You might have heard this riddle: “After a terrible car crash, a boy is rushed to the hospital for emergency surgery. The surgeon takes one look at the patient and says, ‘I can’t operate on the boy. He’s my son.’ Yet the doctor was not the boy’s father. How could that be?”
We really hope you guessed that the surgeon was the boy’s mother. But, if not, we get it. Even in this relatively enlightened age, when we’re in a medical context, there’s a subconscious expectation of a man in the white coat.
Doctors Zina Semenovskaya, Patsy Bowman Aiken, Scott Bader, Haren Heller Dane, and Emma Husain help us deconstruct—if not solve—some of the more challenging quandaries regularly presented to women in medicine, questions to which no one seems to have the answers.
This is the transcript for Episode 8 of the medical podcast My First Cadaver:
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“If you do a segment on women physicians, I’ll give you some great sexual harassment stories I have.”
“If I had a tenth of a penny for every time for every time that I was referred to as a nurse, as a dietitian, as a social worker, as darling, as honey, as sweetheart…”
“I baked a big batch of chocolate chip cookies and instead of starting a fight, I tried to make friends.”
“It’s very hard to walk that line between not being a bitch, but also not being a doormat.”
After a terrible car crash, a boy is rushed to the hospital for emergency surgery. The surgeon takes one look at the patient and says, “I can’t operate on the boy; he’s my son.” Yet the doctor is not the boy’s father. How could that be? Despite the fact that I was surrounded by women in medicine, I remember hearing this riddle when I was a kid and thinking, “Wait...is it his stepdad?” In all honesty, I’ve been really excited to share this episode with you all because it’s a topic that’s near and dear to my heart, because--guess what? It’s hard being a female physician. Yes, it is 2015, and rather unfortunately, it seems some things are pretty hard to change. But don’t listen to me. These women can speak for themselves.
DR. PATSY BOWMAN AIKEN:
More and more women are entering medicine as physicians.That being said, it is still very much a male-dominated field, and that creates a lot of conflict, as you may imagine.
FA: That’s Dr. Patsy Bowman Aiken.
Medicine is very, very hierarchical to this day. It completely drives my husband crazy. He just doesn’t understand it because other professions are not like that anymore. Medicine still is. The attending is the attending, the senior resident is the senior resident. You have a very specific pecking order, and if you don’t adhere to that, it does not go well for you, for the people around you.
DR. ZINA SEMENOVSKAYA:
There are a lot more women going into medicine these days and I think the statistics show that a lot of medical school classes are majority female, which I think is great, but at the same time, the establishment is still very much male, the hierarchy is still very much male,with men in the most powerful positions and in the most “prestigious” specialties.
That’s Dr. Zina Semenovskaya.
I think the society as a whole, still, even in 2015, tends to look at male--especially white, tall men--as these dominant forces and women as lesser. It’s very frustrating, and I try not to let it bother me, and I just joke about it and go about my day, but a lot of stuff happens that’s really frustrating, like I remember, even as a medical student, I was treated horribly--horribly--particularly by the nurses, the female nurses, because I was seen as competition for the males, so they’d be really nice to the male residents and male doctors, helping them out, smiling at them, winking, flirting, and just really being mean to me. The same thing happened when I was in residency. I remember when I was in residency, my residency was at a predominantly African American hospital where most of the patients were African American, immigrants from the Caribbean or from parts of Africa, and the vast majority of the nurses who worked there are also from that community and of course are mostly female as well. I remember one of my co-residents, who was an African American female, she said the only thing that’s worse than being a female resident is being a black female resident, because as horrible as they are to you, they’re even worse to me. There’s a lot of hazing that goes on there. I don’t know exactly why women get hazed so much more than men. I think that part of it is maybe a sense of competition between women in this cattiness, but I think part of it is also this societal--this ingrained thing. I don’t think it’s even conscious where people just look at men as the ones in charge and the ones who have authority. I can’t tell you how many times as the attending I’ve walked into the room, and I have my ID with the word “physician” on it, and I go by Dr. Zina because Semenovskaya is too long, and I say, “Hi, I’m Dr. Zina, I’m the attending,” and I start running things, and I might have a medical student with me who’s tall and male, and he’s quiet, he’s not saying anything, and I’m even giving him some orders, saying, hey, go do this, get me this, I need help with that, and everybody turns to him--the patient, the family turns to him and says, “Oh, doctor,” and I’m the nurse, automatically. I don’t think it’s intentional; I think it’s just where the mind goes. Again, I try to make light of it [and I say] “Yes, doctor, you run things, you talk with them, I’ll go get a coffee.” They say, “You better!” I talk with them, and get to know them better, but it’s hurtful, and it definitely interferes with things.
If I literally had a penny, a half of a penny, a tenth of a penny, for every time I was referred to as a nurse, as a dietitian, as a social worker, as darling, as honey, as sweetheart, I would be cush. I would be in good shape, which is--I don’t have a problem with that. As long as people aren’t calling me bad names, I’m OK with that, but I will say that for the amount of sacrifice and work and effort that have gone into my education and my training, it does kind of sting when you walk into a room and even if you have “Dr.” written on your white coat, it’s on your badge--I try to carry myself professionally and with authority--and to still not get credit, so to speak, for being the doctor, it’s really frustrating. I had one situation when I was a resident when I was on call in the cardiac care unit, and I had been up for 29 hours. I was busy pre-rounding because the cardiologist attending was going to be coming on the unit and we were going to be going through all the patients. So I was running around, and I was standing at one of the nurses’ stations, and I overheard a nurse talking to a patient in one of the bays, and he was waiting to have a procedure done. I had not seen him yet, and I overheard her saying to him, “Dr. Aiken is going to come in, and she’s in scrubs, but she doesn’t look like a doctor, and you’re going to think she’s maybe a volunteer or the dietitian, but she’s your doctor.” I just started laughing. I was so tired at that point that I couldn’t even get offended. I walked in and she turned and looked at me, and said, “See, there she is right now! That’s your doctor.” And the patient looks at me and says, “Yeah, you’re right, she doesn’t look like my doctor.” I said, “Well, it’s very nice to meet you, and I am in fact Dr. Aiken.” I carried forward, but a lot of my male colleagues don’t really have to deal with that.
It isn’t even just that people act like that. I think that we treat ourselves that way. I’ve been an attending for two years, and I feel fairly confident in my skills and my knowledge base, and just the other day I found myself having a professional argument with a male physician a little bit older from a different specialty, and we just disagreed on the treatment for a patient. I found myself very, very certain that I was right, and I wanted to advocate on the patient’s behalf for what I thought the treatment should be. I found myself backing down and just agreeing with him because he’s an older guy and he stood over me and said what he thought and he looked at me dismissively, and I just sort of accepted that. Later, I actually called him back and said, no, no, we’re still going to do this. In the moment, in this confrontation, I definitely reacted that way. It’s so weird, because I’m definitely a feminist, and I’ve been doing this for a little while, and it’s still there. This behavior is so ingrained, and it sucks. Again, I really don’t think people do it intentionally or out of malice the majority of the time. I think it’s just maybe cultural and just so ingrained in us. People just have these stereotypes they jump to. It happens all the time. It’s not even just between doctors and nurses. A couple of months ago, I had a disagreement with my boss. He’s a white male and he’s a great guy, he’s a wonderful guy, and we had this disagreement and a discussion, and I felt that the way in which he spoke to me was very rude and dismissive, so a few weeks later, after the issue had been resolved and we had moved on, I went to talk to him. I said,”The way you spoke to me the other day, I really felt you were kind of dismissive, and I didn’t think that was really appropriate at all.” His response to me was, “Well, that’s just how I argue. For example, when I argue with my wife, that’s what I say to her.” I said to him, “What does arguing with your wife have to do with the way you speak to me? Would you say to a male colleague who was upset with the way you spoke to him, would you say ‘that’s just how I argue with my brother?’” It just seems completely inappropriate that I’m lumped together with his wife, that the way you talk to her is the way you talk to me.” That seems completely crazy, but he thought nothing of that. I think it’s so pervasive that people don’t think it’s a problem.
DR. SCOTT BADER:
I truly, truly believe that it’s much harder as a woman to go through this whole process.
That’s Dr. Scott Bader, a pediatrician and graduate of the State University of New York Health Science Center at Syracuse.
I think part of it, and I have to look at it from the residency standpoint, I definitely saw this more. Because a majority of the nurses in the hospital are women, I’ve always seen a difference in how they interact with the male physicians versus how they act with the female physicians. They will never give at times as much respect. They always make the women physicians work harder for it. That’s one thing, and I saw my wife have to deal with that. The people I never had any problems with would drive her nuts. Other female residents I had worked with, I could see my interactions being so much different from their interactions with the nurses. When I went to college, I had two very close friends who were nurses, and they beat into me very early on that if you want to survive medical school and residency, and to be a good doctor, you have to take good care of your nurses. That’s one of the most important lessons you learn very early on in the whole process.
DR. HAREN HELLER DANE:
As part of my training as a cardiothoracic anesthesia fellow, I was supposed to be in charge of the intensive care unit.
That’s Dr. Haren Heller Dane.
Now, walking into the cardiothoracic intensive care unit, a young resident, much younger than the nurses there, they have been working there for 30 years, so imagine me suggesting something to a nurse who’s been there for 30 years when I’m a young female coming in for the first time in my first week in the intensive care unit, giving them orders, giving them suggestions. You can imagine how anything I have to say is pooh-poohed as “you don’t know what you’re talking about.” I got that a lot when I started as a new anesthesiologist. How long have you been doing this for, they ask me. A lot of it is just trying to establish credit and just keep doing what you do and doing it well, and over time people start to realize you know what you’re doing, and just not letting them get to you, not letting them see you sweat, pretty much. To win the nurses over in the cardiothoracic unit, I saw on my second day being there, that there was no way I was going to survive unless I could try to make friends with these nurses. I went home, and I baked up a big batch of chocolate chip cookies, and I came in the next day, and instead of starting fights, I tried to make friends. I brought in the cookies, the nurses loved them, and I started winning people over, and it got a lot easier.
Since this is a segment on women physicians, I’ll tell you a couple of great sexual harassment stories I have. They were just sort of like, “What?!” There was a nurse at the hospital where I did my residency, and once I asked him to place an IV in a patient’s arm for me, and he said OK. When I walked by the patient a little while later, I saw that the IV was in. I was really happy because it was a very difficult IV placement. When I saw the nurse a little while later, I said, “Hey, thanks so much for putting that IV in for me.” Without missing a beat, he replied, “Oh, that’s not the only thing I can put in you.” I just looked at him, and I was just like, what? I was stunned with his comment, and when I told other people, instead of outrage or “oh my god, that’s ridiculous, you should report him,” they just laughed and said, oh, yeah, he’s probably just flirting. Then, another time, I asked him, the same nurse, to get me a bottle of anesthetic, and instead of getting me the very small bottle that I needed, he actually brought me a much larger bottle than what I asked for. When I saw him, I said, “Oh, thanks, but I just needed the small one; I didn’t need the whole large bottle.” He said, “Yeah, well, you know you can handle a big one,” with a wink. And again, I looked at him and said, “I’m sorry, what?” But this was somehow OK, this is not something you report, it’s something you laugh about, and people were like, oh, he probably wanted to compliment you, he probably just thinks you’re sexy. I said, “No, no, I think we’re missing something here.” I think what’s missing is that I think there’s something really awful, but nobody else seemed to see anything wrong. Stuff like that happens all the time. I just recently had a nurse at the hospital where I work now, the one in Brooklyn, tell me, “If you’re going to work here, you’re going to have to wear bigger pants.” I wear scrubs to work usually, [so I said], “I don’t understand what you're saying. Are you saying I’m fat? That I should wear bigger pants? These pants fit me just fine.” I don’t even know why I responded to that comment, but I was just so perplexed. He just looked at me and said, “Yeah! You are so fine in those pants!” and he laughed. I thought, is he just checking out my ass with the comment that I shouldn’t wear scrubs that are quite so tight? It was just so crazy, it was OK that he said this to me out in the open, in front of everybody. This is baffling to me. You can’t really do anything about it, because if I make a big deal about it, then I’m a person nobody wants to deal with. So you just have to laugh it off. But it’s 2015 and it’s still going on.
DR. HAREN HELLER DANE:
I felt like I had a harder time with older nurses; not so much the young ones. I can relate to the young ones. The older ones were harder to win over because until you’ve proved your ability, they believed you didn’t know what the hell you were doing. I also had trouble with the men, because the men--and I still get this sometimes--they just think I’m pretty. I mean, I may be pretty, but I also have something to contribute here. I want you to listen to what I have to say, because what I have to say will help our patients and will contribute to our patients’ well-being, and I wind up a lot of times acquiescing and making jokes. In the operating room, as a medical student, I remember one particular rotation that I was on in medicine, and I was trying to learn as much as I could, absorb as much as I could on this rotation, I was really interested in internal medicine at the time, and it was very difficult to try to learn and try to shine when one of the attendings was too busy looking at your legs to be a contributory part of your education. I wound up having to wear really long skirts and nothing that was revealing. I was trying to detract from my looks so that I could get a better education. You do what you have to do. I hate to say it, but you’re the only one looking after yourself, so instead of reporting him or making waves, which I guess I could have done, I did the opposite, which was to take matters into my own hands and finagle through it., and try to get people to listen to me for what comes out of my mouth, as opposed to just looking at me.
Another physician I was speaking with was saying that when she first started as an intern, she actually stopped wearing makeup and she stopped putting herself together as prettily as she normally would have, to try to be less of a threat.
Absolutely, yes. But it goes both ways. If a female physician is overweight or maybe less attractive or does not take the best care of her appearance, she’s seen in a very derogatory manner and people make all sorts of snarky comments about her. “Oh, of course she’s a doctor, because she can’t find a man,” that sort of thing. And if someone is attractive, then they don’t take her seriously. And it even goes about your attitude. If a male physician says something authoritatively, maybe presses an issue, maybe says no, we’re going to do it this way, this is how we’re running things, etc., people think of him as strong. If a woman does that, she’s a bitch. But if a woman doesn’t do that and steps back and is nice and polite and tries to be liked, which is what we’re taught to do from childhood, then she basically gets stepped on, and not taken seriously. It’s pretty hard to walk that line between not being a bitch, but also not being a doormat. I think it’s probably true in general society as well, but for sure in the hospital. It’s all so very frustrating, because at some point, you just make a decision. You just say, “I don’t care, I’m not here to make best friends; I’m here to do a job and do it well, and this is how I’m going to be,” and I just hope for the best. It’s very, very hard, especially if your whole life you’ve always been a nice, sweet person. Suddenly you have to step it up and not be that nice, sweet person, because then you can’t do your job.
I’ve gotten to a point in my life, since I’m not 25 anymore, I’m older, I have kids, I have other responsibilities, things I worry about beyond just what’s going on in the hospital. I’m tougher. I can take a lot, and I’m very sweet and smile and all that, but beyond a certain point, if you push me, it will not go well. I think it’s very important for women in medicine, female physicians, to make that clear. I don’t think you have to run around and try to be a guy; I don’t think you have to run around and try to put people in their place or anything like that, but I do think that in order to maintain a level of authority you have to have a backbone and you have to have a thick skin. I had a team when I was an upper-level resident and we had pre-med students on the team. Two were young men and one was a young woman. The young woman by far was more prepared, just frankly knew her stuff better, and the two guys were very capable, but she was clearly on her game more, but she was very timid. She wouldn’t really look you in the eye when she was presenting a patient, she was very timid around the nurses, so she got pushed around and she wasn’t taken very seriously. Meanwhile, the guys handled themselves with confidence, they looked people in the eye, had a firm handshake, all that. They were getting more positive feedback, so I took the young woman aside and I [said], “Look, you have every reason to be large and in charge here. You need to take ownership of that. You cannot let people push you around. I will sing your praises on your evaluation, but you need to earn it, and you’ve earned it by your clinical acumen and your preparation for rounds, but you need to stand with a straighter spine, you need to look people in the eye, and you need to own your space, own your territory, and you need to show these guys that you’re way better than them.” I feel like, initially, it was difficult for her. She was with me for four weeks, and the first two weeks were a little rocky, but I hope I was able to mentor her in a way that put her on a better trajectory with her medical career. By the end of the four weeks, she was clearly getting the attention of the attendings, the nurses were not picking on her anymore, and she was owning her space. I felt like that was really important.
Let’s go to Dr. Emma Husain.
DR. EMMA HUSAIN, graduate of McGill University Faculty of Medicine::
Ironically, this is a good story because I did orthopedics in Canada. Canada has an exchange program with Saudi Arabia, and their residents to the medical school graduates from the Saudi universities can come and train in Canada, and the Saudi government pays our government and they pay the residents, so we get free residents. We don’t pay them; they’re working for the benefit of working in English in a North American hospital. I would say that a third of the residents were Saudi. Men, of course, only men. It’s really funny because I thought since Saudi Arabia is the most strict Islamic country in the world and for good reasons: it’s got all the holy sites and everything. They’re very strict and the most traditional with respect to women’s roles. For some reason, I think it’s the Muslim last name, and the fact that every man has a daughter or a mother, but those were my guys. Those were the ones that--I didn’t necessarily have heart-to-heart talks with them, because that’s not how they roll, but what they did was they constantly protected me, constantly got me to operate, always had me try this, do this, do this, paged me if there was something cool and I was somewhere else doing scut work on the ward. “Oh, you have to come down here and see this.” It was the most unusual place to get support for a North American female, but I felt incredibly protected and cared for by those men. I didn’t have any friends because my peers were men and they were very macho men. I’m sure there was respect but there were no friendships. From Saudi Arabia, with love.
One of the great things about women as physicians is that we do bring a different skill set to the table, and I do think that many times the female mindset is more adept at being more empathic, or taking a moment to listen to what people are saying, and trying to establish eye contact and put people at ease, so I think if you can combine that element--I hate to chalk it up to that maternal thing because I don’t think it’s that--but that ability to connect with people on a more personal level with being able to be authoritative and make decisions, I think that’s really important.
What makes me feel better is that it’s not about me, not about how I feel, it’s not about my interaction with a particular nurse or physician. It’s about the patient and how I take care of them, and to not let anything get in the way of that. That’s just what I have to do, and that’s it. But it’s hard. I come home and I’m like, what the hell did I do with my life? All these years of education, and I come into a job where I fight all day and get sexually harassed. What am I doing to my life? But the people in those situations, the patients, they need the most help, the most care, so you just kind of suck it up and go back to work.
I guess I would say you’ve worked this hard, and have come this far--you just can’t let people get in your way. You don’t have to do it by being mean or arrogant or conniving, but you can kill them with kindness. Show them know you know what you’re talking about. I think you can gain people’s trust and accolades and respect by being yourself. I would say you get further with honey than you do with vinegar.
One last thing to remember as a med student, really important, is happy people don’t treat other people badly. If somebody’s treating you badly, it’s because they’re unhappy. I’ve never been mean to anybody unless I was in a really bad mood or things were really going wrong in my life. People make mistakes and I could be unhappy with them, but I don’t think I ever treated anyone badly when I was happy. If you’re being treated badly as a medical student, A) it’s par for the course, and B) the person that’s hurting you is in a lot of pain if they’re hurting you that much. That’s not for you to fix, and it’s not for you to even care about, but it is for you to realize all these mean things that were said, it’s not completely about you, even though they were all said about you. It’s about the person that was being that mean. Understand that you are not necessarily responsible for all the things that are said and done to you. The other person has a huge responsibility in that. Unhappy people treat other people badly. I think we can all think of some amazing doctor that treated everybody with kindness and respect and had a good word for everyone, and breezed through their rounds, spreading love and joy. Those people did the same job without making you feel like a jackass, and it’s because of who they are and the life they’re living. It’s not all about you. So, every bad day, every time someone says, “I can’t even believe you made it through med school,” or “What are you even doing here?” or “You don’t know this?” Whatever they say, you might have screwed up, but it’s not about you.
For this episode, I struggled with what I wanted to say for our intro and outro, and I just realized why. Because these doctors can clearly speak for themselves, and as you know, despite my childhood dreams, I am not a physician, just your humble podcast host. However, the problems women face in medicine in many ways seem to mirror the issues we collectively face as women in the world at large today, so we must keep making stories of our own, and live our way into the answer by pushing boundaries, speaking up, and challenging old ideas. I mean, really. We can do this.
Thank you to Drs. Zina Semenovskaya, Patsy Bowman Aiken, Haren Heller Dane, Scott Bader, and Emma Husain; the My First Cadaver Team, Papa Claire Music and Compulsion Music, our Nerf-blasting friends at Salted Stone; and special thanks to Robert Meekins, who is not a doctor.
Happy Christmahannukwanzaka from the My First Cadaver Team! Thank you for making our first season such a delight. We’ll kick off the New Year with Episode 9, coming soon in 2016. And remember, guys: Please use a sturdy ladder when you’re hanging your holiday lights, or you could become someone’s first cadaver.
Actually, I do this presentation about urological emergencies, and the title of the presentation is a joke. It says it’s my favorite chief complaint, the chief complaint being: “Yo, miss! I got some shit on my junk. You wanna look at it?” That’s literally what some people say to me when they have a problem with their genitals. I’ve actually heard that many times, but I’m a doctor. I can’t say, “No, I don’t want to look at it. You're discharged.” What can I do? I do have to look at it. So you’re kind of stuck. Am I to remind the patient, look, you shouldn’t talk to me like that? That doesn’t get you anywhere. Very frustrating.