Happy Women’s Day!

Residents of the World,

On 8th of March every year, we celebrate international Women’s day.

This date is also commemorated at the United Nations and is designated in many countries as a national holiday. When women on all continents, often divided by national boundaries and by ethnic, linguistic, cultural, economic and political differences, come together to celebrate their Day, they can look back to a tradition that represents at least nine decades of struggle for equality, justice, peace and development. International Women’s Day is the story of ordinary women as makers of history; it is rooted in the centuries-old struggle of women to participate in society on an equal footing with men. In ancient Greece, Lysistrata initiated a sexual strike against men in order to end war; during the French Revolution, Parisian women calling for “liberty, equality, fraternity” marched on Versailles to demand women’s suffrage.

As we celebrate the International Women ‘s Day, we acknowledge that we still have a long way to go to achieve full emancipation of women from the hardships they have experience because of their race, gender and social class. For example, sexual violence against women and girls and rape are issues that still remain a challenge in our society. Poverty and poor living conditions have added to women’s vulnerability to violence and increased risk of contracting sexually transmitted infections. The physical trauma of violence and sexual assault have left scars and unimaginable emotional damage on many women.

I would like to take this opportunity to share a story from the book titled ‘WHAT I LEARNED IN MEDICAL SCHOOL’ about discrimination towards women:

A CASE PRESENTATION by TISTA GHOSH

This story is written in the form of a “SOAP” note, an acronym denoting the components of a standard medical record used for writing and documenting a patient encounter. The subjective (S) portion of the record describes what the patient reports as his or her medical problem. Next, all objective (O) findings, such as vital signs and the physical exam, are recorded. The assessment (A) is the interpretation of the subjective and objective findings, which leads the medical care provider to a list of potential diagnoses. Finally, in the plan (P), a course of action is set out, including the treatments given ( for example, wound care) or prescribed (medications), other diagnostic studies that may be necessary now or in the future (such as x-rays), and a fol-low-up contingency schedule ( for instance, “return in two days if no improvement”).

1/8/99, 06:30
SUBJECTIVE: Twenty-four-year-old woman presents on her first day of surgery rotation with complaints of anxiety, agitation, and apprehension

OBJECTIVE:

VS (vital signs): afebrile, tachycardic

Gen (general): well-nourished woman, no acute distress

HEENT (head, ears, eyes, nose, throat): pupils dilated bilaterally, round and reactive to light, mucous membranes slightly dry

Cor (heart): tachycardic, no murmurs appreciated

Abd (abdomen): hypoactive bowel sounds

Extrem (extremities): diaphoretic

ASSESSMENT: I had heard all about this guy. Dr. Snead, one of the top dogs in the surgery department, was notorious for both his bark and his bite when it came to medical students. His temper, his mood swings, and his chauvinism had reached legendary heights in our medical school. But rumor had it that he was starting to mellow out as he approached retirement, and his last few groups of students had escaped the rotation relatively unscathed.
“It won’t be that bad,” I reassured my racing heart and my sweaty palms as his massive figure approached. He stopped in front of our group of students, which consisted of three men and me. He scrutinized each of us one by one, his face hard and devoid of emotion.
“You! Stand up straight! This is a hospital, not your mom’s couch!” he barked at the first student.
“And you, what the heck is that pocket book you’re carrying around? That book is a piece of crap! Next time I see you, I want a real surgery text in your hands. Got it?” I felt my face getting hotter as he turned to gaze at me.
“What’s the matter, honey? You nervous?” A sarcastic smile played on his lips. “The rest of you, follow your resident to the wards. But you, sweetheart, you’re coming with me. We’re going to the OR . . .”

1/8/99, 07:15
SUBJECTIVE: Twenty-four-year-old woman presents to the operating room with complaints of uneasiness, foreboding, and a sense of panic

OBJECTIVE:

VS: afebrile, tachycardic, tachypneic

Gen: anxious-appearing woman

HEENT: no change from previous exam

Lungs: clear to auscultation bilaterally with notable shallow respirations

Skin: clammy, diaphoretic

ASSESSMENT: I shouldn’t be so anxious about this, I told myself as I meticulously scrubbed my hands outside the OR. I had seen plenty of surgeries during my obstetrics and gynecology rotation. I was not at all unfamiliar with the OR. It was just that this guy was so intimidating! I was worried that he’d blow up at me if I made even the slightest mistake.
And why was he calling me “honey”? Was I somehow projecting the wrong kind of image? Maybe I should have worn my glasses and tried to look smarter. And then I admonished myself. Why should I have to change the way I look? I should be judged on my abilities, my patient skills, and my knowledge base. My thoughts were interrupted by the looming figure standing next to me.
“Let’s go, sweetie, let’s get this show on the road!” Dr. Snead’s voice dripped with impatience, as I followed him into the OR.

1/8/99, 14:30
SUBJECTIVE: Twenty-four-year-old woman presents with complaints of goose-bumps, chills, mental numbness, thirst, and aching feet

OBJECTIVE:

VS: tachycardic, hypotensive
Gen: fatigued-appearing, bleary-eyed woman

HEENT: slightly diminished visual acuity, mucous membranes dry

Lungs: clear to auscultation, excessive sighing noted

Extrem: 1+ lower extremity edema

Skin: mild pallor

MSE (mental status exam): mild deficits in attention and concentration

ASSESSMENT: I’d forgotten how cold it was in the OR. I could feel the hair rising on my arms, while my teeth chattered silently behind my mask. This surgery would never end. It had already been over seven hours, and we didn’t seem close to ending. I felt my feet throbbing dully, as I surreptitiously stretched my lower back. I just knew I’d never make it out of this surgery. I imagined a janitor stumbling onto my stiff, frozen corpse sometime in the distant future, when the surgery was finally over.“Are you paying attention? Dammit!” Dr. Snead’s angry roar jerked me out of my daydream. It was one of the few times he’d even bothered to acknowledge my presence during the past seven hours. It took me a minute to comprehend that it was me he was talking to, not the resident. “Don’t just stand there like an idiot! For God’s sake, suction that blood already, honey! This isn’t an orgasm, sweetheart, you can’t just lie back and enjoy it!” His bellow reverberated through the OR. No one moved or said a word.
“I must be in some kind of movie,” I told my numbed brain. “This doesn’t happen in real life. Professors don’t say that to students, at least not in the 1990s. This has got to be one of those made-for-TV movies. There’s no other way to explain it.” Silently, I watched my hand reach out and suction the blood. This had to be a joke, a one-time thing. Things would get better, I reassured myself. Or maybe I’d just get used to it.

2/4/99, 05:00
SUBJECTIVE: Twenty-four-year-old woman presents with a history of nausea, fatigue, and tension headaches since the onset of her surgery rotation

OBJECTIVE:

VS: stable
Gen: thin, haggard-appearing woman

HEENT: diffuse tenderness to palpation in frontotemporal areas

Cor: regular rate and rhythm

Lungs: clear to auscultation, poor inspiratory effort

Abd: mild, diffuse tenderness to palpation, hyperactive bowel sounds, no rebound, no guarding, no masses

Extrem: 2+ lower extremity edema, mild tenderness to palpation of plantar surfaces

MSE: mood depressed with blunted affect, mild to moderate deficits in concentration and memory

ASSESSMENT: I felt like I was always walking on eggshells. No matter what I did, Dr. Snead blew up at me. Weeks had passed, and the sight of him still made my stomach queasy. He had started to warm up to the males on my team, and it was clear they’d all formed a Big Boys Club that I was not invited to join. Dr. Snead graciously let me know, however, that if he and “his boys” ever made a beer commercial with topless scrub nurses, he’d let me participate. I’d make a great nurse, he told me. My male classmates never disagreed.
Rounds with him had become a daily nightmare. My neck and shoulders were knots of tension by the time they ended. Every day, he fired questions at us mercilessly. Nobody, not even “his boys,” dared to miss an answer. I read for hours every night, absorbing the latest articles on the symptoms, causes, and cutting-edge treatments of diseases. I really shouldn’t have bothered. Whenever I was next in line to answer a question, his face would take on a patronizing sneer.
“That one might be too hard for you, sweetheart. Why don’t we let John answer?”
Every evening, I went home with my head pounding and my stomach churning. Those were some of the worst months in my life. How could one man make me feel so horrible? I was worried about passing, I was scared that I wasn’t learning, and, most of all, I was horrified at myself for putting up with Dr. Snead’s blatant misogyny. Whenever I’d read in history classes about the treatment of women, I scoffed, wondering why the women didn’t just stand up for themselves. And here I was in the late 1990s, silently taking it, just like all the women I’d read about. Maybe I was in shock. After all, I’d never imagined that this type of behavior really existed in the United States anymore, not outside of television. Maybe I was just naïve. And maybe, just maybe, I was too scared to do anything about it. After all, he was one of the heavyweights of the surgery department . . .

ASSESSMENT: Twenty-four-year-old woman rotating through surgery who suffers from . . .
Suffers from what? I wasn’t sure, exactly. So many words float through the media today, haunting our thoughts and actions—sexual discrimination, sexual harassment, sexual misconduct . . . the list goes on and on. What does it all mean? Did those words apply to me? All I knew was that I didn’t want them to apply. I didn’t want to be associated with those terms at all. I just wanted to forget and move on. After all, I was a medical student—my purpose in life was to learn, not to make waves. And the issues were far too unsettling. No medical student should have to dwell on them.
My perception of medical school had changed dramatically. I felt myself grow hardened and jaded about the so-called learning experience of clinical rotations. Did fear, discomfort, and intimidation really enhance a student’s educational environment? Apparently they’re supposed to, I often thought cynically.

PLAN: None. I really didn’t know what to do. Every night, I weighed my options. I wanted to be brave and address the issue, to be strong and stand up to the system. But the truth was, I didn’t have the energy to face the potential consequences. So I adopted the only plan that I felt I could handle: pass the surgery rotation. Keep quiet, get out, and never look back. That was all I had to do.

The End

SMSA

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