I went into medical residency with the expectation of being provided an education and a work environment which was conducive to learning. I knew ahead of time that residency training in a surgical subspecialty was going to be demanding in the investment of time, energy and focus in the management of patient care and acquisition of theoretical and practical clinical knowledge. What I was not mentally prepared for was the social hazing or as my program director put it, “the unspoken rules of residency”.
As stated in ACGME program requirements:
VI.B.6 “Programs must provide a professional, respectful, and civil environment that is free from mistreatment, abuse, or coercion of students, residents, faculty and staff. …”
VI.C ” … Psychological, emotional and physical well-being are critical in the development of the competent, caring, and resilient physician. …”
Unfortunately, my experience of residency training was one too many years of perpetual gaslighting. At the end of it my confidence was destroyed to the point where even basic tasks seemed like a monolith. It wouldn’t be until years after I left when I finally realized I had experienced the exact same dynamic as a victim of domestic violence. The process starts insidiously, subtly and in the end I realized my entire identity and self-esteem had been eroded. I didn’t know who I was anymore. It took years to get it back. It took 6 months to regain my baseline ability to speak articulately. My own family had difficulty understanding what I was saying as I could not verbally organize my thoughts coherently.
Looking back, there were some red flags that showed up right at the beginning. One of the chief residents had asked me to meet up with him after I finished rotating through the program. During our conversation, he lit a cigarette and then asked me “do you want to get into a residency program?” I thought the question was odd and replied “doesn’t every medical student?” He then said ” do you think the attendings want to sleep with you?” I was shocked by this question and said “no! what makes you say that?!” He then said “do you think Dr X (the chairman) wants to sleep with you?” I said “no, what are you going on about, is that the done thing?” He then said, “all I’m saying is don’t sleep with any of the faculty.”
The conversation caught me off guard and since he was one person, I thought he was the odd one out and brushed it off to mean nothing serious. In hind sight, it was a red flag as to how I was being objectified. I was not seen as a colleague on equal ground. Not only that but his comments were a reflection of how I as a woman would be expected to negotiate power and have my position be protected from scrutiny in the workplace of the medical profession.
On my first day of residency, I recall the program coordinator reminding the entering interns that the chairman believes strongly in “no fraternizing.” Later I would be introduced to a second year female resident who had gotten into the program through her social connections with this very same chief resident and another senior resident both of whom I would later find out had major anger issues. She handled them with flirtation and self deprecating humor as far as I had seen. I had asked her how she managed to be “such a good politician with these guys” she replied “oh its because I’m such a flirt and a tease.” I asked her why she decided to handle things this way. She said it was because of how she had seen the male residents “take down an alpha female.” She said “they tore her to shreds” during a grand rounds conference. A woman resident from another department introduced a male colleague as her “work husband.” A female attending associated with the department also told me “there will always be someone out to get you and that means you have to document everything to protect yourself.” I asked her why? Her reply was “welcome to being a woman in medicine.”
The chairman reinforced these gender roles by telling me “your chiefs are married and miserable so I don’t think that any of them will make good mentors for you.” He absolved any of my chiefs’ accountability towards mentoring me because he was insinuating I was a sexual temptation that they would only resent. In turn, I could not expect them nor him to be relied upon as a junior level learning. Instead he told me multiple times that he would send me to “charm school”. He also told me that I should hang out with the other female resident because “the guys like her.” Yet it was known amoungst the male residents that the chairman had asked her to show up in his office everyday to ensure she had taken a birth control pill.
When I held a party an ED resident who was an acquaintance at the time asked me “so what do you think of your co-residents?” This was before the year I started to work with them. I replied “I think they will make good mentors.” He said ” I mean, what do you think of them as guys? Do you think any of them are attractive?” I said “no, why should that matter?” He said “because you’re going to work with a bunch of psychopaths.”
Rather than mentoring and constructive feedback, I was ridiculed and undermined by the chiefs right from the beginning of my specialty training. I was told “it was obvious, it’s like breaking traffick laws” and told that “you maybe cute but you’re not a doctor and you should thank me for my honesty.” Along with his sexist remarks the chief was absolving his responsibility of mentoring me and throwing me under the bus to heads of faculty. I was on the receiving end of, as per my attending mentor had put it verbatim, “the chiefs had been beaten by their chiefs and now it is their turn to do the beating.”
A male faculty member in another department caught wind through the grapevine that I was being targeted. He took advantage of my position of weakness to see if he could sneak a date out of me. He had approached me during a time when a patient needed to be intubated and he handed me the MAC while staff were in the room telling me “I’m giving you props.” Afterwards he asked me out to dinner which at the time, he did not explicitly tell me he was asking me out on a date until after I met up with him. My response was “I thought you were married with kids.” He replied “no, that’s why I asked you here.” At that point I felt pretty manipulated but kept those thoughts to myself because he was faculty. During the conversation he said “residency is like being in a family with a lot of siblings. If the older siblings feel like the parents are giving the younger siblings more stuff, their response is ‘hey why is she getting that when we never did?” I certainly did not believe based on the way I was being treated, that I was getting access to more education or resources. I knew I could not go to upper levels for help. Instead this male faculty member thought he could trade his mentoring and protection for having a sexual relationship with me.
The harassment from the chiefs throughout the year was very intense. I couldn’t sleep for days due to anxiety, couldn’t think straight and it affected my performance as it would have most emotionally intact people. I am amazed I managed to function as well as I did. By that point I had even received an email from one chief instructing me on how to exactly have my bowel movements each morning. I tried my best to tough it out as I knew that I would be seen as weak if I went to the faculty. When I finally could not take it anymore, I broke down in tears in front of my program director in response to the months of harassment I had endured. He literally smiled, chuckled and said “boy have you had it rough and this is why we are sending you to see Dr X .”
I was sent to see the psychiatrist who had the faculty position of oversight of the resident health and wellness committee. He told me that I needed to change my appearance, wear my hair down, change my glasses to “something less severe.” He said “your co-residents are nerds, they think you are exotic and they do not understand you.” He also told me that “residency is like a marriage and have you ever been to Saudi Arabia?” It all sounded very similar to what a well respected female trauma attending had told me the prior year. She told me I needed to “dumb it down”. The psychiatrist had told me that I needed to publicly apologize for my poor communication to the male co-residents. He told me “it’s because they would not be expecting it. They will see you are being the bigger person.”
This was the faculty’s response to the anger management problems of their chief residents. The chiefs behavior of course was absolved, I on the other hand was sent to HR where I was told by the HR interpersonal skills coach that “you’re in a patriarchy, you must accept mia culpa.” The coach said “have you ever watched the movie My Fair Lady?” He said “they want you to be more like them.”
At the time I felt so confused. I did not understand what the patriarchy was. The first time I heard the word was from the HR coach. I had never seen Audrey Hepburn’s My Fair Lady and I didn’t know why I would be seen as exotic. I was a nerd too. It took me months of reading sociology and Women’s studies books to piece the meaning together. I was a feminine woman who was threatening power hungry sexually repressed men and not fitting their gender stereotype of how such a woman needs to behave to prevent them from having their sense of masculinity threatened.
I felt a lot of frustration that this was the sexual political game female physicians were expected to play by both men and women doctors. The concept of a female doctor having to gain respect through behaving gracefully made me feel that this was in fact enabling abuse of power. The words “grace” and “emotional intelligence” had become tarnished and euphemisms for something sinister.
When I left the residency program one of the former chiefs texted me and said ” you want to know the truth? We didn’t want you to match here…because you are not a doctor or surgeon .. and you should thank us for our honesty. ” When I asked this former chief what I should become he replied ” a porn star.”
The derogatory statement he made was meant to add insult to injury in a situation that any resident leaving a program would find sickening to read. Yet he felt entitled and empowered to write it in a text because he knew he would not be held accountable. Prior experiences in his life with both men and women had reinforced his deduction.
It was a realization that the only way for women to be free of gender discrimination, sexual harassment and have self agency in their professional power dynamics is if they stop enabling the patriarchy and being its gatekeeper. Instead both men and women need to know mens’ place in their working relationships with women in the medical profession as quality patient care depends upon it.