Dr Rhona Mahony

Twelve months ago, L’Wren Scott, one of my favourite fashion designers died. To alert the world about her passing, the New York Times led with the headline ‘Mick Jaggers’ Girlfriend Has Died’. The publication received mass criticism but their rationale was that Mick Jagger was more popular than L’Wren. Thus, their article would receive a higher number of ‘clicks’.

I had no relationship with L’Wren, I was merely an admirer of her work but I was horrified on her behalf. The New York Times later apologised for their reporting and amended the headline but the controversy sparked an idea in me. I was consistently frustrated by the rhethoric which is employed in the media to talk about and to women. I wanted to refocus the conversation and actively began to meet and interview women who inspired and interested me across the domains of journalism, education, sport, literature, technology, theatre and music.

This ‘Extraordinary Women’ series is one of my proudest achievements and I could not be more honoured or excited to present the fifteenth conversation with one of my heroes; Dr Rhona Mahony. Rhona is the Master at the National Maternity Hospital on Holles Street in Dublin but what defines her as extraordinary is her compassion, dedication, ambition, curiosity and sense of humour.

How would you describe yourself, both personally and professionally?

I think I’m evolving all of the time. Like most people, I’m not sure I’m quite sure who I am. I work hard, I am very committed to the National Maternity Hospital but I also love the elements of life outside of that too. Particularly, with my family – my husband and children are very important to me. I’m quite simple in my tastes, I love to run, I love good food, I do enjoy the odd glass of wine and that’s me. I’m not so complex. Oh, and I love to read books.

What kind of books?

I’ll read anything – from the back of an old Cornflakes box, a new novel to the older classics. The greatest pleasure I have is being lost in a book. Funny enough, I find escapism in books more so than in any other medium. I don’t watch much television, I do like the radio but I love to read. Someday even, I would love to write a book.

Fiction or non-fiction?

Probably fiction but based on some of my own experiences. Like most fiction, I guess…

Based within the medical sphere?

No, I would love to step out of that sphere for the book. I love medicine, it’s incredibly absorbing and you don’t get to step outside very often but when I do, it’s like breathing oxygen. Sometimes it’s lovely to step into a different form. Recently, I was at a conference in the Abbey Theatre looking at communication and war. It was fascinating to step in and see other people describing their differing goals, perspectives and outlooks. I think those alternative perspectives is what really interested me whilst being an Eisenhower Fellow. I got to travel around America with people from various different backgrounds, jobs and countries. I was fascinated but I suppose as you grow older and learn more, the world feels bigger – for me, it feels as though there is even more to explore.

What was your biggest learning curve from being an Eisenhower Fellow?

The whole basis to Eisenhower is a belief in the discipline of collaboration. Dwight D. Eisenhower was an amazing diplomat but a very experienced military figure too. I read his biography and he strikes me as being a very nice man too. Having been through the Second World War, he was very concerned about the Cold War. He was very keen for leaders to know each other and felt that if people could do that and simultaneously almost forgot about the politics and semantics, the leaders could have a collective conversation about their aspirations to improve society. Thus, that idealistic society would not just be an abstract aim but a definite possibility. So much of our negotiations are coming from fixed points and often, you don’t have a chance to find that nuance that connects us all from which we can build on.

Eisenhower is also about globalisation, I had a great opportunity to learn about other cultures. You begin to realise that although some of the challenges which they face are very different to ours, some of them are incredibly similar too. Being able to freely speak with people who are of other occupations, including journalists, writers, someone who is head of a pension fund, another is head of an education strategy is a fascinating and invaluable insight. I love learning and to be able to learn about such a wealth of different people and experiences was probably the highlight of being an Eisenhower Fellow.

How did being an Eisenhower Fellow impact upon your profession?

I have a very different profession because I work as a practicing obstetrician and I’m the CEO of the hospital. It’s a very unusual juxtaposition but helpful too as I understand both obstetrics and the business element. I am also incredibly lucky to have a brilliant management team that supports us in being strategic within the hospital. What I’ve learned is how essential strategy is – where is the hospital going? What will the next generation of women need? What will they want? I’m always very interested in hearing from that cohort of people and in particular, what their aspirations are for the hospital as all of this – it’s for them.

I have two daughters and I’m very conscious that I would love for them to have somewhere special to go to. I want the maternity hospitals to be considered an important part of the community and that they would be both really valued and really loved. Most importantly though, the maternity hospitals would give very safe and excellent care because it is the place where we begin and is greatly responsible for the future of our country. I am very passionate that we are born safely and I think it’s for society to ensure that we nurture our children.

Society is all-encompassing but what would be the most efficient vehicle or method to ensure that nurturing occurs?

Education. It’s a big passion of mine and there is a great need for our society to pay attention to the importance and value in education. Firstly, it’s probably the greatest indicator of good health but it can also dictate the quality of life which people can enjoy. Education allows people to realise their potential but it also allows people to protect their decency and goodness because they can articulate and stand up for what’s right. If a society doesn’t place a value on education, very quickly it can become disadvantaged as so many are silenced.

That gap between those who are heard and silenced just continues to widen.

Completely and I think we have to be very careful of that in Ireland. I am incredibly grateful to my school for all that it has given me. We have to ensure that we continue to have teachers who are dedicated to education and we afford mportance to them in society. Education can change people’s lives, it can remove a lot of disadvantage and although it cannot protect us from everything, if you purposefully allow it to diminish, I think you have a big problem.

You raised two questions earlier – What will the next generation of women need? What will they want? – How would you attempt to answer those questions?

Firstly, they want to have excellent healthcare and obstetrics – they want to have a safe delivery of their baby. However, I also think that what we are looking for is that giving birth is valued and even more so, for women to be valued. Sometimes in Ireland, we are perhaps not as grateful as we should be when babies are born. When things go very badly, it’s obviously devastating but it is, none the less, part of the difficulty of life. Life isn’t as easy as we would like it to be but I suppose what women want and need is for us to provide a support for them not just in the good times, but in the bad times too. I would like to see a hospital where their function is not only to deliver babies safely but a place that offers support social and holistic care so that we can mind everyone.

I always think of it as a Leaving Cert class [laughs]. You want to get your class through the hoop but you’re also wanting to mind and protect them. You know that the exams will be challenging and difficult but you simultaneously want to cultivate a space and an environment that will support both their bodies and their minds. The Leaving Certificate and childbirth can both be incredibly overwhelming.

Speaking of school, you began Junior Infants at age three. Was starting school at that age ever a challenge?

I am the youngest in my family, my brother and sister were already in school and I famously say that I was always badgering my mother to get to school too. Eventually, my mother said, ‘Off you go, then’ – thinking that I would be miserable but I loved it [laughs]. I had a very happy school experience. I went to the Holy Faith in Clontarf for both primary and secondary school and I was incredibly fortunate that my friends stayed with me for my entire schooling. That was amazing and is possibly the reason as to why I was so happy there.

Looking back at that time, I had some very brilliant teachers who gave me an excellent start in life and are why I am standing in this office today.

The access route to medicine has changed quite significantly since perhaps you completed your Leaving Certificate. If you had to attempt it now, do you imagine you would find it more challenging?

I can’t imagine that I would get in now. The points are so high and the addition of the H-Pat is gruelling. I’m really not sure what the H-Pat contributes to the assessment. There are so many students who attain remarkable results and the pressure to receive those grades must be incredible and this H-Pat equates to an additional struggle. Medicine is such a broad degree and I don’t know how an exam can discriminate if you are suitable for medicine or not. When you qualify with a medical degree, you could go into pathology, you could spend your entire time in a lab or you could have a very hands-on interpersonal job. There is such a diverse range of options available and I’m not entirely sure that you want the top one per cent of the population all becoming doctors. Maybe you want a mix of people and there is an element of humanity that is essential too which is not being assessed in the prospective practitioners.

I understand that the system is attempting to be fair and it is really difficult to determine what method would be the most fair and supportive for students but I’m very glad that I’m not trying to get a place in medical school in the current academic climate. I think the young people work so hard and I cannot imagine the heartbreak that is experienced by those who get so close but just barely don’t make it. I often think of them. It seems so cruel because those who want to study medicine, their ambition is altruistic and they have such drive to do good. As someone in a managerial position, it is such a privilege to meet them and to work with them.

Whilst you were training, you undertook placements in St Vincent’s and the Mater Hospital but what was the key learning that you acquired whilst on placement?

The best story that I have is courtesy of Malachy Coughlan, who is one of my favourite teachers and consultants – he’s retired now. I was in the Mater Hospital in the role of a Senior House Officer. I was working with an incredible team and a woman came into our care who had end-stage cervical cancer and it had only just been noticed. She had a challenging life – one that had a lot of abuse. When she came to us, we knew that we would not be able to operate on her and that our role would be merely to support her. The nurses and all of the staff were so kind to her and it seemed that for the first time, she had somewhere safe to be.

Finally, she had found a place in her life where she felt cared for. It meant a lot to her but it was soon time for her to go to the Hospice. As medical practitioners, we knew that the Hospice was the best place for her as the care is so fantastic and specialised but she really didn’t want to go. She felt that she was losing the family that she got to know at the hospital and thought the displacement symbolised another cohort of people rejecting her. She arrived to the Hospice in Raheny and my consultant said to me, ‘You live in Raheny – when you get home this evening, I want you to go visit her’. I did and I remember when I walked in, she announced my arrival to all of the clients and she was just so happy to see me. I went home crying and she died just some weeks later.

For me, that’s a very good example of how, apart from the application of medicine, humans under our care need humanity too. Sometimes we’re not able to cure everyone, nor can we save every baby, it’s not within our ability but we must not forget the human aspect to our profession. Sometimes it’s not about administering the cure but in fact, it’s about that moment of kindness that can have a monumental impact.

Not only do we have to remember that patients are humans, but so too are doctors. How do you imprint upon student doctors that they too must care for themselves?

At the moment, I’m putting great energy into supporting the staff of the hospital. It’s a very difficult climate at the moment, particularly in obstetrics. There is almost a consistent conversation in the middle which narrates to the public that malpractice is occurring in our obstetric units and that we are not caring for people – that’s very difficult for staff as they are working in very under resourced areas and consistently are doing their absolute best. The staff are suffering at the moment because that relationship and trust that they have with their patients is currently being undermined and eventually staff will become disillusioned. Even worse, they become scared and terrified that their names will be the next ones to be mentioned in the paper. I wish that we could live in a world where no one would make a mistake but that’s unrealistic.

How do you support those staff?

We meet every morning at 7:30am for a clinical handover. That is the meeting’s main function but it’s also an opportunity for me to be present to inquire how the staff are and to be open to questions, problems and queries which the staff are experiencing. We also take time out to discuss challenging cases, gain and learn from the insights of younger and more experienced staff whilst also questioning the societal, educational and of course, medical implications of the case. For me, this is one of the elements of the hospital that cultivates the incredible teamwork that we have in Holles Street. This is not something which I started but it has been handed down throughout the generations, with each Master adding to the ethos of the hospital. My aim for the year is to continue to work incredibly hard in supporting staff as if they are overtired, over-worked or if their self-esteem falters, this isn’t going to make them better doctors and ultimately, will have a negative impact on patients.

When you first took on the position of Master at Holles Street Hospital, did you face any difficulties or challenges due to being both the first female and Northsider to take the role?

[Laughs] Largely, I took it in my stride but perhaps that’s because I had been working in Holles Street for many years and everyone already knew me. Thus, here in the hospital, there was no discussion due to my gender but externally, that wasn’t the case. Various reports would lead with the headline of ‘Female Master’…

Does that terminology bother you?

Mostly, I just ignore it. It’s not relevant nor is it overly important but it was interesting. In those early days, I also came across quite a few people who would try to project onto me what and who they thought I should be as Master. I was busy just trying to be myself and there was a huge amount of commentary on what I wore but you never hear that same rhetoric about what suit Sam from the Rotunda Hospital wore today. Working in Holles Street keeps you quite grounded, the profession is the same regardless of your gender as are the challenges and for that reason, I’m aware that those conversations and headlines occur, but I try to pay as little attention to them as possible.

Over the past several months, you’ve been very vocal, within a public forum, on obstetric care and in particular, the Eigth Amendment. Was this an experience you embraced?

I was very naive and really didn’t expect the level of conversation, criticism or questions that arose after I spoke at the Oireachtas. I was invited to address the joint committee on Health and Children and at the time, I thought it was the right thing to do – I still do. From a medical perspective, I was asked to give advice on this issue but I didn’t expect the level of attention that it and I received. I thought it would just be a normal meeting where some would be airing their views whilst others would be taking notes. I was not prepared for that level of interest. In my role, you don’t have a PR representative educating you on what to say and how to act and thus, from that point of view – you are quite vulnerable.

Would that vulnerability stop you from doing it again?

No, if it’s the right thing to do – I’ll always do it. I’m not looking for a career in politics, nor do I wish to be famous. I speak at these events if they are good for the hospital and good for women in Ireland. That’s my sole motivation and in part, I feel that speaking within that narrow focus is very much part of my job as Master of the hospital.

You have led great change here at Holles Street Hospital, but what do you envision will occur during the remainder of your time in this position?

When I first began, I set up a strategic plan – as most people do – every now and again, particularly when I’m having a difficult day, I’ll take out the strategic plan and have a look at it. The plan is somewhat idealistic and I won’t be able to complete everything but looking at the plan, I can clearly highlight the most essential elements and the actions which I won’t leave office without completing. The fundamental core aspects of the plan are that we need a different infrastructure – we need a new hospital for women and I’m incredibly passionate about that. If we could build a state-of-the-art, modern hospital where women had access to the best facilities, clinicians and resources, we would also change society’s feelings and attitudes towards obstetrics. I really want that!

Sometimes I visit and speak with all-girls schools. Surrounded by so many brilliant, intelligent young women, you can’t help but think how fantastic it would be to have a place where they feel safe, cared for, a location where great amounts of research are undertaken and of course, where obstetric best practice is solely employed. Birth is a societal issue – everyone is born. It’s really important how you start your journey and during my time as Master at Holles Street, I would like to see us focus and champion that.

That would be my primary strategy but second to that would be staffing; we don’t have enough consultants or midwives and we must keep advocating for that. With the right numbers of staff, we will be in a position to continuously train those who are on college placements and it will also permit us to offer continual professional development courses for those more experienced practitioners. Increased staff will cultivate this cycle that will bring about success.

Is it possible that some of the frustration that young doctors feel is due to the disconnection between secondary school education and particularly, the Leaving Certificate and the material and qualities which they must study and employ as a doctor?

It’s possible and I think that Transition Year is excellent as often students have an opportunity to visit us here in the hospital and they attain a realistic image of what the profession is. It’s essential that young people are exposed to that transparency, not just in medicine but in law, theatre, education, the full range of professions. Simultaneously, I try to visit schools to portray and to answer their questions about the reality of my role and what it takes to work in a hospital. However, I think we really need to increase that connectivity between school and third level and not just to those who attend private education but also to the entire spectrum of the student body.

There are so many brilliant young people who span the breadth of this country but they don’t see themselves in these roles and even more upsetting, they don’t see it as being something which could be for them. If we could break down that barrier and encourage young people to see that all education is an option – whether that is university, apprenticeships and further education – the impact which it will have on society will be monumental. We need to allow people to become involved in what inspires them. We need to value these people and help them to understand that they have choices and options – they’re not just employed because they need to pay bills, we want them to have pride in their jobs and spend their time doing something they enjoy. We have an incredible amount of work to do in Ireland, in terms of education, but it can only benefit us and the future of our population.

Apart from releasing your first non-fiction novel, what are your other personal goals for the next decade?

At some point, I would love to study history. As I continue in this journey, the one thing which is becoming evident to me is that I still have so much to learn. By that, I don’t mean that I feel stupid but sometimes I feel quite ill-informed in specific areas and there’s all of this knowledge out there that I want to explore. My overall ambition though, is to evolve into a space where I am content. It’s not that I wish to be raving and happy all of the time but if I could get to a place where I am quietly content and can appreciate my family, friends, and the current moment in a holistic way – that’s something I’ll be continuing to strive for until 2025.

Thank you so much to Rhona for participating in this conversation series. 

Interview originally published May 29, 2015