As I hug my younger daughter’s little head at school drop-off, the calming aroma of her hair fills me with peace. She scurries across the schoolyard toward her 2nd-grade classroom, her big backpack bouncing up and down, seemingly with its own agenda and dwarfing her tiny frame. As soon as I leave the school, my focus switches. I’m at the edge of my patient’s hospital bed, reviewing the day’s treatment goals. I cautiously engage the patient because of his racist comment regarding oxygen adherence the day prior: “Those Mexicans are always watching. If they think I have something they can steal, like an oxygen machine, they’ll steal it.” The patient did not seem to notice from my last name that I might be Mexican. I am in mid-sentence when a male clinician walks into the room. Without acknowledging me, his eyes, and the patient’s connect. Facing me, interrupting, he says, “Did you hear about the woman that backed into a meat grinder?” Perplexed by this question, I respond, “No, is she OK?” He leans in toward the patient and smiles, “You know this one.” The patient responds, “You bet I do: DIS-ASSED-HER.” The clinician and patient laugh. I’m confused. The clinician then points toward me and says, “So how is she treating you?” Wiping the tears from his eyes from his fit of laughter, the patient responds, “Oh, she’s a total bitch!” Both the patient and clinician laugh again. My jaw drops. What? Even in jest, this seems grossly inappropriate. In a span of under a minute, I move from planning the treatment goals for my casually racist patient to total confusion and, finally, anger. The clinician’s pathetic punchline now makes sense, and I’ve just been called a bitch at work. My heart races — I feel enraged — I walk out of the room. Unsure of what to do next, I leave the hospital for a walk and breath of fresh air. I begin reflecting on my anger and send the clinician an email: “We need to talk about the inappropriate conversation in the patient’s room. I am on the ward all day. Come find me.” Eight hours later, I receive his response: “Worked late. Here’s my cell. Call me if you need me.” My immediate response: “No, this needs to be in person. Find me tomorrow.” The next morning, the clinician approaches me at the nurses’ station: “Hey, should we go and talk in a conference room?” I respond, “No, here is good.” I recount the prior day’s conversation, making it clear that I am offended. Confused, the clinician says, “What? You and I are friends. I didn’t mean anything with that joke. I was just trying to connect with the patient. I didn’t mean to interrupt you. I didn’t hear him call you a bitch.” Is he genuinely surprised by my discomfort? I recount the entire conversation again. “I’m sorry,” he says. “I just didn’t think I was offending you with the joke, and I didn’t hear him call you a bitch.” Then I ask, “Do you have daughters?” He responds, “Yes, two of them.” “I want you to consider the kind of culture you are creating for women and men. You can’t tell inappropriate jokes and be respected. You cannot diminish my authority as the patient’s physician by telling sexually inappropriate jokes. You cannot laugh after a patient calls me or any woman a bitch.” I had initially hesitated to bring up daughters because after all, it was completely unnecessary to invoke the idea that a man remember his daughters in order to garner respect for women. Even so, at the mention of his daughters, he pauses a moment and looks down: “Yeah, I’m sorry. I continue, “Imagine if your daughters became physicians, and a clinician speaks to them this way?” This admonishment seems to get through: He stops justifying his actions and simply says, “I’m sorry.” His tearful eyes lead me to believe he is remorseful. Until this point, I was so enveloped in the moment that I had forgotten that during our conversation, we had been encircled by other clinicians. After he leaves, a nurse taps my back to say, “That was amazing. I wish I could do that.” I relax. I did it! I said everything I wanted to say, and I stood up for myself right then and right there. Too often, we become complacent with how women are treated, particularly in professions that are male-dominated. Women in medicine often find themselves in situations that feel inappropriate yet may do little at the moment to modify this behavior for fear of other’s incredulity or job security and because this behavior is an accepted social norm. I found myself questioning whether my anger at him following the conversation was an overreaction. I believe that through the inspiration of my own daughters, I empowered myself to face him and resolve the anger I felt. Moreover, rather than reaching out to the office of integrity or his supervisor, I faced him myself. It is unacceptable to objectify women or to condone prejudice against women. This type of behavior can have a cumulative effect on well-being and career trajectories. Men and women need to collectively stand up against inequalities and educate clinicians and patients that sexism will not be tolerated. As a Latina physician and particularly at an academic institution working with students in training, we need to explicitly discuss sexism and racism as we train everyone to treat each other as equals. We need to demand a culture where this type of behavior is not tolerated, and we need to create an inclusive, interdisciplinary environment between clinicians and the students we train. The same day that I confront the clinician, I pick up my daughters and hug them tight again, knowing with all my heart that when we demand respect in the face of discrimination, no matter how insulting or surreptitious it may seem at the time, we will make a difference — a difference that our daughters will experience. Lilia Cervantes is a hospitalist. Source
