I am a nervous and anxious person at baseline. I am going to go ahead and blame this on the wonderful world of genetics, seeing as my mother, as well as my two sisters, suffer from the same affliction. What does that mean, however, a third-year medical student transitioning to life on the wards? It means constant fear of criticism. It means stuttering and fumbling through oral presentations while feeling the skin on your face slowly turn red. It means perpetual thoughts of inadequacy. “Okay, here it is, the moment where everyone finally realizes I’m here not because of competency, but because of sheer dumb luck.” These thoughts weigh me down, not always, but sadly, enough to be bothersome. However, what saddens me above all is the fact that a few students, many students, most students, feel the same. There is a wide range of “traits” that could aggravate this vulnerable position even further, and sink a student deeper into this chaotic whirlpool of emotions. For me, it is being a woman.
I was in the OR, standing behind the blue drape. I remember curiously asking the anesthesiologist about the “dance” between sedation, and, simply put- not killing the patient as heart rate, blood pressure, and ventilation are monitored with ceaseless attentiveness. It came as no surprise when later on that day I learned that the motto for anesthesia is “vigilance”. After a while, my interest wandered past the machines and over the drape. It was an off-pump CABG surgery. I marveled at how the surgeon coordinated the placement of sutures with the beating of the heart. I squinted my eyes to see the surgical needle so delicate and thin that it seemed invisible. I looked at the sternum, split in two, clinging on to its rib appendages and remembered thinking– how in the world are they going to put this thing back together? It was then, lost in my own thoughts, that I heard a male voice say, “Who are you?”
“Oh, me?” I asked, looking to see if there was someone else standing behind me.
“Yeah, you.” said the surgeon impatiently.
“Oh.” I peeped, my voice a bit shaky. “I’m Monica, the medical student. I’m with the anesthesia team this wee–.”
“What are you interested in?” asked the surgeon briskly, cutting me off.
“I’m interested in pediatrics.” I replied.
“Of course you are. You’re a girl in med school,” he said, not even bothering to look at me. Playing my part as the dutiful medical student, I said nothing. The surgery proceeded without complications.
I was angry. I was angry for two specific reasons. One, was the way the surgeon so overtly discounted pediatrics as a noteworthy specialty. Here was yet another physician buying into inter-specialty stereotypes that often bombard us as medical students. He was not the first to rag on pediatrics, and he will not be the last. Two, was the way he said “girl”, sneering almost. His comment labeled me. It infantilized me. I was no child, and I had worked just as hard as my male colleagues to get to this very stage of my life. Male colleagues, who I find it hard to imagine would ever be referred to as “boys”.
This is just one example of a microaggression I have encountered as a female medical student. Rather than wallow in self-pity, waiting for the culture of medicine to change, I decided to prepare accordingly and approach these comments (which were bound to occur again) analytically and systematically. As a medical student, and quite frankly, a care team member positioned on the bottom of the hierarchy, I had to be ready.
First, I wrote down possible responses to these comments. Cordial responses of course, but also ones that supported my role as a student doctor. Second, I practiced saying these comments, out loud or in the mirror to assure a smooth delivery. As a student with painful anxiety, who stutters during oral presentations, who feels perpetually inadequate, I knew this step was especially important. And lastly, I vowed to support fellow medical students who would one day encounter similar microaggressions. Often it is much easier for other people in the room to step in and diffuse an uncomfortable situation, especially when emotions are high. We must advocate for our fellow students, and other care team members in general, who possibly, like myself, feel perpetually inadequate.
I know that my self-doubt will not last forever. It will slowly crumble over a period of years as my knowledge and clinical skills strengthen. However, I do not think this lack of confidence will ever fade altogether, and microaggressions will unquestionably always be present. However, I now have tools to use when side comments unhinge me internally, while externally, my face remains stoic and my mouth remains closed. Maybe future Monica will have the strength to look that surgeon in the eye and say, “Yes, pediatrics is a field where women physicians predominate at the moment. However, in my class there are many brilliant, accomplished women AND men who have decided to pursue it.”
I have a funny feeling that as time passes, this statement will be stutter free.