Monthly Archives: October 2021

A Cup of Coffee

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I saw the physician I was working with return from the cafeteria with her normal cup of coffee and a second small coffee. She walked by our computer station and into the patient’s room.

The patient had been plagued by a headache that morning when I saw them, not long before the physician arrived with a cup of coffee. The patient had requested coffee because it usually helped with their headaches. Of course, they would get coffee with their breakfast tray later, but that could take hours.

The patient had had a rough year. They’d been in the intensive care unit several times after trying to kill themselves, the first time almost not surviving. They’d lost a child to overdose. Their life had other stress-causing features. The patient was calm when they were under our care, but they’d attacked their nursing staff earlier on during their hospital stay.  

When the physician returned to our computer station, I thanked her for getting the patient a cup of coffee. Little acts of kindness like that are not as common as you’d like them to be. The hospital is full of burnt-out thoughtful people (also known as staff). It’s also full of people with all kinds of diseases. The diseases of the brain can be quite tough. When a psychiatric illness sends people to the hospital, there’s the suffering of the patient and there’s the challenges that they sometimes pose for medical staff. The brain is a powerful organ and when it gets sick it can do all kinds of things. As such, when healthcare staff are overworked (which is always these days) and when the hospital is full (which is most of the time), patients with brain diseases do not always receive the kindness that they deserve from their care teams. But, on that morning, this patient did.

I thought about that cup of coffee. It brightened the patient’s morning. It can be hard to remember the little things we can do to help others. But, on this occasion, the physician I was working with reminded me by setting an example.  

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One Example of Sexism in the Operating Room

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Often enough to be considered a pattern, the men in the operating room chose to discuss the annoyance of the hospital’s anti-harassment yearly training videos and anti-harassment policies when I was the only female in the operating room with them or when it was just an older female nurse, them, and me. And while I also find the hospital’s anti-harassment training videos frustrating (for entirely different reasons than my male counterparts), I did not appreciate when a surgeon said he could get tips from the scenarios in the video. I did not appreciate his comment (despite his humorous tone) because the truth is that harassment doesn’t just occur in training videos. It occurs all the time and in all settings of women’s lives.

And I found it interesting that these men were complaining when most of them are fathers of daughters, and many are fathers of young daughters. And if the risks weren’t so high for me, I would have asked them the questions I pose now, “How old do you think your daughter will be when she first gets cat-called so badly she feels unsafe? How long riding public transportation will it take before she has a set of rules she follows because of the physical and verbal harassment she experienced from male passengers?” The use of “when” and not “if” is intentional.

You see, women close to me have been strangled and shoved into walls. I’ve sat by as a younger woman asked for advice from an older woman about what to do because her husband raped her every night. I’ve been called by friends in tears because they were cat-called so badly they were shaken. I’ve sat with women as they hid behind dark glasses waiting to get photos of their bruises to use in court. On my first day of one of my first jobs, my preceptor told me how to use the printer and warned me to be careful of our male boss. He left the company before I had to worry about exactly how careful I had to be. By the time I’d worked in healthcare two years, two of my female friends had been groped by male patients. I’ve only been training in the hospital as a medical student for six months and already two female physicians have taken time out of their busy schedules to have lengthy conversations about how to keep my head up and build my career despite disrespect from male colleagues and male patients.

And the reason I would ask the fathers of young daughters the questions above is because I know they love their daughters. And I know they can’t fathom that they are being exactly the type of men who will get in their daughters’ way as they reach for their dreams. And I would ask the fathers of young daughters these questions to remind them that they cannot protect their daughters from the future. And, truth be told, they will likely never know the harassment episodes of their daughters’ life. And I would ask these questions to recommend that they learn how to respect women so that they can set an example for their daughters of what it’s like to be respected. That way, when their daughters do experience disrespect, they know it is not their shortcomings but the shortcomings of the disrespectful one. In other words, it’s worse to be a daughter of a father who doesn’t know how to respect women because he sets a poor example of the male gender. And the behavior of these men in the operating room made it clear that they still had much to learn about respect despite surgeons being among the most highly educated people around. What an unsettling reality to have so many years of education and still lack competency in a basic principle like respecting all humans.

You can look up the statistics in the US for harassment and rape of women (and other demographics) if you’re curious. It’s an easy Google and the numbers are almost as bad as the news that makes the front page of the newspaper. If you want to get really dark, look up statistics related to intimate partner violence. The numbers are horrific. And the numbers always surprise me because all women are daughters and perhaps sisters, mothers, and partners. Fathers and mothers see the statistics and are inclined to tell their daughters to be careful. To not drink too much. To not wear too revealing clothing. To never set down their drink. To not walk alone at night. To not live on the first floor. To lock their windows and doors. To always go out with friends….the list goes on. But the question I always wonder when I hear these statements of warning is why don’t parents just tell and teach their sons that “no” means “no,” “stop” means “stop,” respect applies to all people regardless of genitalia, and that drunk or not you are responsible for your actions? Because all men are sons, and many are brothers, fathers, and partners. It would seem more helpful to prevent the problem of people harassing others, than react to the problem by telling the victims to avoid harassment.

I also find parents’ lectures of caution stifling because they do not address so many of the manifestations of sexism their daughters will experiences. Yes, there is the risk of rape and physical abuse. But for those women going into competitive or historically male professions many of the troubles we face as women are more subtle and persistent than acts of violence. The times we’re told we’re mean or bossy when a male counterpart with the same behavior is considered strong. The times we’re ignored, spoken over, interrupted, and discredited despite consistently being correct. The times (like in the operating room when men decided to complain about harassment protection for women) when we’re othered and made to feel like demanding respect isn’t a right, but a burden we place on our male counterparts. The times we’re underpromoted, underpaid, and passed over simply because we are women. The times we must dig deeper than our male counterparts not because of shortcomings but because our parents taught their daughter to be cautious and taught their sons to be bold.

And as these fathers of daughters discussed sexual harassment policies as an annoying restraint placed on them, I thought about their daughters. I knew when they’d be cat-called. I knew how long it would take on public transportation before they developed their safety rules. And I hoped for those daughters’ sake that they would have men that set an example of what it’s like to be mutually respected. It had made such a difference for me to coexist with many men who looked at me as a person and not some different creature. You see, it’s helpful to know respect is possible because at times it seems like a fictional concept. I thought about those young daughters one day standing where I was. I sent them strength. As much as I hoped the world would change in the years between us, I wasn’t sure it would because these men I stood with in the operating room would still be here. And their sons who had them as role models would be here too.

And I was once again weary, not so much because of the long hours I was spending studying or the fact that I was scoring equal or better to many of my male counterparts in medical school while also getting cat-called and navigating colleague and patient sexism, but I was weary because these men in the operating room, like so many others, stood in the way of my father’s daughter. They stood in my way because they made things more difficult for me than my brothers simply because of my genitalia. None of this was new or surprising, but it did make the hours in the operating room seem especially long. And if the operating room had been a safer place for me, I would have told these fathers the reason I didn’t like the hospital’s anti-harassment videos was because they were triggering for those of us who have been sexually harassed and spoke of a justice system that I have not found anywhere I’ve worked. And I’ve worked in many places.

In Her Memory

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I’ve been thinking about an old Paraguayan woman, La Abuela, who died this year before I was able to return and see her one last time. Her eyes were cloudy and her knees swollen when I last saw her. She hobbled short distances holding onto chairs and walls. She was from an era I have only glimpsed through stories shared while gazing out at the world passing by and over snacks. She wrapped her hair in a scarf each day and worn simple skirts and shirts. And always worn sandals. She was the mother of one of the señoras who took me as a daughter during my years in her community and with whom I still often speak.

La Abuela was alive during the Chaco War (1930s). It was a particularly deadly war for Paraguayans. My and her community in Paraguay has a jail. When she was younger, she used to cook for the jailguards. That was in the era of the Chaco War when the jail was full of Bolivian war prisoners. I guess during that era the prisoners could leave the jail and she used to cook for them too. When I lived there, the jail was still active, but she had long stopped serving the folks who lived and worked there.

She told me how it used to be. It used to be that the only way to get to Asunción, the capital of Paraguay, was by canoe down the river that ran around our community. It was hard to come and go during those times. When I lived there, it was a simple 2-hour bus ride into the capital—a journey I made frequently.

She told me that later, once the road was constructed, she used to run a bunkhouse for the bus drivers. She would cook for them. She had one rule, no women in the bunkhouse. And if she found out the bus drivers were sneaking in partners, she’d no longer offer them a bed. She was a woman with strict ideas about how things should be.

And there was a period when she worked in Asunción, cleaning homes. That’s how she and the señora who was a mother to me, learned Spanish. Paraguay is bilingual. But the people of rural areas speak more Guarani than Spanish. And the people of the city speak more Spanish than Guarani. And that’s despite the dictator they had for about 35 years during the middle to end of the 1900s who tried to erase Guarani.

La Abuela endured the dictator, her Guarani remained more robust than her Spanish. It was thanks to her time in Asunción that we could communicate reasonably well in Spanish. She’d reminisce of the order that used to exist under the dictator and the chaos of current times. We did not discuss the disappearances and deaths of the dictator’s time. She was a strong woman and she had seen more sadness than I could fathom. But she was more likely to discuss the wind and recent gossip than sadness long past. 

La Abuela and I shared many afternoons sitting on the porch watching the school children walk by and various neighbors run errands. And she had so many stories of getting up early and working hard. Of her garden. Of cooking. Of milking the cows. Of raising children. Of her neighbor’s parrot who spoke so well and was once stolen and then returned. And the hazy day and mango shade would fade to dusk. We’d sit in the evening, still hot but without the beating sun, and we’d have dinner. And the stories would continue interspersed with many long periods of quiet contemplation.

No one knew exactly how old La Abuela was. She was from an era when records were stored in the family’s memory. She had had too many of her own children to remember her exact birth year after her mother died. But the wrinkles of her face and the grayness of her hair and the curvature of her spine spoke of many years of hard work.

I knew La Abuela was fading before she died because her daughter told me. Her daughter told me when her mother became bedbound. In Paraguay families care for the sick. I knew her daughter was caring for La Abuela. La Abuela had 6 children, but only one daughter. It’s almost always daughters who bear the brunt of caring.

I got the tearful message that La Abuela had died from her daughter not long before I had a huge exam. At the time, I didn’t have much left in me to think about death. But these days I see lots of people La Abuela’s age in the hospital. Recently my team helped several families put loved ones on hospice (care for those likely to die in 6 months, usually less). And while medicine can cure many things, it cannot stop death. And I think about La Abuela’s daughter caring for her in her last days. And I know that the care La Abuela received at the end of her life was equal or better than any hospice care the US has to offer.

I think about the thatched roof and the dirt floor of her home, the wood fire on which she and her daughter cooked with smoke billowing around them, and the stories of the ants and mice that sometimes passed through the house. I find myself smiling. Because as complex and sophisticated as medicine becomes, hope isn’t found in the hospital. It’s found at home and in our hearts.

La Abuela built a home large enough for all her children, grandchildren, greatgrandchildren, and me to visit peacefully; a home where the mango pits she planted so many years ago were now towering trees offering shade to whoever might need protection from the sun. And as summer slips away I think about that shade waiting for me whenever I can once again visit our community. She won’t be there when I return, but I know her daughter and I will share stories of her life.