Us, too

Yesterday, we had an afternoon-long retreat for our entire medical practice. As work retreats go, it was fairly productive. But the most powerful part was after it ended.

The meeting was adjourned, but a group of doctors and nurses lingered, chatting. Almost all of us have families and other responsibilities, but we rarely get to talk to each other. Like, really talk. So there it was, a busy weekday, getting dark out; and there we were, some of us with coats on, holding our bags, ready to run home.

Someone brought up the recent rash of celebrity sexual harassment cases. Then someone shared their own story. Suddenly, everyone had a story.

And one by one, we sat down again, set the purses on the floor, and listened to each other.

One of our senior nurses described being thrust up against a row of lockers by a male medical student. Shocked, the only thing she could think to say was: “But I’m married!” to which he replied: “All the better!” She managed to elbow him hard enough that she could escape.

Did she report him, we asked? What came of it? Oh, no, she described. Sadly, back then, fending off physical advances from medical students and residents was basically a given. It was just part of the job.

We reflected on how the culture of medicine has normalized this kind of predation, to the extent that perpetrators got away with these behaviors for years, decades even. One of our senior physicians told us how, when she was a resident, a teaching attending on the wards enjoyed grabbing and pinching the bottoms of unsuspecting female trainees. She knew about it, everyone knew about it, but given the power differential and the times, no one reported him. It was years later that she learned he had been caught… doing things to anesthetized patients, and was charged for the crimes. Today, she feels guilty about not stepping forward earlier. But the sad truth is, the only one who would likely have been punished would have been her.

Then there were scads of similar stories. A younger colleague told us how, as a medical student, she was rotating through radiology. Her teaching attending invited her to be a subject for his study of the veins of the leg. It sounded clinically interesting, and as he was her supervisor who would be grading her, she was eager to please. So when he asked her to don a hospital johnny and accompany him to an exam room, she didn’t think twice.

Then he slathered ultrasound jelly over her leg, and began rolling the probe up. And up. And up, droning on about the saphenous vein et cetera, all the way to her groin and with no indication that he was going to stop. She jumped off of the table, announced that she had to be somewhere else, and ran out.

Another senior physician described how when she was a pre-med, it was rumoured that a certain organic chemistry professor would only bestow A grades for the women who slept with him. She was a very good student, and deserved a high grade based on her academic performance. So when said professor called her into his office and told her, flat out, that the only way she would get an A grade was to sleep with him, she said No. Angered, he declared that the highest grade she could possibly get from him would be a B-minus. She walked out, and that is the grade she was given. It was such an anomaly on her record, that during several medical school interviews, she was asked to provide an explanation.

I have tales to tell as well. As a trainee, I had the privilege of attending a lot of educational conferences. At one, I was thrilled to hear a talk given by a respected, well-established physician whose work I had long admired. I even had his book, which I held hugged to my chest as I waited, patiently, for a moment of his attention after his presentation. He signed the book, and we chatted. He seemed to take a particular interest in me. Walk with me, he suggested, and as we strolled through the hotel, he shared details about his career path, while also asking me questions about my own work and interests. I could not have been more flattered.

When we stopped in front of a door, he waved me in. Come, let’s continue our chat, he smiled. The room was on the main floor, and it wasn’t entirely obvious that it was his personal hotel room, until we were inside. He sat down on the edge of his bed, and I perched myself rather awkwardly on the edge of a chair that also held a piece of luggage.

Then, the esteemed physician/author began to undress. Still asking me professionally appropriate questions and going on and on about his own career, he slid off his shoes and socks. Then, he unbuttoned his shirt, and removed his tie.

It was when he stood up, facing me, and undid his belt that I bolted. Flushed, confused, I stammered something about meeting friends for dinner, and backed out of the room.

A classmate of mine in medical school had related a similar story about one of her undergraduate professors. When she told us about it, I asked her if she had reported him, and I was mystified when she admitted that she had not. Yet when the same thing happened to me, it never remotely occurred to me to report him. Not at all. At the time, it felt like the whole thing had been my fault, my own misunderstanding, my mistake.

What almost all of these stories have in common is a power differential combined with a male-dominated culture. Professor and student, attending physician and trainee, even medical student and nurse circa the 1970’s, all represent lopsided relationships: the powerful versus the vulnerable. Medicine, and particularly academic medicine, have long favored everything men say, do, and want. Put all these things together and you have a hell of a lot of #metoo stories.

But now what? The big question at the table was: Is it too late to report these incidents, if the perpetrators are even still alive? How reportable are these behaviors? In my case of the stripping physician, he didn’t force me into his room. He never said anything lewd or suggestive, nor laid a hand on me. I was able to exit freely.

But everyone at the table gasped when I shared my experience. We know that what he did was wrong. He was clearly in a position of authority, over me, a trainee. He was powerful, and I was vulnerable. His actions were sexually suggestive, and I did not consent. This is what sexual harassment is. What if his actions that day are part of a larger pattern? What if he, like my colleague’s buttocks-grabbing attending, has gone on to commit more heinous acts against otherwise unsuspecting victims?

We are experiencing a sea-change, a shift in our cultural norms. Even rich, famous, formerly invincible predators can be exposed and brought to court. So, do we who have experienced these episodes in medicine now have an obligation to report? If I know that Mr. Stripping Physician is a teaching attending at a major medical school, what do I do? What about Mr. Sketchy Leg Vein Study? Or the others?

There were more stories yesterday afternoon, and I’m sure there will be more as we move forward. I take heart in this. I am hopeful that people are speaking up, and that their voices are being heard. But I am also not sure what to say about what has already happened. Let me know what you think.