Mansplaining Women’s Empowerment

I went to a training on managing aggressive patient behavior, mostly via verbal de-escalation. The class included a section on basic physical defense—such as getting out of a chokehold and escaping when someone grabs your arm. The skills were useful, but I found myself more frustrated than fulfilled by the class. What ruined the class was that one of the instructors preached for 20 minutes about how the young women in the class should feel empowered by the self-defense skills he just taught us. He told us some stories about women who were raped and killed because “they didn’t put up a fight.” He explained how we should be careful, avoid bad situations, and if attacked fight back.

Mansplaining: definition from the wiki article, “(of a man) to comment on or explain something to a woman in a condescending, overconfident, and often inaccurate or oversimplified manner.”

I was insulted by the lecture because as a woman I’ve been told countless times to be careful. When I told my family I was joining a night crew on an ambulance squad, almost before I was congratulated on finally starting as an EMT, I was asked if it would be safe for me to sleep at the station with my male crew members. Throughout my Peace Corps training, we had sessions on gender relations and how to avoid getting raped in our host country. In college, our advisers used to give us party-going strategies to avoid getting drugged. The list goes on.

It is NOT empowering to be told that you’re a victim and will always be a target. It is NOT empowering when people create boundaries (perceived or real) for you. It is empowering when others complement you on your success, offer intelligent advice as you work through challenges, and lend their support as you strive to reach lofty goals. Let me offer an example of what disempowering and empowering look like:

Disempowering: In a recent conversation with a male nurse, both the fact that I’m applying to medical school and my age (I’m almost 30) came up. The nurse didn’t comment on my age until I mentioned I’d applied to medical school. Upon hearing about my professional ambition, he “jokingly” asked why I wasn’t married and pregnant at my age. That is such a classic example of sexism it could be in a textbook. He never would have asked any man that question, even in jest, about applying to medical school.

Empowering: Upon telling one of my mentors about a test score I wished was higher, he said that he was sure I’d be just fine and turned to the other person with us to explain that “good” by my standards was quite different than “good” by most standards because I have high expectations.

Being an adventurous, single woman does clash with society’s view of women. How can I travel to foreign countries alone? It’s so dangerous. How can I go hiking or camping alone? It’s so dangerous. I’m not going to argue that those activities are safe. What I wish to suggest is that I have the intelligence to decide for myself what is safe and not safe, worth the risk and not worth it, and how to avoid unnecessary danger. I don’t need people to remind me how awful the world is. I need people to help me figure out how to overcome the challenges between me and reaching my goals.

What I wish that the instructor of the class about managing aggressive behavior knew is how many creepy men I’ve avoided in my life already, long before his class. I wish he understood that I don’t need him to tell me I should be careful and fight back. It is not empowering to be viewed as a potential victim of aggression, especially sexual aggression, even if you know how to fight back. It is empowering to be seen as a peer and fellow human with dreams, strengths, and weaknesses that transcend sex and gender. That is what women’s empowerment is all about; being viewed as an intelligent being and not an object or target or static lump.

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On Not Becoming Jaded

One night a coworker in the emergency department, who also aspires to be a doctor, asked me if I was worried about becoming jaded as I worked in health care. I answered confidently that I wasn’t worried about becoming jaded, my hope for humanity waning, or burning out like so many medical professionals do. He was skeptical, but I am certain of only that one aspect of my future.

Defining Jaded

Especially late at night when most patients are tired and grumpy, the drunks roll in after exhausting the bars, and the patients held for mental health evaluations decide to spend the early morning hours holding yelling matches that involve nonsensical accusations against staff, it’s easy to see how one can grow tired of working in a hospital (and specifically the emergency department). In medicine, we take care of everyone, even if they’re jerks to us, because the fundamental principle of health care is that we serve all people.

Not so long ago I was greeting patients in the waiting room at the emergency department. We had around 20 folks waiting for rooms, the rooms weren’t changing over, and the wait times for many were over 2 hours. That’s a recipe for an unpleasant experience as a greeter, and the recipe was rich that night. I had a parent repeatedly insult the staff, including me, and ask why we hadn’t brought her child to a room yet. That was annoying, but manageable. What got to me was when she stormed up and demanded to know why we brought back “a drug addict” (her words, not mine) before her child. Her argument was that her child had a bright future while that person was a lost cause. Of course, I couldn’t tell the hysterical mother just how awful it is to watch a person go through withdrawal shakes and then seizure. That’s something you can only understand once you see it. I couldn’t tell her about the alcoholic who came to us one night shaking so badly he couldn’t drink water from a cup. I couldn’t tell her how he had looked me in the eye and told me he wasn’t human anymore. That mother was choosing to believe him, but I knew that that patient was human even if he didn’t feel like he was. That angry mother in the waiting room clearly had never seen a person beat an addiction—winning the daily fight to not give in to a drug or alcohol for years. I have.

It’s not the job of medical professionals to pass moral judgment. Sometimes we are weak and tired, and we do judge our patients’ life choices. But if we were to slip into a world where we used our personal morals to decide who should receive care, we would betray the heart of medicine. Medicine was never meant for only a select few.

In my view jaded is another way to describe losing empathy. There are many presentations—impatience, anger, and hating work to name a few. These feelings come when we are too tired and too worn out to see patients as humans. They come when we no longer find joy in the small things about the job that are awesome. And jaded becomes the norm when we give too much. It’s easy to work hours no one else would dream of working when you’re in health care. Each hour is rewarding because we help someone feel better, but the hours take a toll on the giver.

Considering all the above, how am I so certain I won’t become jaded?

  1. My empathy comes from selfish sources, so I don’t expect that it will fizzle. The first source is curiosity and the second is a love for stories and puzzles. Each human has a story. Each sick person is a puzzle. The curious mind can’t help but wonder about the story plot and the answer to the puzzle. These two factors are some of the main reasons I veered down the medical path in the first place.
  2. I know that I’m brave enough to step away and recharge as well as to shake things up when caring for patients under specific conditions becomes wearisome.

How do I know I am brave enough? Paraguay. While living in the land of Guarani, I cultivated an ability for self-reflection and the bravery to face fears because they were required to survive the Peace Corps. Paraguayans also showed me the value of letting yourself be still. In America, we are so determined to be productive we schedule every moment. I think running around all the times makes everyone miserable no matter what their profession. I also think those who become jaded forget to reflect and change. They fail to see that their job is draining them until it’s too late and, then, they lack the courage to change their work so it’s fresh again. It comes down to the best professional advice I was ever given. When I asked a presenter in one of my undergraduate classes how she knew when it was time to leave a job (she had an awe-inspiring, lengthy job history) she said, “You’ll know. You know when it’s time to leave.”

She was right. We do know when it’s time to mix things up. The hard part is taking the steps to act upon what we know. But, if we do take those steps, then jadedness can never catch us. The moment she gave me that advice, years ago now, I promised myself I’d be strong enough to change my course whenever I “knew” it was time. That strength sent me to Paraguay and brought me back to Vermont. So, no, I’m not worried about becoming jaded. I’m just excited to see where my adventures in medicine bring me.

Human Side of Medicine

Not so long ago I worked a code (cardiac arrest = patient’s heart stops and they neither have a pulse nor are breathing) in the field. The patient was middle-aged and had a complex medical history. The patient’s father, visiting from out-of-town, found him unresponsive, started compressions, and called 911. We did all we could—did compressions, ventilated, pushed epinephrine and other medications, and analyzed for a shockable rhythm. As we worked the father knelt at his son’s head. The patient’s fiancée sat outside the house. As it became clear that we were not getting our patient back, my crew chief reviewed, outload, all we had done. She asked us if we could think of any other interventions we hadn’t yet done and then she engaged the father, explaining why we were going to stop resuscitation. Once we had stopped she went outside to talk to the fiancée.

As heartbroken as the patient’s family was, they were calm when we stopped CPR. They had seen us sweat over their loved one, try everything we could, and ask for suggestions. We included them in our decision to stop our efforts. We lingered after our care was done to answer questions and offer condolences. This call showed me how it is within the pauses between action that we connect with our patients.

The human side of medicine comes through when we take time to ensure our patients understand what is happening and our plan for treatment. It comes when we include our patients and, when appropriate, their family in decisions about their care. And it’s completed by taking a moment to share their feelings, whether of relief after a successful procedure or sorrow after the loss of a loved one, before we scurry on to our next case.

Amid medical histories and assessments of signs and symptoms that lead to differential diagnoses it can be easy to let the presence of a disease or condition consume our attention. We can focus so intently on the disease that we forget humans bear the illness. But, below the clammy skin and wheezing is a person with a family and life experience just like you and me. And, what the patient will remember from their time during the flurry of a medical crisis is how someone treated them. It’s the offering of a kind word or an act of kindness on the worst day of someone’s life, not just the hope and likelihood that we have a cure, that defines good medicine. I try to remember to take advantage of the pauses by offering a blanket or bit of conversation to my patients. There aren’t always many pauses in my day, but when there are I don’t like letting them go to waste. It’s in the shared moments between points A and B that we build our humanity, but we must be attentive or we’ll miss the opportunity.

In Arlington Cemetery

This summer we held a memorial for my grandfather in Arlington Cemetery. His name will be on one of the niches in the columbarium. He was in the Navy and served in the Korean War. The service was short and concise. I think its precision and simplicity was well suited to my grandfather who was a high school and college math professor and liked things to be just right but not conspicuous. The chaplain was empathetic and caring and the soldiers who performed the flag ceremony were on point. As we said our formal goodbyes a trumpet’s song floated in the air above us.

My grandmother used to comment how they enjoyed when I visited because I’d sit all day and laugh as my grandfather told stories. He was a particularly gift storyteller with the dry wit that ignites my science-loving and logic-focused brain. He told stories of the Navy (usually when he and his comrades were causing trouble), his struggles as a student (he went for a doctorate in math but didn’t finish his thesis because of a disagreement with faculty), or his adventures as a teacher (he had many years of teaching from which to draw).

In EMT lingo, my grandfather had an “extensive cardiac history.” When I called my grandmother after hearing of my grandfather’s passing she told me, “The EMTs who responded to my call were wonderful. You do good work.” She said that even though they couldn’t get him back. His heart had stopped and he had no cat-lives left. When my grandfather died, I’d been volunteering as an EMT for several months.

I’m still and EMT and I also work in an emergency department. An interesting thing about providing emergency medical care is that your mission is to lessen pain and ward off death, but you end up seeing a lot of both. You end up being there when medicine meets it limits and the time of death is pronounced. I sometimes wonder what the EMTs at my grandfather’s death thought. I wonder how they ran their emergency call. What did they do to make my grandmother feel like they’d done the right thing? I hope the families of my patients have the same impression when we determine it’s time to stop CPR.

I used to visit Arlington National Cemetery periodically when I lived in DC. I like cemeteries because I enjoy walking the tombs and imagining the histories of the people they memorialize. Now when I visit Arlington, I won’t have to invent my grandfather’s story because I know it. I’m a product of it. I think of him often, partly because I wish he’d send me some of his math-genius as I continue my medical studies. Mostly, I think of him because he is one of the few people I know who successfully and completely built a life he loved. His only unfinished business is the family he left, especially his wife, but we’ll join him again one day if afterlife exists. Until then, we’ll keep making stories worth telling just as he always encouraged us to do.

Photo Credit: Mary Lou (family friend)

Night Shift

A few months ago, I started working the night shift in an emergency department (ED). Those who have known me awhile were surprised that I decided to work owl hours. When no other forces are at play, I happily get up at 5 a.m., even 4:30. Until I took the ED job, I got up early to study or run before going to work. In college, I worked the opening shift at Starbucks. In high school, I got up to work out or study before my sibling hooligans stirred. I love the stillness of dawn before most people rise. Growing up, I saw deer, foxes, and herons in the gray hours of misty summer mornings. I like the dampness of dew on the grass before it’s evaporated by the sun. I enjoy watching the sun creep over the horizon as I listen to the bird songs crescendo.

I wasn’t particularly surprised I started working the night shift. I’d suspected it’d come to that a few years ago, when I was still in Paraguay. I remember thinking about my return to the US, and my terrible tendency to lay my paper planner out in front of me and plot how to fill the blank spaces. I remember thinking, “Going into healthcare is very dangerous for someone like you. It’s a 24-hour business. Make sure you block out time to sleep or you just might not get enough rest.”

The night shift was the most practical choice when I started my ED job. The wage is higher and it leaves the day for studying or errands. Flipping my sleeping schedule was no light matter, however, especially because I started going to bed an hour before I used to get up. It’s also been a challenge finding a new eating schedule that works for me–I now eat meals at completely different times than before I worked nights.

There’s a strange stillness in the ED when the early hours of the morning approach – 1 a.m., 2 a.m., 3 a.m.. Even when a very sick person arrives who requires many hands to care for them, the ED is strangely quiet in the morning. Many patients are sleeping or too sleepy to chat with their family members anymore. The patients staying with us until a bed opens in a facility that can help them heal their mental health challenges are usually sleeping or partaking in quiet activities. Sometimes a drunk patient arrives and disrupts the silence, but often they too fall quiet as the morning creeps onward.

Now instead of waking to stillness, I head to bed in its midst. As I drive home from the hospital, the birds are just starting to sing, but the sun’s rays aren’t yet seeping into the sky. The roads are empty save for a few souls coming home from a party or, perhaps, going to work. I arrive at a silent house, those there are sleeping. Not even the dog, when he’s visiting from my parent’s home, greets me when I open the door.

When I first started working nights, I was always tired. But, now that I’m used to it, I’m no more tired than I would be after any long day at work. There’s something about the night shift that keeps you coming back. Perhaps it’s because I like quiet, or perhaps it’s because I like the self-efficiency that’s required when you’re providing quality health care without all the resources of regular business hours that excites me. More likely, it’s that the people who work the dark hours are different than those who work when the majority of society is awake. Many of us won’t work nights forever, but we have some reason to do so now. It’s the fact that we have a reason to be nocturnal, I think, that creates a sense of comradery that’s different from any dayshift vibe I’ve known.

Prayers

Trying to get into medical school is a bit of a slog at times. I’ve been lucky to have people support me during each leap through the hoops of fire. Recently, I’ve had a few folks tell me they’re praying for me, and then qualify their statement by saying they know not everyone believes in God. I was surprised that they felt the need to acknowledge I may not believe in their God.

In Paraguay, my adopted mothers prayed for me almost every time I left their house for mine (so almost daily). I am and was always thankful because of the sentiment. I believe it’s tremendously generous and kind when a person cares enough to think of me, to support me, and then to ask for help on my behalf—whether they communicate with their God or simply wish me luck.

In America, I think we publicize the extremes. I see politics radically divided. Political opinions are often based on extreme visions of how things should be or a rebellion against others’ interpretations of right and wrong. These hardline stances don’t allow for more than one opinion to thrive. To me, holding an unweaving “I’m right and they’re wrong” stance is limiting because it creates rigid definitions of aspects of life that neither the State nor another individual can interpret for me or you.

I attended church often in Paraguay because the church was the center of everything in my Paraguay community. I did not and still do not believe in the God of that church. But, I could feel how strongly my Paraguayan friends and family believed in their God. To them, their God was not only the source of life and reason for living but also the definition of love. Going to church allowed me to better understand how they saw the world. The Paraguayans who welcomed me into their lives knew our views of God were different, and they still embraced me as a dear friend. They included me in their secular and religious activities, answered my millions of questions that began with “Why?”, and they accepted it when I sat out from certain rituals because they were “too much for me.” What these shared experiences taught me was that we do not need to have the same definition of life and love to build friendships. We just need to be comfortable knowing that even though we see eye-to-eye on some things and share some history, we also hold very different views of certain aspects of life.

My hope is that someday the US won’t just be tolerant, but that each of us will be comfortable standing side-by-side with folks who are different from us, be strong enough to ask questions to learn more about how those different people see the world, and be proud enough of our belief system to follow it without expecting others to pledge allegiance to our view.

When I think of those who prayed for me before I took the MCAT, I’m thankful. Perhaps their prayers didn’t mean to me what they meant to them, but I think we share the knowledge that what I was doing was hard and whatever assistance they gave would be part of my success.

Christof

There’s a guy, Christof, in my neighborhood who collects returnable bottles from the recycling we put out on the corner for the city each Friday. One day when my father was visiting me, he struck up a conversation with Christof. One of Christof’s daughters went to college and the other didn’t–Christof joked that the daughter who finished college doesn’t have a job while the other one does. He collects bottles to help both of them.

I don’t often drink anything that comes in a redeemable bottle, but since chatting with Christof, my father started saving his seltzer bottles…he drinks a lot of seltzer. My father brings the bottles to my house (even though I live about 2 hours away) when he visits so I can give them to Christof.

I work nights, so it’s challenging to put out the recycling before Christof passes. One morning I saw him, though, collecting from the neighbors. As he walked by, I ran out and asked him to wait a moment. He paused, a smile lighting his face. I handed him 2 huge trash bags of bottles I’d squirreled in the garage for a few weeks. He thanked me a million times, wished me a blessed day, and was on his way.

At first, I thought my father was ridiculous for saving bottles for Christof. But, that morning when I saw Christof’s face after I handed him our bags of bottles, I realized that my father was right. We can get so caught up in all the big things we should do that we do nothing. Christof reminded me that it’s the small things that add up in the end. And, luckily, life is full of small things.

Determination: 2 Girls, 1 Hill, 1 Tree, and 1 Ladder

As children, my friends and I spent hours wandering the woods. We lived in rural Vermont in the middle of hills covered with sugar maples. One of my best friend’s families made maple syrup as part of their living—they collected their sap using draft horses. And it is with that friend that this adventure took place.

Far up on one of the hills behind her house, maybe a 40-minute hike across a river and bushwhacking through the sugar bush, was a monstrous tree. It was a Pippi Longstocking tree, a tree of wonder and stories. It was the most perfect tree for a tree fort you can imagine…and the branches didn’t start until 20 feet above the ground.

Those high branches spread out in such a way as to almost make a floor. My friend and I thought that if only we could reach those branches it would be the best thing in the world. We dreamed of hanging a hammock from those taunting limbs and eating a picnic up in the canopy. We thought about our future tree fortress on many occasions, staring up from the ground, until one day we contrived a plan.

Her father had a very tall ladder—one of those aluminum ones that has two sliding parts so it can get even longer than it appears at first.

We started in the morning. She took one end of the ladder and I the other. Those ladders, though hollow, are not light. We discovered this not long after crossing the river and starting up the hill. We also realized that zigzagging through trees was a lot harder when you are attached to another person by an 8-foot, stiff ladder.

We stopped occasionally. We argued about the best way to go through the trees. We sweated and got scratched by brayers.

And, after what seemed eons, we reached the tree. We lay the ladder against it, expanding it to its full length. We observed the ladder. We were scared. It was so tall and the ground wasn’t even. Surely, we’d fall if we climbed it. Surely, if we fell we’d die. We talked about climbing the ladder. About falling. About how amazing it probably was up there. “Fine, hold the ladder,” I said. And I put my foot on the first rung. I was shaky. It was high. My heart pounded. I got about 6 feet above the ground. I paused. The ladder felt wobbly. I wasn’t sure if I should keep going.

Slowly, carefully I reached the top rung. The branches were still overhead. I’d have to grab them and then swing my legs up and hang sloth-style to get up in the tree. I stood at the top of the ladder a long time. My friend first shouted up that if I wasn’t going to do it I should come down so she could. Then she suggested that we not do it at all.

I grabbed the branch and I swung up. “This is awesome!” I said, sitting and staring down at her on the ground. She joined me, with the greatest care because the ladder was unsteady, especially without someone holding it.

We sat up in the tree until we got hungry. The only reason we ever left the woods was because we were starved.

Some people will tell you your dreams are impossible. Don’t bother with them. Someone else will help you carry a ladder.

Framing: Beautiful Microbe, Beautiful Molecule

Before I started down the health science path I studied communications. In communications, there’s an idea called “framing.” Framing is a theory that’s often applied to the media and how it shapes public opinion about certain topics. The concept is that how you talk about a specific topic (ex. healthcare)—such as the tone you use and the details you include (or leave out)—can shape other people’s perceptions of the topic.

I’ve noticed that several of my science professors use framing as a teaching tactic. And, despite knowing exactly what they’re doing, I still fall for it.

I’m currently studying microbiology and organic chemistry. There’s a lot of new information to learn and for organic chemistry there are a few new thinking skills I’ve been practicing—such as being able to think about molecules in 3D. It’s an interesting challenge to train your brain to be able to rotate different molecular structures using only your imagination. I’m lucky enough to find microbiology and organic chemistry fascinating, but still it’s hard work. That’s where the framing comes in.

My organic chemistry professor introduces particularly complex or tricky molecules as “beautiful molecules.” “This is a beauuuutiful molecule,” he’ll say. He’ll also start a new chapter by saying “This is an important chapter. This is very cool…let me tell you why.” And, somewhere in that explanation of how awesome the challenging topic is, he’ll make a few comments about needing to practice the skills he’s about to show us. “But I will teach you how to…” he will conclude.

My microbiology professor does the same thing. I always know when he’s preparing to introduce a particularly complex metabolism, process, or cycle used by bacteria because he’ll pull up a picture of a microbe and say “This beautiful microbe…”

Those are current examples, but my general chemistry professor did the same thing. His word for hard concepts to learn was “interesting” rather than “beautiful.”

So what’s going on with this inappropriate use of descriptive words? Framing. Why? Because it works. As absurd as it sounds, it’s way easier to fight with a beautiful molecule than a molecule that’s “annoying” or “difficult” or “challenging” from the very start. I don’t think microbes are necessarily beautiful, but I approach them with much more interest and forgiveness when they are presented to me as “beautiful” rather than “ugly” or “evil” or “bad.” And, when trying to complete long chemical equations, it is a lot easier to complete the “interesting” problem than it is the “hard”, “tricky”, or “terrible” problem.

What’s my long-winded point? Before I dove into science I heard that it was “hard” and “confusing” and “dry” and “boring” and many other potentially negative adjectives. Sometimes I completely agree. But, most of the time, I do think it’s amazingly interesting. I think we’d do a lot of young people thinking about their future (and older people looking for something new) a service if we framed science as something wonderful. Sure, there is plenty about it that’s hard, and even monotonous, but most of it (all of it maybe) is not beyond most people’s reach. We’ve just conditioned our population to think science is either too complicated for them or not something they’d find interesting by describing it as scary, trying, and a thing that only geeks and brilliant people do. It’s worth a frame-shift around science. Why? What better way to find answers to medical questions, renewable energy questions, etc. than having more people researching and exploring those topics?

Energy Levels

Atoms cling to, share, or pass electrons. They do whatever it takes to make themselves more energetically stable—not reactive and content as they are.

I think we have some lessons to learn from atoms and their energy lowering endeavors—let’s say we are the atoms, the electrons are aspects of our lives, and the energy state is our emotional state.

In the world of negative electrons and positive atom nuclei, the more energetic the relationship (imbalances in charge, which basically means repulsion and attraction forces aren’t equal) the less stable and the more likely the atom is to undergo change. Electrons in high-energy states, unstable, cause chemical reactions from little ones like putting baking soda in vinegar to big ones like bombs exploding.

I’ve noticed a similar situation in my own life…and those around me. The higher the energy (emotion)—whether it be negative like stress as deadlines and huge projects loom or positive like an awesome vacation—the more reactive we are. Of course, our fizzing reactions might be petty arguments and our explosions could be bouts of extreme agitation, but nonetheless we are more likely to respond dramatically when our emotions are high or low.

The thing that’s clever about atoms is that they are willing to exert themselves to achieve a more stable state. In other words, they will do the atomic version of sweat it out—to ensure they’re living in a happy medium. And, they’ll go to great lengths to defend and maintain a stable state once they have it.

I propose, just like atoms, it’s worth it for each of us to build into our “to-dos” a little bit of energy maintenance. Atoms maintain stability by shedding or attracting electrons…what are the electrons in your life?