TAMPA - Lin Cochran sits on the edge of a decision.

She is 54. She is unsure about whether she has reached menopause.

When women enter menopause - at an average age of 52 - they stop menstruating. This obvious sign won't appear for Cochran because she had a hysterectomy years ago.

But Cochran wakes up in the middle of the night, beset by insomnia. Sleeplessness could be a sign of menopause, she reasons. The lack of sleep wears her down.

Should she take estrogen? Would it help?

Because adequate estrogen protects a woman's heart and bones, doctors frequently prescribe estrogen therapy - in the form of pills, patches or shots - for women in menopause.

Cochran's mother had heart bypass surgery. Will she, too, be susceptible to heart disease later in life if she rejects hormone replacement therapy now? she wonders.

Still, she is hesitant. She believes that menopause is a natural event. She isn't yet sure if it must be managed by medication.

Cochran, who works as a decorator for a fabric store in Tampa, jokes that she is probably the last woman on the planet to try hormone replacement therapy.

Symptoms of menopause, which are also signs of estrogen depletion, may begin with hot flashes or vaginal dryness.

But more serious problems may lie down the road.

Without adequate estrogen, a woman's bones may thin rapidly. She may develop osteoporosis, brittle bones that can lead to devastating spine and hip fractures.

She also may be more susceptible to heart disease. Estrogen helps pre-menopausal women stay resistant to heart disease, say doctors. With too little, arteries can become less supple and more likely to clog.

Of course, not every woman gets osteoporosis or heart disease as she ages. And some women sail through menopause without bothersome symptoms.

So how does a woman decide which group she belongs in - the group that takes estrogen therapy after menopause or the one that doesn't?

For many women, there are concerns about possible long-term hazards of taking estrogen, including whether it increases the odds of contracting breast cancer.

In recent years, the amount of information about hormone replacement therapy has been enormous, says Tampa gynecologist Bruce Shephard. Even so, he says, doctors cannot generalize when helping women decide if they should take it. Each decision must be based on the individual.

Shephard co-authored ``The Complete Guide to Women's Health'' (Penguin Press) in 1985, which was revised in 1990. He is working on another update of the book.

``In general, I am a proponent of hormone replacement therapy in the right patient who is informed,'' says Shephard.

That means knowing a woman's family history. If her mother had heart disease or osteoporosis, it is more likely that she would benefit from it. And if she has had a hysterectomy, it's easier to decide, he says.

In the 1970s, studies showed that estrogen therapy raises the risks of cancer of the lining of the uterus. But that risk can be reversed and even lowered if progesterone, another hormone affecting the uterus, is prescribed along with estrogen, says Morris Notelovitz, a Gainesville physician who specializes in menopause. He also is co-author of ``Menopause & Midlife Health'' (St. Martin's Press), published in 1994.

Notelovitz says he poses two questions to women during their annual checkups: If they are taking hormonal therapy, why? And if they're not taking hormonal therapy, why not?

``I tell my patients to stay on it one year at a time, but look to the long-term benefits,'' he adds.

Two categories of women probably should not be on the therapy, says Notelovitz.

The first group simply doesn't need it.

``If you're going through menopause without any untoward symptoms, you don't have any risk factors for heart disease or osteoporosis, and you're physically active and have a healthy lifestyle, there's absolutely no reason in the world... you should consider hormonal therapy,'' Notelovitz says.

But, these women should realize that things change, he says, especially in medicine. Therefore, they should re-evaluate their decision every year.

The second group includes women with cancers that may grow faster if they take estrogen.

``Women with breast cancer obviously are in this group,'' says Notelovitz.

Even so, in the long term, he says, medical research may be able to distinguish which breast cancer patients can safely take estrogen supplements. Some studies are under way at the National Institutes of Health to answer that question.

Whether estrogen therapy promotes breast cancer has been the latest hot button for women. Many studies say there is no increased risk, reports C. Alan Sevener in his 1995 book ``It's Okay to Take Estrogen'' (Eclectic Publishing). But he also cites a 1993 analysis of 24 studies that concluded that some risk can't be ruled out.

``The breast cancer risk seems to be very, very small,'' says Shephard. ``For long-term use over 10 years, there seems to be an increased risk. But the data is not confirmed; it's conflicting.''

Both Shephard and Notelovitz say heart disease poses a greater threat to women than does breast cancer. The benefits of taking estrogen therapy in preventing heart disease, therefore, may outweigh the slightly increased risk of breast cancer, they say.

Six times more women die of heart disease than they do of all cancers combined, says Trudy Bush, a professor at the University of Maryland Medical School, in a 1995 article of the Women's Health Digest.

Karen Morris, an office manager in Pinellas Park, has been taking estrogen therapy for 10 years, since she was 43. Even though a mammogram six months ago showed a suspicious speck in one breast, she isn't afraid to keep taking estrogen. A biopsy showed the speck was benign.

``When I take my estrogen, I can handle the world,'' says Morris.

Emotional distress and vaginal dryness were the first signs of menopause for Morris, who attributes her relatively early change of life to the hysterectomy she had in her 20s. A friend told Morris that estrogen therapy might help her weepy moods.

``I would cry at the drop of a hat. Life was hard for me,'' she says.

Because estrogen therapy helped her so much, she has become its biggest cheerleader.

``I say it's working great for me; you may want to try it,'' she tells other women.

Notelovitz says estrogen isn't a substitute for antidepressant medication but it can improve a woman's mood. And emerging research hints that it may affect the brain in other ways, he says, such as preventing or slowing down the onset of Alzheimer's disease.

Once a woman decides that she wants estrogen therapy, how long should she take it?

``In 10 years time, we might have different alternatives that make this issue irrelevant,'' says Notelovitz. ``But for the present, I'm quite happy to prescribe estrogen for 10, 15 or 20 years.''

Estrogen therapy helps women build bone or reverse osteoporosis. But three years after stopping the therapy, osteoporosis can advance to what it would have been with no hormone therapy, says Tampa gynecologist Stephen Welden.

The development of heart disease after the therapy is discontinued is harder to measure, says Welden.

Welden says when he recommends hormone replacement therapy, about 15 percent of the women won't try it because they're afraid.

But his job, he says, is to help women make informed decisions.

``They have to ascertain what the risks are and be educated enough so they can decide.''

ESTROGEN: YES OR NO?

When should women consider hormone replacement therapy? If they have the following: -- Symptoms of menopause, including hot flashes, vaginal dryness or psychological symptoms, such as depression, irritability, confusion, mood swings, insomnia and early-morning awakenings.

-- An early menopause, either surgically or naturally before age 40.

-- At risk of developing osteoporosis.

-- At risk of developing cardiovascular disease.

Who should avoid it? Women who have: -- Unexplained vaginal bleeding.

-- Breast or endometrial cancer (cancer of the uterus lining).

-- Had a recent heart attack.

-- Melanoma.

Source: ``Menopause & Midlife Health''

TAMPA - Teri Boland works as a hairdresser, but for the women sitting in her salon chair, she is frequently confidante, adviser and friend.

As hair is snipped and curled, talk is likely to take a personal turn.

That's what makes hair salons a good place to educate women about the importance of early detection of breast cancer, according to the founders of a new breast cancer education program.

This month, a nationwide campaign called ``mirror image'' is under way at more than 5,000 hair salons across the country. The campaign encourages hairdressers to talk to their clients about breast cancer.

The program is new this year, and its originators plan to make it an annual event. The idea got started at the magazine Modern Salon and is sponsored by 11 salon industry manufacturers.

``We know that women feel very comfortable in salons and are used to discussing their lives and issues which affect them with their stylists,'' says American Cancer Society President LaMar McGinnis.

``Mirror image is... helping them [hairdressers] reach out to their clients with potentially lifesaving information,'' he says.

Statistics show that one in eight American women will be diagnosed with breast cancer, especially as they get older. The American Cancer Society estimates that 182,000 women will develop breast cancer this year and 46,000 women will die from it.

Early detection, through breast self-examinations or mammograms, increases the odds of survival because the cancer is most treatable in early stages.

Salon Colorance, a hair salon in Carrollwood owned by Boland and her husband, Adil, is one of the shops participating in the mirror image campaign.

Other hair salons in West Central Florida taking part are Hair Junction in New Port Richey, Mystic Hair in Tampa, Yellow Strawberry in Sarasota, Scissor Sisters Salon in Dunedin and Hair Ego in Safety Harbor.

``We cater mostly to women, so this was a good idea for us,'' says Adil Boland of Salon Colorance. ``Ninety-five to 97 percent of our clients are women.''

A longtime client, whom the Bolands also consider a good friend, was diagnosed with breast cancer recently, another reason they wanted to participate in the campaign.

In their salon's bathroom are posters explaining what women can do at different stages in their lives to detect breast cancer. For instance, women in their 20s should do breast self-examinations every month; women older than 40 also should have regular mammograms, as recommended by the American Cancer Society.

The salon's hairdressers are wearing T-shirts that say ``mirror image'' in reverse so the words can be read by clients looking into the mirror. Brochures about breast cancer are by the cash register for clients to take home.

The stylists also are talking about breast cancer.

``Teri and I discuss women's issues, particularly health, and Teri is very well-informed,'' says Linda Hughes, a frequent client of Boland.

Hughes, who is 47 and works as a personal trainer, says the reason she feels comfortable discussing things with Boland is because they have developed a personal relationship.

As for Boland, she says the hairdresser's chair is a good place for women to hear about breast cancer and early detection. Because many women who visit salons do so regularly, repeating the message may help it sink in.

``The more they hear it,'' says Boland, ``eventually they'll get the idea.''

FACTS ABOUT BREAST CANCER

-- Finding breast cancer early can save your life.

-- As you age, risk for breast cancer increases. Three-fourths of all breast cancers occur in women older than 50.

-- Most women diagnosed with breast cancer have no history of it in their families.

-- Early detection often means less surgery.

-- Women older than 20 should do a breast self-examination every month to detect lumps or notice changes.

-- Women between 20 and 40 should have their breasts examined by a physician every three years. After age 40, a doctor should examine your breasts every year.

-- The American Cancer Society recommends mammograms for women without symptoms every one to two years if they are age 40 to 49. Women older than 50 should have mammograms every year.

Source: American Cancer Society

Women can reduce the chances of having a baby born with spina bifida or anencephaly by taking folic acid.

TAMPA - It's a simple step.

Yet few women know about it.

If you're a woman who might become pregnant, take a vitamin containing folic acid every day.

The chances of your baby being born with the serious birth defects spina bifida and anencephaly will be reduced dramatically.

The U.S. Public Health Service recommends that women of childbearing age take 400 micrograms of folic acid daily.

If all women in the United States followed that advice, the number of babies born with spina bifida and anencephaly, disabling and fatal birth defects, would fall by 50 percent to 75 percent, says Godfrey Oakley, who heads the birth defects section of the Centers for Disease Control in Atlanta.

Now, every day in the United States, six to nine babies are born with the neural tube disorders, says Oakley.

Spina bifida is caused when the neural tube, which becomes the spinal cord, fails to close when being formed in an embryo. This happens during the first weeks after conception.

Children born with spina bifida often can't walk, may need shunts to drain fluid from their brains and can lack bowel and bladder control, says Jeane McCarthy, a neonatologist at All Children's Hospital in St. Petersburg. Two newborns with spina bifida were being treated there last month.

Spina bifida patients usually need medical attention throughout their lives, says McCarthy. Babies with anencephaly are born without brains or only partial brains and die soon after birth.

But because these defects happen so early in gestation, they can occur before a woman first misses a menstrual period and realizes she is pregnant.

That is why doctors now recommend that women take folic acid before they plan to become pregnant. Such a routine also would protect unplanned pregnancies, estimated to be about half of all pregnancies in the United States.

But most women don't know about the protective benefits of taking folic acid.

A Gallup poll in March for the March of Dimes Birth Defects Foundation showed that only 28 percent of American women take folic acid daily. Even fewer - 15 percent - were aware of the U.S. Public Health Service's recommendation issued in 1992.

The recommendation came after medical studies in the 1980s and early 1990s showed that adequate folic acid intake could dramatically reduce the number of babies born with spina bifida or other neural tube disorders.

The studies were done in the United States, Hungary, the United Kingdom and Australia.

In them, women took folic acid supplements instead of just getting the vitamin through food. It's almost impossible to meet the daily requirement by diet alone, says Oakley of the CDC. Leafy, green vegetables and legumes are foods that contain folic acid.

Folic acid in pill form is better absorbed by the body than folates - the form of folic acid in foods. You need about twice as much folic acid when it comes from food to meet the recommended dose, says Oakley.

``I recommend women do both. Eat a good diet and take a [folic acid] pill,'' he says.

Many multiple diet supplements contain 400 micrograms of folic acid. Prenatal vitamins usually have 800 micrograms, but that is to protect a pregnant woman from getting anemia in later pregnancy and not to prevent birth defects, says Oakley.

There is no danger, he says, of consuming too much folic acid and it has no known side effects. Folic acid is water soluble, meaning any excess will be excreted in urine.

High doses do have the potential of masking anemia caused by too little vitamin B-12, primarily in the elderly, says Oakley. But that is rare.

Oakley would like to see America's grain and cereal supplies fortified with folic acid. Some breakfast cereals, such as Total and Product 19, already have it.

The Food and Drug Administration is finalizing recommendations to do that in some form. Completion of the recommendations is expected in the next few weeks, says an FDA spokeswoman.

``It is prevention by the stroke of a pen,'' says Oakley. ``It's an enormous opportunity to increase the likelihood of having healthy babies.''

FOLIC ACID AND DEFECTS

-- More than half of neural tube defects can be prevented if all women of childbearing age consume 400 micrograms of folic acid before and during pregnancy.

-- The most common neural tube defects are spina bifida and anencephaly. Spina bifida results from the failure of the spinal column to close. Anencephaly is when skull bones fail to develop completely and there is only a partial brain or no brain at all.

-- The neural tube develops about three to four weeks, or 18 to 30 days, after conception. This is often before a woman realizes she is pregnant.

-- Six to nine babies are born each day in the United States with spina bifida or anencephaly.

-- In 1992, the U.S. Public Health Service published its recommendation that women of childbearing age consume 400 micrograms of folic acid every day, beginning at least one month before a pregnancy begins and continuing through the first three months of pregnancy. The recommended dose also is calculated sometimes as.4 milligrams. That is another way of saying 400 micrograms.

-- The easiest and most effective way to get enough folic acid is to take a vitamin.

-- Some breakfast cereals are fortified with folic acid.

-- Folate-rich foods include dark, green vegetables, yeast, citrus fruits, bread, dried peas, beans, lentils, liver and organ meats.

Source: Centers for Disease Control

The last one came home seven years ago, but some things you never forget. Mostly what you don't forget is that it is going to be a long time before you get any sleep.

In all, over the years we brought home three boys from the baby factory, although about the only difference in each instance was the cost.

I think the tab for No. 1 was $10, which was for the use of the television in the room. It seems to me that No. 2, who came along three years later, went up to around $350 and that No. 3 went just over the four-figure mark, assuring that there would not be a No. 4.

I assume that the real cost for each delivery at the baby factory was considerably more than that, but in those days insurance covered most of the charges.

Like everything else except most of our paychecks, those costs have gone through the roof.

Unfortunately for those of us who still think having a baby is a reasonable alternative to actually having some money left over two days after pay day, things are getting tough.

It's not that having a baby has changed much in the last few years.

What apparently has changed is that doctors are no longer in charge. It seems to me that in the dark and misty past, it used to be the doctors who told you if you were going to live or die and what you should do in either case.

Of course, in those days you generally knew who your doctor was and there was a pretty good chance he might recognize you, even with your clothes on.

Now health care has largely been turned over to the insurance companies, which run health-care programs through what are known as HMOs (Huge Moneymaking Operations).

These HMOs work because they are able to cut costs that the old traditional ways couldn't deal with.

HMOs don't quite have the personality of the old family doctor. I mean it's not likely you're going to get a TV series like those for Dr. Kildare and Ben Casey, only now called ``HMO'' on the tube.

IT'S A BOY, Y'ALL COME BACK

A story in The Chicago Tribune this week told of one 28-year-old mother who was ordered out of the hospital 24 hours after giving birth to a girl. The story said it was typical of what is being called ``drive-through delivery'' mandated by HMOs trying to cut hospital stays.

According to the story, maternity stays that in 1970 had averaged 3.9 days after a normal delivery had dropped to 2.1 days by 1992 and now average as little as 24 hours in some states. Shoot, it usually took me 3.2 days just to sign all the forms in the hospital's billing department.

Last month the American College of Obstetricians and Gynecologists issued a statement calling the moves a ``large, uncontrolled, uninformed experiment that may potentially affect the health of American women and their babies.''

The story also quoted an HMO lobbyist, who said: ``In many cases, there's no reason that, with an appropriate after-care program, a mother can't rest and get the care she needs at home.''

I don't know about that, but I do remember that I needed the extra couple of days of having her in the hospital to get the house straight before she came back home.

THE LAST MEAL

And I know she looked forward to that last night in the hospital, when we were entitled to our free ``gourmet meal'' the hospital treated new parents to before sending them back home with a free box of diapers and a few cans of infant formula.

What made it special was that it would be the last meal the two of you would have alone for the next 25 years.

You had your choice of dining in the patient room or going to this romantic little dining room they set aside for the banquet.

There would be four or five new mothers with their husbands. The mothers would all be carrying those little plastic doughnuts to sit on and the husbands would have four-day beards and the haggard look of someone who has just been down to the billing department.

The meals were OK, but the nurse assigned to pour the wine never looked happy. I also was a little suspicious of those little plastic cups they poured the wine into. They looked awfully familiar.

I suppose the hospitals don't do that any more. Maybe they have some kind of drive-through at the side of the hospital where you can pick up a couple of burgers with your free diapers and formula as you drive off.

The birth was difficult, a grueling labor followed by a delivery so damaging that repairs to the birth canal took two doctors several hours.

Even so, the new mom and baby were discharged less than 48 hours later.

Had the delivery been uncomplicated - or less complicated - they would have been home in just 24 hours, maybe sooner.

For those who had babies when childbirth was considered so debilitating that it required nearly a week of recovery in the hospital, a 24-hour stay after an uncomplicated birth seems inconceivable.

Now, even women who deliver by Caesarean are often home within 48 hours.

It's hard to move, much less stand, sit, walk or take care of a new baby, just six, 12 or 24 hours after a vaginal birth, 48 hours after a Caesarean.

But that's the new reality in hospitals across the country - a new reality driven by the cost-conscious insurance industry.

They're called drive-through deliveries by one board member of the American Medical Association, an organization that recently delivered official opposition to making discharge decisions based on money instead of medicine.

The new mom I spoke with called her 48-hour stay too brief.

``The day I went home I didn't even have control of my bladder or anything. I think it stinks. ... I would have been stronger and felt better if I'd had the extra day. It would have been easier dealing with the baby and I don't think it would have taken me so long to recover.''

Her criticisms are typical.

There are others, too.

NOT ENOUGH TIME

There is no data regarding the health consequences of early discharge. Insurance industry officials say that criticism of early discharge comes from doctors forced to compete in the marketplace for the first time and that longer hospital stays are possible if they are medically necessary.

But health officials warn that new mothers may not know how to care for a baby and can't learn in 24 hours.

Twenty-four hours may also not be long enough to recognize an illness in the infant such as jaundice or a complication of birth in the baby or the mother.

Twenty-four hours also may not be long enough to see if the infant is eating well.

All of these concerns have been echoed by the AMA, the American College of Obstetricians and Gynecologists and even several states. Maryland and New Jersey both recently passed laws mandating that insurers pay for a standard 48 hours of postpartum care in a routine delivery.

California and Massachusetts may follow. Even the U.S. Senate has introduced similar legislation.

On the local front, Fred Karl of Tampa General Hospital announced that TGH may offer its maternity patients two free days at the hospital in addition to the time paid for by insurance.

Karl's laudable action may be based in part on hospital marketing. It can't hurt the venerable public institution in its managed care wars to offer two free hospital days that in turn will attract the profitable private obstetric trade.

But is legislating the length of hospital stays - even though it's appealing - wise?

MONEY VS. MEDICINE

One local gynecologist who got out of the obstetrics business after 30 years and an uncounted number of babies says discharge decisions shouldn't be made in the political arena or the insurance office.

``That isn't medicine. That's money and politics.''

Lumping all new mothers into one group is impossible, he says. There's a difference between a teenager giving birth to her first child with no help at home and a mature woman giving birth to her fifth with a house full of support.

``I've had patients who wanted to go home right away. If there's no medical reason not to, they ought to be able to. It's very hard to make hard and fast rules.''

He agrees sending women and babies home too early poses risks.

But ``too early'' depends on the woman, the baby and circumstances, he says.

``It's all so individual. I don't know how you legislate this kind of thing.''

If he had to choose, however, between blanket early discharges or government-mandated extended stays, he'd pick the latter.

``I'd rather err on the side of safety.''

LAND O' LAKES - It was nearly a century ago that a professor at Johns Hopkins Medical College told one of its first female doctors to ``go home.''

Dorothy Mendenhall didn't listen. She later would become a pathologist and discover the cell that causes Hodgkin's disease.

Today the accomplishments of female physicians are undeniable. They have quadrupled their numbers since the 1970s and now comprise 19 percent of the nation's healers - compared with 6 percent in 1900.

Doctors agree the obstacles for women aren't as blatant as in Mendenhall's day. But, simply opening hospital doors to women has not assured their equality in higher-paid, male-dominated specialties.

Women historically have and continue to cluster in pediatrics, internal medicine and family practice fields. Only in one surgical specialty - obstetrics and gynecology - do female residents command parity.

And that comes after at least 43 years, the amount of time the College of Obstetrics and Gynecology has tracked figures.

``I could have been a damn good surgeon. That's just not what I wanted to do,'' says Diana Dell, an obstetrician and president of the American Medical Women's Association in Alexandria, Va. ``Many women just look at [surgery residencies] and say, `I could do it, but why should I?' ''

Studies have found that male professors recommend women enter nonsurgical specialties more often than men, but college deans deny that female students are shepherded into particular fields. They say students merely follow their interests.

This may be true, skeptics agree. Still, the trend is anything but coincidental.

``I am aware that there are some students who are being told that they should be at home taking care of their families,'' says Nancy Mendenhall, professor and chairwoman of the department of radiation/oncology at the University of Florida (UF) in Gainesville. ``But, I think it's complex as to why more women aren't choosing surgical specialties to go into.''

Many surgical residencies span five to seven years, mandating the most demanding hours of any other. The rigid training sometimes requires 32-hour stints. And the limited patient contact helps send women into nonsurgical fields.

Ask, and few women will chalk up the gap to blatant sexism or discrimination. As Clearwater pediatrician Deborah French puts ``It wasn't that I was discouraged to enter surgery - it was that I wasn't encouraged.''

Still, the numbers are paltry.

-- In Florida, women represent 18 percent of the state's 25,555 doctors. And, of the 21 neurosurgery residents at the University of South Florida and UF, none are women. About 12 percent of the schools' 133 general surgery residents are female.

-- Female doctors comprise about 125,800 of the nation's 669,000 physicians. But only 1.4 percent enter neurology, and about 5 percent are surgery residents.

-- Fewer than 1 percent of women residents specialize in colon and rectal surgery, geriatric medicine or orthopedics.

Yet, predictions are that by 2010, 30 percent of the country's physicians will be women, according to the American Medical Association.

``If you look at other professions where women have entered, there's no reason in this world women shouldn't have been prominent [in medicine],'' says Michael Cacciatore, a third-year ob/gyn resident at the University of South Florida. ``I can't find any excuse for it.''

MISTAKEN IDENTITIES

Female physicians are uncommon enough that they sometimes are mistaken for assistants and asked to fluff pillows and do other housekeeping tasks.

About half of the 501 women residents surveyed for a medical journal article published in January said they were the targets of sexual advances. Nearly 90 percent revealed they had experienced ``sexist slurs,'' the Archives of Surgery study showed.

Women residents at USF's college of medicine say female doctors sometimes are called ``honey'' and ``darling'' by patients and colleagues. Doctors agree the names are unintentional - that they're traditional colloquialisms, a generational habit.

Gender occasionally isolates them, female doctors say, particularly from ``guy talk'' and professional discussions that may go on in male locker rooms. But, they agree, that happens infrequently.

``I haven't personally had any obstacles. But there have been situations that were very uncomfortable,'' such as the time male residents were describing women's legs, says Elsa Ulfers, a fourth-year obstetrics student at USF. ``I have personally found that I've been encouraged every step of the way.''

Male doctors agree.

``I don't see the good-old-boy system,'' says David Arnoff, a general surgery resident at USF. ``I think most young women make a decision. They see the demands of surgery and they see how we get yelled at and they say, `I'm not going to have people yelling at me. I'm not going to work 120 hours a week.'

``It's not that they are any less intellectual. They just chose not to live the lifestyle.''

STRESSFUL TIMES

Time restraints perplex both men and women. So much so, that during the mid-1980s medical schools in New York tried to limit work for all residents to 80 hours a week.

Surgeons exploded. There was no way students could get the training they needed or keep up their hospital workload on those hours, they said.

``It's absolutely grueling,'' says Jane Orient, executive director of the Association of Physicians and Surgeons in Arizona. ``I don't think you should look for equal representation in certain specialties. It would be stupid. It's like expecting half of carpenters to be women.

``There are certain abilities that are better done by certain genders. You can't force women to choose certain specialties. You can't change the nature of the job. Or the nature of people who choose to do it.''

Case in point: David Arnoff's wife, Christine, was very interested in general surgery during medical school at USF. She later chose obstetrics.

``I felt most comfortable here and thought this is where I could do the most - research, some surgery and delivering babies,'' she says. ``And, yes, it does take a special personality profile to go into general surgery.

``The surgeons I know are extremely driven, aggressive and focused. It's a perfectionist type of specialty. ... Not to say that others aren't. I just didn't think I could survive the residency.''

One male surgery resident among a dozen interviewed at Florida's three medical schools - in Tampa, Gainesville and the University of Miami - admits, ``We're very crude and rude in front of women. Dirty jokes. Vulgar language. There's no holding back. Surgery is the last bastion of manhood.''

Figures prove him right. Only 7 percent of the country's surgeons are women.

MEETING THE CHALLENGE

``Unlike other forms of medicine, I think [surgery] is one of the last disciplines to come around to the fact that women are just as good as men. ... You have to be aggressive,'' says Jancentha Buggs, a second-year general surgery resident at USF and the only girl in a family with three children.

``I think you know [the challenge] and you're prepared for it,'' she says. ``So it makes you work harder. It makes you a better doctor.''

She tried to suppress an interest in general surgery and convince herself she didn't want to live the life of a surgeon. Two years ago she gave in.

She has no regrets. Buggs speaks of surgeons like Marines.

``Without a doubt a surgeon is respected and almost admired by your colleagues because everyone knows that internists can only do so much. At some point pediatricians say, `OK, it's bad; we've got to call the surgeon,' '' she says. ``It's an ego thing. You come in and everyone steps aside.''

Still it can be intimidating for a woman to be alone or one of the few in a sea of male residents. Medical college residents say more women would be drawn to surgical programs if there were more of them.

``If little girls grow up and know they can be a doctor, then that is going to have an effect on the amount of women in medicine,'' says Dell of the American Medical Women's Association. ``That's really changing the imagery of women professionals. Kids coming up have seen pediatricians who are women and they are familiar with them. It's no longer the doctor `he.' ''

Figures from medical schools echo Dell. About 36 percent of today's medical students are women. And, Buggs says, it's up to female doctors to take this generation of women physicians under their wing.

``In light of the fact that there is an overwhelming amount of stress, that one bad call and a human being is dead, you need to constantly verify to yourself that this madness you deal with every day is surmountable,'' Buggs says. ``I think the affirmation of that is being able to identify with someone who is similar to you. Where you can say, `They did it. I can, too.' ''

SPECIALTY       YEARS      WOMEN/MEN  % OF     WOMEN/      % OF
                RESIDENCY  (UF)       WOMEN    MEN (USF)   WOMEN
OBSTetrics/gyn  4          12/11      52       16/13       55
General surgery 5-7        10/49      17       6/38        14
Neurosurgery    5          0/14       0        0/7         0
Pediatrics      3-5        46/28      62       11/18       38
Psychiatry      4          16/22      42       11/18       38
Internal medcn  3-5        30/84      26       38/100      28
Cardiology      5          1/10       9        0/10        0

Sources: University of Florida and University of South Florida medical schools Tribune graphic

TAMPA - Terry was more angry than scared when she tested positive for HIV. Her reaction made perfect sense to a distressed 18-year-old mind.

``When I found out, I wanted to kill the world,'' she tells six women relaxing on a circle of worn, cloth couches. ``I had sex with a whole lot of men. I don't want to even count.''

Some nod and say they know where she's coming from. Others remain silent.

Welcome to the weekly support group for women with HIV at Francis House, a place where they can talk openly about living with the virus that causes AIDS.

They tell their stories in rambling, two-hour sessions surrounded by paintings, some unfinished because the artists died before completing them.

The women paint a picture of their own lives with the hope of helping others.

Run by Sister Anne Dougherty, Francis House has offered understanding since 1989 to those HIV infected.

More than 300 men, women and children come to the North Florida Avenue building seeking help through a variety of support groups. Workers also provide child care; art, fitness and nutrition classes; and counseling.

The support groups help those infected or affected by AIDS, including sessions for Spanish speakers, survivors who have lost a loved one, and another specifically for women, the fastest-growing group of new HIV cases nationwide.

Terry and other members of the women's group talk frankly about their symptoms and AIDS-related ailments. They are plagued with bouts of diarrhea, vaginal herpes outbreaks during pregnancy, and exhaustion. They also worry about chronic yeast infections and cervical cancer.

They compare T-cell counts, which measure the strength of their immune systems.

T cells are a type of white blood cell that defends the body against infection and cancer. A count below 200 is the main indicator of AIDS; a normal range is 800 to 1,200.

The women jokingly snub a newcomer, an infected high school student, when she says her count is more than 1,000.

``Can I have some of yours?'' they tease.

Some women swear by AZT - a drug that keeps HIV from replicating. Others swear they'll never take it. They say it causes T cells to drop.

Maria Caride, 28, takes as many as 10 pills a day. The Tampa resident has her own system for timing the medication: ``I'm going to take them all in one hour. ... Otherwise, I'll forget.''

Doctors think Maria got the virus in her early teens. She has known for five years.

She gets irritated when people tell her everything will be fine.

Terry, now 25, of St. Petersburg, agrees. ``They say, `Honey, it'll be OK.' But it won't be OK if I don't wake up.''

Some of the women, including Terry, didn't want their last names revealed. Terry fears repercussions from her past; others want to protect their families, especially their children.

Some families don't know.

Like others in the group, Terry doesn't have visible symptoms such as severe weight loss or skin lesions.

They share something else: Most were infected through unprotected heterosexual sex.

That's a big change from a few years ago when most women contracted the virus from sharing needles with other drug users, says Ericka Burroughs, community educator with the Tampa AIDS Network.

``Their partners are bisexual, I.V. drug users or have other partners without protection,'' says Burroughs.

ON THE STREETS

Terry joined a gang as a teenager in St. Petersburg and soon was addicted to crack cocaine and alcohol. She turned tricks to pay for her next fix.

As a joke, Terry and fellow gang members went to the health department for screenings for sexually transmitted diseases. What she found out wasn't funny.

She got married at 22 but couldn't get up the courage to tell her husband her secret. As it was, she had to get high to break the news three years later.

``He said he wanted it, too,'cause he's in love,'' Terry says, rolling her eyes in disbelief.

He has tested negative for HIV. So have her four children.

Terry shows up at a recent meeting wearing a hoop in her nose and trendy, oversize clothes on her small frame.

She says she dresses up to visit high schools as part of the outreach program of the AIDS network. At the schools, Terry tries to project a serious air with the hope that her story will keep at least one student from treating AIDS lightly.

She wants them to see that people with HIV can look like everyone else. Most stare in wide-eyed disbelief when she introduces herself.

``I want you to know I'm a beautiful woman, but I'm also a dangerous woman to your health,'' she tells them.

Still struggling with her addictions, Terry is back in a drug rehabilitation center in Tampa's Town'N Country neighborhood.

She's away from Francis House for weeks or months at a time. But the women still greet her with open arms whenever she returns.

``We're glad you're back,'' Maria tells Terry with a hug.

KEEPING IT TOGETHER

Maria first married at 15 in a small town in Massachusetts. Four years and two children later, she found out her husband was shooting drugs.

They split up and Maria took the children.

A few years later, she got pregnant and came down with shingles, a viral infection that commonly plagues older people with impaired immune systems. The infection caused blisters and pain in her nerve endings.

Her doctor suggested an AIDS test. No one prepared her for the results.

``All they told me is that I'm HIV positive and my kids have a 50 percent chance [of being infected]. I felt like a zombie. I kept thinking my kids are going to die.''

Thankfully, they tested negative.

A year later she met her current husband. She told him about her disease and said she wasn't looking for a relationship. Still, he persisted.

``He said, `I'm not going to judge you for that. That's your past.'

``He stood by me. He didn't want to let me go,'' she says.

After building a four-year relationship, they got married. She talked him into an HIV test, which came back positive.

A former intravenous drug user, he thinks he had the virus before they met.

They moved to Wimauma to make a new life. The unexpected happened - she got pregnant even though they used condoms.

This time Maria took AZT. The drug can decrease the chance of a mother passing the virus to her child from 30 percent to 8 percent.

The AZT worked. She and her husband have a healthy baby girl; they call her their ``miracle child.''

Growing up with two HIV-positive parents has caused her children to learn adult values early. She tries to instill independence and realism.

What's the point of finishing school, her 12-year-old son asks, if Mom might not be around to see graduation?

Maria tells him: You can't do it for anyone else but you.

``I don't want him to give up on life because I might not be here,'' she says.

Last year, Maria went to the funeral of her first husband.

She approached his girlfriend to tell her she was HIV positive.

The woman told her what Maria had suspected but never heard from her ex-husband: He was HIV positive and had been for years. But he never told her.

Although still angry, Maria uses the story as an example to her children to put themselves first.

``The bottom line is you are responsible for yourself. `I've got to watch out for me.' Your life is in your hands and you need to take full control.''

BREAKING UP

Christy thinks she got the virus from a blood transfusion after she was hurt in a car accident in 1983. A year ago her doctor suggested an AIDS test. Christy was married, had a son and was two months pregnant when her test came back positive.

She took AZT during her pregnancy but it didn't work. Both her sons have tested positive. Her husband, negative.

Christy and her husband's relationship took a turn for the worse when she broke the news.

``He's taking drugs to cope. It disturbs him more than me. Shouldn't it be the other way around?'' she asks.

The Seffner resident says she can't work anymore because of the persistent numbness in her hands and feet. She's not sure if it comes from her medication or the disease.

Christy is hoping for a disability check.

``I've worked all my life making $9 to $10 an hour. I had to quit. I applied for Social Security but... I've been waiting for two years. When do they want to give me the check, when I'm in my grave?''

The 29-year-old says it's difficult taking care of two children she constantly must take to the doctor.

A two-week supply of an antibiotic her younger son needed to fight an infection would have cost her $398 if it weren't for Medicaid.

She has chosen not to tell the kids, but thinks her older boy knows.

One afternoon while watching television, a story on AZT and AIDS patients appeared on the screen. It's a drug he has seen around the home.

``He looked at me like he knew. I was waiting for him to ask and he didn't. It was as if he didn't want to know.''

He wished to go to Walt Disney World; Francis House sent him. When he asked Christy why, she told him it was because he's special.

Christy asks: What else could she say? She didn't want to tell the 9-year-old the truth.

While most of the women struggle to explain death to their children, they have come to accept it themselves.

``There's no guarantee even if you don't have HIV. You were born to die,'' says Maria.

Beyond the disease, understanding binds these women.

``It's like no matter what problems I have or how I feel, I can let it all out here without being judged. There's no conditions here,'' explains Maria.

``You really feel the love and caring when you come through those doors.''

Through lunch and past their scheduled session, the women share a part of themselves.

Terry says, ``I feel if everyone would just work together to speak to the community...''

``... it'll give a wake-up call across class and race lines,'' finishes Maria.

Christy says the key to stopping AIDS is to stop the denial. She calls it ``the lie.''

``The lie is: `I don't want to know.' ''

AIDS FACTS

According to the national Centers for Disease Control and Prevention: -- 58,428 women in the United States have AIDS.

-- Women represent 18 percent of all cases, up from 7 percent 10 years ago. (In Hillsborough County 387 women have AIDS - about 14 percent of county AIDS cases, health officials say.) -- It is estimated that one in 800 women have HIV.

-- AIDS is the fourth leading cause of death in women 25 to 44 and the leading cause of death in black women in that age group.

QUESTIONS?

-- National AIDS Hotline
(800) 342-2437

Spanish hot line
(800) 344-7432

Hearing impaired
(800) 243-7889

-- Florida AIDS/HIV Hotline
(800) 352-2437

Spanish hot line
(800) 545-7432

-- Tampa AIDS Network
(813) 979-1919

-- Francis House
(813) 237-3066

TAMPA - With women demanding more improvements in the status quo nowadays, one area that has seen many changes is health care. And if statistics are an indicator of supply and demand, more women are switching to female gynecologists.

The University of South Florida graduated five men - but no women - from its 1985 obstetrics/gynecology residency program, says Michael Hoad, associate director for public affairs at USF Health Sciences.

But this summer's incoming class consists of one man and five women.

``It's nearly a complete reversal in a little over 10 years,'' he says.

Nationally, the percentage of women ob/gyns has increased from 18.1 percent in 1985 to 25.9 percent in 1993, the most recent year for which figures are available from the American College of Obstetricians and Gynecologists in Washington.

``The pendulum has swung,'' says Anna Parsons, assistant professor of ob/gyn at USF. ``Women ob/gyns are hot properties now. Women used to think female doctors were inferior, as everyone did. But now that women in general are more empowered, they appreciate women in all medical professions.''

Marci Krop, a gynecologist who has practiced in Clearwater and Tampa for nearly two years, says she has many patients who have switched from a man. ``They just feel women understand better what they are feeling, what they are saying. However, I have known males who I think do a great job and women who fit the stereotype of the uncaring male,'' she says.

One Tampa resident who prefers the woman-to-woman rapport is Evelyn Stewart.

``I just recently switched to a female ob/gyn, and I'm glad I did,'' she says. ``I always felt like he [her former male ob/gyn] was getting too personal and too friendly. I was talking to him once about a persistent leg cramp, and he kept asking me about my sex life.''

Others have had more traumatic experiences that caused them to change doctors. One patient stopped going to her male gynecologist because of an incident that happened when she was single and in her 20s.

She suspected she was pregnant and went to her gynecologist - a man in his 50s - for a test, hoping the results would be negative. But when he came back to tell her of the positive results, she recalls, he broke it to her by saying, ``So, you've been messing around with the big boys and it caught up with you, huh?''

``He was very flip and unprofessional about the whole thing,'' she says. ``I was humiliated and embarrassed - he made it a worse experience for me than it already was.''

PUSHED HYSTERECTOMY

Another Tampa woman says that in the'80s, she underwent surgery for a precancerous condition of the uterus and a severe infection developed. Her male gynecologist immediately wanted to do a hysterectomy.

``I was in my early 30s and I didn't want that,'' she says. ``I had to push him to give me antibiotics to see if that would work first.''

Ten years later, her reproductive organs are still intact and functioning properly.

``He just wanted the money. He didn't care about me as a human being,'' she says.

Compassion and better understanding are the reasons most often given by patients who opt for a woman ob/gyn.

``The majority of my patients who have switched mainly say they weren't given the time and that things weren't explained to them,'' says Mary Lee Josey, a Tampa ob/gyn. ``They feel that since women have children, they can understand each other better.''

That rapport can benefit physician and patient in other ways. Women sometimes are inclined to withhold past conditions, such as terminated pregnancies or sexually transmitted diseases, on a medical history if the physician is male.

``Some things are embarrassing,'' one Tampa woman says. ``I think males are judgmental and look down on us.''

Another aspect of the gender argument focuses on age.

``I find that the younger physicians view women in a much more positive light,'' says Linda Saul-Sena of Tampa. ``When I was pregnant, my gynecologist was the senior doctor in the practice. I was having a lot of pain, and we discovered it was caused by a cyst.

``When I asked him what I was supposed to do, he said, `Suffer.' I wrote the most scathing letter to him and switched to a woman.''

Later, after Saul-Sena's woman ob/gyn moved to a larger practice, she stayed with the same group. Her current ob/gyn is male, but younger than the one she saw during her pregnancy.

``The younger ones have gone to school with women and have been socialized with the idea of women as professionals and as fellow members of the human race,'' she says. ``I think they can relate to patients better than those from the old school.''

MORE CHOICES

Tampa ob/gyn Kathleen Kilbride says she understands why so many women feel more at ease with a woman ob/gyn, but added that the sex of the physician doesn't necessarily influence the care given.

``The good thing about more women going into the field is that patient choice becomes greater,'' she says.

If there is a downside, it comes at the expense of male physicians.

``I think males end up suffering reverse discrimination because of the stereotype of women doctors as more sympathetic,'' Krop says.

And, indeed, males are experiencing the feeling of discrimination as early as medical school.

``Because more and more women have been going into ob/gyn, now our male residents are grumbling about feeling they're being discriminated against,'' USF's Parsons says. ``It's very irritating to them.''

But are established male ob/gyns suffering the same pangs as the residents in the Tampa area?

Michael Jaeger, who has practiced in Tampa for six years, acknowledges the perception by women that women physicians make better doctors.

``But most people just want a caring person who simply understands the physiology of the problem. A good doctor is a good doctor, regardless of gender,'' Jaeger says.

``And we don't really feel women are encroaching on a male domain. There are other changes in medicine that supersede that argument. We feel encroached upon by insurance companies and things much higher.''

Krop agrees. ``I think the benefit of more females in the field is that women are lucky to have a choice these days,'' she says.

GRADUATES FROM USF'S OB/GYN RESIDENCY PROGRAM

            NUMBER   NUMBER  % OF 
    YEAR   OF WOMEN  OF MEN  WOMEN
    *1998     4         2     67 
    *1997     3         3     50 
    *1996     2         4     33 
    *1995     3         3     50 
     1994     3         3     50 
     1990     2         3     40 
     1985     0         5      0 
    *Projected number of graduates
   Source: USF (Anna Parsons and Michael Hoad)


HOW WOMEN HAVE FARED NATIONALLY AS OB/GYNS

          NUMBER    NUMBER  % OF 
    YEAR  OF WOMEN  OF MEN  WOMEN 
    1993   9,240   26,379   25.9 
    1990   7,551   26,146   22.4 
    1985   5,597   25,270   18.1 
   Source: American Medical Association