Racism and Discrimination, Words from the Wards
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The I Do’s … and Don’ts of Medicine

He drives through the door with his automatic wheelchair to park himself into the corner just beside the attending’s desk. I meet him at eye-level when I sit down in the cool, creaky plastic of my own chair. Upon reviewing his charts, I came across a history detailing six different occurrences of cancer — that’s at least six surgeries, treatment regimens, and what people in palliative care deem — “life-threatening illnesses.” I’ve learned it’s an umbrella term used to encompass, in large brush strokes, the broad spectrum of ailments presenting with the symptoms of pain and suffering that call for the involvement of the palliative care team.

Six cancers, he confirms — he calls them “speed bumps,” each with a stretch of smooth, easy driving before he buckles up to hit the next. We prompt him with increasingly personal questions in the exact way palliative tends to do in order to open a gateway into more sobering topics. He begins to tell us about his family, specifically his grandson, who just turned 26 — just two years older than me. Likewise, he has family friends who have children, two beautiful girls, who have also hit their mid-20s. “One of them took a liking to me,” he continues, meeting my gaze, and hesitates for a beat, “Are you married?”

“No,” I answer, and he grins, a bright, lopsided grin that begins to spark something uncomfortable in the lurch of my stomach.

“Do you want to be married?”

I pause just a second too long — long enough for him to laugh a raspy, grating sound that makes me shift back into my seat. “Eventually,” I answer, and my attending gives me a reassuring nod, like I have just given her a meaningful diagnostic assessment rather than a hazy, ambiguous response to a rather invasive question.

Undeterred, he presses onwards to inform us that he had to delicately shut down this 20-something-year-old girl, and in gracious form tells me, “You know, I told her we couldn’t hook up or anything.” He’s still grinning like he’s letting me in on a highly exclusive secret that I want no part of. I purse my lips, thoughtfully, in what I hope he interprets as a polite smile, before he drops all pretense completely —

“I wouldn’t mind if we went back out there and told everyone you were my girlfriend, though.”

When I started my week at the Veterans’ Affairs Medical Center, I was vaguely warned of the difficulty of being an Asian-American woman in this building, in any professional service but especially as a health care provider. The attending I worked with on the inpatient floor, an Asian-American man, alluded to it fleetingly after we saw a patient together who began to harp on the fact that we were both Asian halfway through our interview. The conversation began with, “So my wife is Korean–“ and, after many other unfortunate digressions, ended with “–such a fine people you all are.” When we returned to the residents’ room to debrief with the team, the attending shared our interaction with resigned, comedic inflections that I recognized as an all-too-familiar reflection of myself. In professional settings, the default reaction is to downplay, to not let these comments and casual microaggressions slip through the carefully crafted balance of cool nonchalance and unimpeded confidence in order to avoid appearing vulnerable, overly sensitive, or — the very worst — incapable.

“I will say, though– “ the attending added, nodding to me, “I think it is much harder for an Asian female doctor in this hospital than for me on any given day.”

It is in this very room, with the unabashed proposal from this patient, that I truly feel the weight of his words.  The patient finds his groove and becomes relentless with his propositions. For the next half hour, he peppers them aggressively throughout his anecdotes, eyes flickering to me each time, and even with all the discomfort and burgeoning nausea rising in my throat I find myself laughing along inadvertently. The revulsion only comes later, after a fuzzy delay — as if I’d been watching myself from afar becoming a whole other, demure, acquiescing little Asian girl, a spectator to my own diminution into an object of exoticism.

Just before checking out, he flips over the business card my attending has handed him. “So is your number on here? You aren’t going to walk out with me?” he asks cheekily, and again, on demand, I laugh. “I’m just kidding. You know that, right?”

Do I?

In the aftermath of the encounter, the attending I am working with in the outpatient clinic is kind enough to sit me down and apologize — a gesture I am grateful for but also one that bewilders me, because I’m honestly not sure what exactly she is apologizing for. She prefaces her indignation by sharing instances of inappropriate, flirtatious behavior, and sexism that have occurred for her here in this hospital as well.  This hospital that serves as a liminal space we all occupy together as people who have apparently made a seemingly tacit agreement that this is just how things are. “It’s not okay,” she says, nodding her head vigorously as if to affirm her own stance. “I know you are super early on in your career and it can be hard to do so, but I think that we should all be calling out patients on behavior like this so that they know it is not appropriate. Just because we are health care providers who are expected to be professional doesn’t mean we should be okay with being treated this way.”

She is absolutely right. And yet, I feel the protest rising again within me, a response almost as automatic as the smiles I pulled out for this patient moments ago. It is a deflective response, a defense mechanism. I suddenly realize, unbidden, that my most visceral reaction is to defend myself. A situation like the one I was just in poses a real danger to myself but more importantly,  to the most inner and subconscious parts of my psyche.

“I mean,” she goes on to say, “We should be able to stand up for ourselves. I think to myself, there is nothing this patient could actually do to me.”

Could, I think to myself, or would?

What would he do to me, given the chance?

It is a thought I hold myself back from voicing. I am not in the right mindset or properly informed enough, I feel, to start talking to her about what it means to bring context to the forefront when dealing with the intersectional nature of being a minority woman. My only rights to doing so are my own lived and shared experiences, and even so, I still primarily adhere to the fact that I, too, live in a privileged space. I was born here in the States. I grew up with immigrant parents who wholeheartedly supported me and my endeavors, held my hand through all my detours and meltdowns, and provided me with any resource they could offer even if it left only the bare minimum for themselves. I live in a world where I do not fear being pulled over to the side of the road by a policeman with a gun in his holster, nor do I know firsthand the experience of fighting to survive the day on rationed food, threadbare clothing or shelter. I live in a society where nine times out of ten people will not doubt my educational degrees. They won’t question the validity of my sick days, my setbacks, or ignore me when I say I am suffering or in immense amounts of pain.

What my attendings impart is how they feel by their own lived experiences. My outpatient attending continues by referring to the posters that surround us, wedged in between frames of famous founding physicians and encouraging phrases, posters that demand “NO CATCALLING” and “TREAT EVERYONE WITH RESPECT.” She is completely valid in her indignance, both on account of herself and for me, just as my inpatient attending is valid in how he chooses to handle the microaggressions he undoubtedly encounters regularly. In fact, he came back only hours later that same day to tell us he had just been asked if he participated in taekwondo training, an inquiry based solely on his presentation as an Asian man.

What I believe underlies both of these experiences is the need for acknowledgment. Our task in donning roles of professionalism as health care providers comes hand-in-hand with all the aspects of our identity and the tolls that come with it. This is especially significant as the younger generation, consisting of more and more intersectional identities, becomes more commonplace not only in society at large but also in the health care world. As health care providers, we have been taught that the patient always comes first: care for them, alleviate suffering, cure their disease, save their lives. We are handed a mute button for times when we may have more negative, judgmental thoughts or unconscious biases with the people we are assigned to care for. We are told to proceed with caution because professionalism means dutifully using that button. The people who hand us that button assume we won’t be abusing it and that we will learn to toe the line between becoming a compliant robot and an individual who defends against a violation of their privacy, rights, or respect.

However, when this ideal of professionalism is compounded by someone like me — a minority woman colored by a recurrent, pervasive backdrop of objectification for pleasure by Caucasian cultures; a female person of color who feels the need to tread carefully to succeed in a field historically dominated by men — where does it leave us? I can try valiantly to believe that, had I not been caught so off-guard, I would have refuted that patient and stood up for my own sense of dignity. But what I could not articulate, and what I will continue to relive and relearn each time I step back into that hospital, is that there are times the implicit violation and oppression behind language like his will make me and my body instinctively feel unsafe despite being in a secure medical environment. In the future, I may resort to my submissive laughter, my detached acceptance, and my unspoken complacency but in no way do I claim it to be the “correct” reaction. As someone who often struggles with a deep-set fear of appearing vulnerable or incompetent, it is practically the complete opposite of how I would like to imagine I conduct myself. However, it is the reaction I absolutely may default to in an instance guided by self-preservation and defense from the veiled threat my body construes from words like his.

There is no easy solution. Perhaps it isn’t quite as simple as merely learning to stand up for myself. It is, rather, the recognition that these encounters are only scratching the surface of experiences that I believe are both much too common for women of color in the health care field and much too infrequently addressed or discussed openly. As someone who has just recently embarked on the early stages of my career in medicine, I hope that as we progress we can bring ourselves to become more attuned to the intersectional experiences of colleagues and patients alike in order to reconcile how these identities affect us simultaneously and to afford us better perspective and emotional processing as health care providers. It is perhaps more important than ever to acknowledge these experiences as the female workforce in health care increases and to create space for meaningful discourse moving forward.

Image credit: IMG_4047 by Masa__Israel licensed under CC BY 2.0.

Jennifer Li (1 Posts)

Managing Editor

Emory University School of Medicine

Jen is a fourth-year medical student at Emory University School of Medicine in Atlanta, Georgia. In 2016, she graduated from Emory with a Bachelor of Arts in English concentrated in multi-ethnic contemporary American literature and a minor in Music. Jen is passionate about addressing healthcare disparities, highlighting intersectionality and patient-centered care, narrative medicine, and mentorship/education. Aside from medicine, she also enjoys poetry, piano, tennis, indie concerts, Asian-American media, and spending too much time in coffeeshops. After graduation, she aspires to pursue a career in Internal Medicine.