. I love being able to make things better and thinking about how we can improve care, improve quality, and monitor and evaluate our progress.”
Two and a half years ago, shortly after taking on her role as clinical head in 2014, she retired from obstetrics.
“It’s a huge privilege delivering babies, and I do miss that,” she says. “Seeing a new life is absolute, miraculous joy. It’s a privilege being part of somebody’s life at a time that is so unforgettable and special, but I realized that I was spread too thin – I had taken on the administrative role, and my passion is urogynecology. I didn’t want to practice obstetrics in a marginal way. I’m somebody who really believes that if you’re going to do something, you should give it 100 per cent. Obstetrics is one of those things that when you do it, it’s exciting and exhilarating and very rewarding, but it’s also very stressful and demanding. The hours are exhausting. I did it for almost 20 years after finishing my training, and I reached a point where I knew I needed to do other things.”
Even so, when she left obstetrics, she says she felt guilty for a long time.
“And so, I decided I had to put that energy somewhere, and if I’m not staying up all night delivering babies, I better do something else. I started volunteering with the SWITCH clinic. It’s an inner-city clinic where I provide gynecology services to a vulnerable, under-serviced population. I heard about it from residents, and I thought, if young doctors can do this, surely I can too,” she says, adding that she has set up an emergency colposcopy service at her clinic that allows patients of SWITCH to receive treatment at her clinic on a walk-in basis. A colposcopy is a procedure used to examine the cervical area for cancer and other conditions.
“It’s been unbelievably successful,” she says. “I would say 90 per cent of the women I’ve seen have needed treatment, and 100 per cent of them have shown up for their surgeries. These women are the most vulnerable group of our population – they’re the patients who typically die of cancer of the cervix, and even preventing one death makes a huge difference.”
“I’m deeply invested in my patients,” she adds. “It means a lot to me to be a skilled surgeon and to make good decisions that will help people. One thing I’ve learned about medicine is that the resilience of the human spirit is incredible.”
While SWITCH may be Dr. Epp’s most recent foray into volunteerism, it’s certainly not her first. For the past 20 years, she has flown to La Loche to deliver an average of four one-day clinics a year to women who might otherwise not have the opportunity to get gynecologic care. She also canvasses for the Cancer Society.
“I’m always the last person to get out there and return my stuff,” she says laughing, “but I do canvass. I think it’s really important to participate, however you can, in promoting positive change. I’ve been taught to lead by example."
Dr. Epp has a lot to be proud of in her career, but she’s most proud of what her success is teaching her daughters, ages 20 and 24.
“I’m most proud that I’ve been able to show my daughters that you can be a woman in medicine, you can accomplish what you think you need to, but you can also be a mom and a human being. You can make mistakes, try again, forgive yourself, not be perfect, and that’s okay. It’s okay to achieve excellence but not perfection,” she says, adding that when it comes to life lessons, her daughters are her teachers.
“They taught me the most about life and how to interact with people, appreciate people and care for people,” she says fondly. “They have taught me that it’s really important to be a listener and to not make assumptions about why people are doing or not doing something – to ask them.”
Dr. Epp says it’s important for everyone – physicians included – to have fun and nurture a life beyond their careers.
“In the summer, my husband and I and our kids go to our cabin. We love to play – play means we’re out on the water all the time. My husband and I love to entertain. We love food. We love to travel and explore new cultures. We’re just interested in tasting life,” she says excitedly, the hint of a mischievous glint in her eyes.