His words penetrated like shards of glass; my face flushed and my eyes welled up. We were sitting in his dingy office in the entrails of the hospital, dirty coffee cups littering his desk, stacks of papers in disarray, photos of a family who must love him thumbtacked to the wall and all I wanted to do was to scream. “I am not going to let him see me cry,” I willed myself. I swallowed the lump in my throat and, realizing it was pointless, I navigated the conversation to the end. I walked out of his office, down the corridor, to the chapel and then I cried. It was a cry of sadness and anger. I had gone into his office to ask for the same hourly salary earned by my colleagues; equal pay for equal work. But he didn’t feel like dealing with me on a Saturday afternoon. He wanted to work his shift and not be bothered by administrative duties. “Personally, if it were up to me, I wouldn’t have any internal medicine doctors working in my department.” His words reverberated in my mind.
Dr. Weiner, whose name matched his personality, was the acting chairman for his department; the understudy, temporary and replaceable. With callous detachment, he told me: a) not only did I not deserve equal pay, but b) I was inferior to his skill level and those of the other doctors in his specialty. He didn’t just hit. He hit below the belt. When I asked him for a pay raise, you’d have thought I was asking him to wire transfer the money directly from his own account. Hospitals and departments have budgets but he chose to respond to my legitimate request by ambushing me.
I’m valuable to his department, working there long before their program existed. As a student, I sewed up a dead guy’s chest in the trauma room before his family said their final goodbye. A year later, I met my husband, an intern, as he attempted a spinal tap on a large, obtunded woman. I’ve grown up in that hospital over the past quarter of a century; first as a student, then as a resident and now as faculty. I’ve argued with anesthesiologists and orthopedic surgeons, told undocumented immigrants they don’t meet criteria for emergent hemodialysis and Spanish-speaking women that their pregnancy has failed, examined more body parts and heard more stories than there are words to a page. Since the new program began 7 years ago I have covered shifts so faculty can attend Wednesday lectures, retreats and I pitch in whenever they are short-staffed. I’m a skilled clinician, respected by nurses, physician assistants, nurse practitioners, residents and other physicians. I can quickly clear a busy waiting room and I see patients independently. I don’t have to have a resident there to do the dirty work. I do it myself.
To provide some background, my training is in internal medicine. Internists are the thinkers, the problem solvers, the puzzle fixers. I’ve practiced medicine for 19 years if you count since the end of my residency training, 22 years if you start the clock at the end of medical school. Though an internist, I still like to work in the acute care setting of our city’s large, public hospital. This department is a relatively new field and as the new kid on the block, they are still trying to stake their claim. Like a dog marking his territory, Dr. Weiner was pissing around the perimeter of his domain that afternoon. I got too close to the boundary and damn near got bit.
Theoretically, medicine is the noblest of professions, based on compassion to others. However, to one another, physicians can be terribly cannibalistic. Especially within teaching institutions, egos run amok and thinly veil insecurities., Asking a consultant for recommendations, because it’s in the patient’s best interest, often results in a dressing down. Collaboration is perceived as a sign of weakness. If you can’t figure it out on your own, then you might as well pack up your bags and go home. It’s a subtle form of shaming. Internists do it to surgeons. Surgeons do it to internists. All specialties do it to emergency medicine doctors because they are the ones trying to admit patients to your hospital service. Finally, men will shame women and then women will shame other women or those inferior to them in rank.
This caste system, or hierarchy is not new and though it’s improved over the past 2 decades, it’s still pervasive. I’ll complain to my husband, a white, male doctor, about this and, because he doesn’t fit the mold, sometimes he gets defensive or his feelings hurt. He tries to understand the undertones of sexism and racism experienced by his wife or his colleagues and he becomes indignant on our behalf. He offers, “If I had been in that room, I would have said or done this or that.” But he’s always had the good fortune of walking into the patient’s room, the meeting or the consultant’s office in his white coat as a white man with everyone automatically assuming he knows what he’s talking about, deserving of awe and respect. As the white man, even when you mess up, you are still venerated. My kids have coined the phrase, “Dad Facts”. Dad Facts are proclamations of truth based on nothing other than a father’s insistence that it is so. Once, my 17-year old son was asking me a serious of questions to which I had no answer. My response was, “I don’t know” to all of his queries to which he sighed, “I wish you just had some Dad Facts. Even if the answers don’t make any sense, they are still comforting because they are stated with such conviction.” Dr. Weinerwould have never spoken to my husband the way in which he spoke to me. If he had, my husband would have come after him with some Dad Facts and set the world back on its axis.
Let me offer a few vignettes as illustrations. Recently, I accompanied my husband while he went to get his allergy shot. Our middle son wants a cat and my husband is deathly allergic, as in throat-closing, epi-pen needing anaphylaxis. But, because he loves our kids so much, he is willing, quite literally, to put his life on the line for our son. When we pulled into the clinic’s 1970-style parking garage, the car across from us was being broken into by a young black male.
A young black male was breaking into the car parked across from us.
I made a mental note to myself in case I needed to give a description to the cops: He was about 30 years old, bearded, skinny, 5’11’ and he wore a yellow construction vest, jeans, a navy t-shirt and jandals with socks. We watched as he unsuccessfully jammed, in through the driver’s side window, a white, metal coat hanger twisted into a 2-foot long probe. “Hey man,” he called to us, “you have a long piece of metal I can use? I locked my keys in the car.” We shook our heads and kept walking. One of us mentioned to the other, “Do you think he really locked the keys in the car or do you think he’s trying to steal it?”
Thirty minutes later when we walked back to our car he was still fishing through the window. However, this time he had his wife, their 4-year old son and infant daughter, waiting patiently alongside him. The family unit changed our biases. Suddenly he was no longer a thug trying to steal a car, but an unfortunate young man trying to get his family home. For the next 45 minutes he and my husband worked together on a common project, trying to open the car door while, I talked to the mom and entertained their little boy. Finally, a locksmith came along and opened it with a slim-jim. We paid for the locksmith because they didn’t have enough money. We left with a sense of satisfaction that we had done something good but neither one of us addressed the underlying prejudice we had both brought to the table.
So, a little bit of backstory: my mother had me when she was 19 years old without a shot-gun wedding to legitimize the situation. It was quite the scandal. Just before I turned 2 years old, she married the man who adopted me and who I consider my father. They had my little brother but separated and divorced by the time I was 13 years old. Though she later went on to get a nursing degree after my brother and I left the house, she raised us on less than $20,000 a year. Determined never to be in her financial situation, I decided I’d work hard and become a doctor, like her brothers, my uncles, whose monetary support helped us survive. I also discovered, early on, that my brain was my biggest asset. The better I did in school, the more people paid attention to me. I got noticed enough to get a partial scholarship to a private, 4-year liberal arts college.
Most of what you learn in college is done outside the classroom. I had just moved into the dorm, classes had not yet begun, and one afternoon several handsome fraternity boys came through the dorms dropping off embossed invitations to the incoming freshman girls. The tea parties to which we were invited were supposed to be social gatherings intended to welcome new female students; at least this was the justification on paper. In reality, they were sanctioned date-rape parties. The night of the parties, a dozen of us from my floor, strangers just 2 days prior, put on make-up, party dresses, heels and walked over to fraternity row where these seemingly polite, young men poured us fancy drinks. I spent most of the night talking to a good-looking upper classman from New England. I was 17 years old, still a minor, and ridiculously naïve. When he asked to show me something upstairs, I wanted to be cool so I followed him to his room. No one was present to tell me it was a bad idea and once we were alone, he quickly tried to round the bases. When I told him he couldn’t put his hand down my pants, he became angry. I lied and told him I was on my period. This was not the night he had envisioned and he was pissed. It was late and with the only shred of decency he possessed, he drove me back to my dorm. As I got out of his car, full of shame, he told me that I shouldn’t have come to the party if I wasn’t prepared to sleep with guys and certainly not if I was on my period. “That’s the only reason we have these parties. To sleep with freshman.” It was 1986. Welcome to college.
Six years later, I started my clinical rotations in medical school. Up until that point, medical school had consisted of lectures in a large auditorium with all 200 of my classmates. Clinical rotations took place inside a hospital and you were part of a team consisting of residents several years out of medical school, other medical students and a member of the faculty who’d come by for 1-2 hours a day. Most of your time was spent with the residents who did the bulk of the patient care and teaching to the medical students. The third-year resident on my team would keep me and my female student partner in the hospital till 3 or 4 am and make us listen to his narcissistic tales of driving in fancy sports cars with Wayne Gretzky and of the number of women he had bedded (despite being married). Fred’s misogyny knew no end and he deftly wielded his power over us. He was going to be a cardiologist, was chosen to be a chief resident and he gave us our grade and evaluation. Anything to piss him off and we’d have a failing grade. So Carie and I endured his inappropriate comments and endless rants. “Are you wearing a bra?”, he once asked me. On a separate day, he asked me why I dressed like such a lesbian. Who was I going to tell? All the faculty were old white men and there was no such thing as sexual harassment in the early 90s.
Fred wasn’t the only guy to say horrible things during medical school. One day I overslept my alarm and came in 20 minutes late on my surgery rotation. The 5th year surgery resident, a loud and overly confident guy, told me in front of the entire team, I wouldn’t be late to rounds if I didn’t sleep with my boyfriend in the morning. I was the only female on the rotation except for another female physician assistant student. All the guys laughed and we were sent to change dressings on post-operative patients.
Shaming doesn’t come from men alone. Women can be equally injurious. Rather than support one another’s decisions, fear can get the better of us and we tear each other down, particularly when it comes to differences in work-life balance. My decision to work part-time was a no-brainer. I had breast cancer when I was 37 years old and my kids were 6, 5 and 3 years old. I didn’t want my impending mortality to cheat me of time I had to spend with my family. So, for the past 10 years I’ve put career aspirations on the back burner and driven a lot of car-pools, packed a lot of lunches, volunteered in many classrooms and done some doctoring. Recently, in a professionalism workshop at my institution, a very senior female faculty member stated women who work part-time have been flailing in their careers. When I envision a person flailing, I think of someone drowning with their arms and legs akimbo, struggling to stay afloat. I hadn’t been flailing at all. I was navigating my career, my family and my disease with finesse. Obviously, this woman has never met me or she’d be asking me for advice.
In hindsight, Dr. Weiner and all the other phalluses have done me a favor. Not getting that pay raise sucks but I gained something far more valuable; insight. You can be the smartest person in the room and yet lack wisdom. I’ve encountered a fair share of fools in my lifetime and I’m sure there are more to come. The ludicrousness of peoples’ comments can be comical. Every one of these characters is emblazoned in my memory. Marionettes in a dark comedy of puppets; the theater of the absurd. You can’t put a price tag on someone’s value. My worth can’t be cheapened, no matter what others may have said or done. The fact of the matter is this; I’m priceless.
- Posted using BlogPress from my iPhone
