My Future is just as good as my Sutures – Females in Medicine

My Future is just as good as my Sutures – Females in Medicine

“If you were male, we would have assumed you could suture.”

The doctor had a bright smile on his face and, as always, was trying to be charming. I looked over to my friend to confirm I’d heard him correctly. She looked as astonished as I felt. Here was a young, intelligent and upcoming surgeon and he was telling us that our weeks of hard work hadn’t mattered; only our gender did.

By this point in time, we had put in more than 50 hours each week at the hospital. We had attended every surgical theater on offer, stood on our feet throughout the day following doctors, answered difficult questions, assisted in procedures, held up necrotic limbs, pulled back engorged intestines and sutured-up multiple abdomens.  We would come home tired and then study for hours about the conditions we had seen in order to learn more the next day. But despite all of this, here we were sitting in a room, with a flirtatious male being told that I had “lost weight and looked good” and the fact that I didn’t have “a boyfriend after all this time is unbelievable”. Where was the mention of our hard work? Our clinical improvement? Our persistence? Our enthusiasm? Where was the advice for me as a student looking at a career in surgery? Where was the acknowledgment of us as future doctors? Where was all of this? It seems that after weeks of diligent study, only my changing figure and current relationship status were worthy of mention. That’s when it hit me – Welcome to the exciting world of being a female in medicine.

 “After weeks of diligent study, only my changing figure and current relationship status were worthy of mention.”

As a fifth year medical student I am sad to say that I have seen, experienced and heard many scenarios echoing the themes of my most recent encounter. A woman walking through a hospital is often confused for a nurse, allied health professional or aide. While these jobs are integral to patient care and healthcare functioning, it highlights the fact that people often assume a female is not a doctor but the male next to her is. While on ward rounds, there are always patients who thank the males on the team by saying “Thanks doctor,” and then turn to the females and say “thanks girls.” When offering to administer needles or insert catheters, it’s not uncommon for patients to say “oh I got a pretty one,” while addressing the female medical student. These small yet frequent occurrences show how, on a daily basis, we women in medicine are not equated to our male counter parts.

Historically, there have been more male than female doctors. In the 1980s, only 25% of GPs and less than 1 in 6 specialists were women. However, fast forward to 2017 and females out number males in medical school 55% to 45% and dominate fields such as dermatology, pathology and family medicine. A 2017 JAMA study has even found that patients treated by female physicians have significantly lower mortality and readmission rates compared to those treated by male physicians. Yet, despite these achievements, female doctors are still paid ~ $20,000 less than their male counterparts and are woefully underrepresented in the areas of surgery and leadership. Even though  preferences for specialty areas across male and female medical students are the same, fewer than 12.5% of hospitals have a female chief executive, less than 30% of medical schools have female deans and only 1 in 3 chief medical officers are female.

 Female doctors are still paid ~ $20,000 less than their male counterparts and are woefully underrepresented in the areas of surgery and leadership

Most of the areas where women are poorly represented offer limited options for work flexibility and require years of training that coincide with the prime of our lives. However, I believe the barrier of “perceived credibility” also plays a large role in this gender gap. For example, after having had placed countless cannulas and done many sutures, a close friend of mine asked an anesthetist if she could place the IVC for a patient in theater. The doctor took one look at her, said that he’d prefer someone who actually knows what they are doing and reluctantly let her do it. Fast forward to the next patient, and a male student asked to do the IVC while admitting he had never done one before. For him, the doctor was happy to oblige and assisted throughout the procedure. It is frustrating and demoralizing to see how male students need only don scrubs, and suddenly they’re experienced and enthusiastic. It doesn’t matter if I have been standing for the past 2 hours waiting to assist in a surgery I had painstakingly studied about. You see, the male student who doesn’t know the first thing about lignocaine has a strong Y-chromosome that clearly makes him a better choice.

Women in medicine and surgery need to be taken as seriously as males; it is the only way to truly move forward. Treating us differently and placing less value on our capabilities alienates us and furthers the gender divide. In fact, lack of support and the presence of internalized bias discourages females from actively seeking out the careers they dream of. Medicine is a long, hard but rewarding road. It is exhilarating yet tiring and requires you to be your best even when you feel less than that. You see people at their top and you help them at their worst. Coming straight from high school, medicine is a degree that matures you quickly and gives you a wealth of experience in a few fleeting years. As a senior MBBS student standing on a precipice about to jump into a career as a doctor, I see a field that is bursting with opportunities. I am excited for what my future holds. But, this undeniable gender inequality scares me, angers me and saddens me. In this day and age women like me should not be made to feel our ovaries and mammaries make us less able to do surgeries. We should not be told that being pretty makes the needle we are administering “hurt less”. We should not be told that our career options are more promising in fields that work 9am – 3pm. We should not be cut down before we even begin. So please, the next time you see a female in medicine acknowledge her skills, her experience, her wisdom, her hard work and her dedication. Acknowledge her as a doctor and as an equal – I ask from you nothing more and nothing less.

The next time you see a female in medicine acknowledge her skills, her experience, her wisdom, her hard work and her dedication. Acknowledge her as a doctor and as an equal – I ask from you nothing more and nothing less.

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The Best Gift Ever!

I have the best parents ever. I know that’s something you say as a five year old trying insult your schoolmates at play time – but seriously my parents are amazing. There are many reasons why but because my attention span isn’t large enough to fit them all into one blog and also because I don’t want you to feel too devastated that you don’t have my parents, I will focus on just one. Ever since I was a little kiddo my parents always liked to go on trips and see different places. It didn’t matter if we were on holiday and sightseeing or en route to a work convention, they always made it a point to see the places that were around us. In the 20 years of my life I have had the opportunity to see more than 10 countries and over 100 different places. I can’t even think of anything else I’ve done 100-times, that too all in the company of Mumma and Pappa A.

Seeing so many places, experiencing so many cultures and eating so many varieties of food (that’s why I was a chubster) opens your eyes so much it’s crazy. You get to observe the similarities and differences that persist past geographical boarders. You get to meet and interact with people who are worlds apart from you both in distance and culture. You learn to connect as people and it is heart warming how friendly people can be. Pappa A is the master of making friends where ever he goes – in Dubai he became best friends with the porter who was subsequently devastated when we had to leave, he made a mate in a road side shop owner in northern Karnataka and in Eqypt our driver was a fan because father could speak some Arabic. Going to so many places also means we get to create countless memories together – we often fondly look back on the time when Pappa A and I lost our glasses to tactful monkeys or the holiday when Mumma A walked hand-in-hand with a monkey thinking it was mini-Nimmy or better yet the time Mumma and Pappa left behind mini-Nimmy on a busy Delhi Metro platform (one kid – c’mon guys you have one kid!). It’s experiences like these that tether us together and have allowed me to have my best friends as my parents. These memories are more valuable than any number of iphones or laptops – I would not trade them for the world.  Aside from meeting people and creating memories, going to places that are different to the place you call home gives you a reality check. Going out reminds you that the world is so much larger than the town and suburb you live in. It is so easy to put blinkers on and go about your daily routine but once you see the many forms life takes, you realise there is so much more to the world. It sounds very cheesy, but when the realisation hits you it is both refreshing and terrifying.

Going to places like India also reminds me of who I am; this is something that is easily diluted if I do not take care to preserve it. I love experiencing my Indian heritage, Hindu culture, traditional foods and mother tongue – in fact because we come back so often, it is comforting to be able to slot into our family’s life without feeling like we live thousands of kilometres away for 11 months of the year. Creating memories with cousins and constantly being in each others lives means Mumma and Pappa A have allowed me to create lifelong bonds that I will cherish now and into old age. I have friends who haven’t seen their family in India for over 10 – 15 years; when they come back home they feel so out of place it is sad to see that they have lost so much of their heritage. It is a large commitment to come to India every year, but the relationships that I have had the opportunity to create are absolutely priceless. It is one of the best things my parents have done for me and I hope to be able to give my kids the same (cheesy nimmy strikes again!). So thankyou mum and dad, thankyou thankyou THANKYOU!

So there you go, reason “uno” for why Mumma and Pappa A rock. There are like 100 others but my attention span has reached its limit so they will have be covered in another post (I don’t want their heads to get too big). Also if I promise to write another blog about them, maybe they’ll remember me on the Delhi Metro next time!

Invisible Medical Student-itis

20 y/o, female, third year medical student, presenting with a serious case of invisibility. Onset was sudden, 3 years ago upon commencement of the degree. Slight decrease in symptom severity over the past year as knowledge has increased however the true extent of the invisibility depends on which ward she is in. Symptoms are exacerbated by consultants and senior regs but alleviated by nice helpful doctors and nurses.

Most recent case of the ailment

  • Site: Intensive Care Unit
  • Associated symptoms: No motivation, bored, sleepy, feeling stupid, sore feet from no chairs available for the med student and overwhelming urge to go home.
  • Timing: 4 hours (was projected to be 8hrs but left early from intolerable symptoms)
  • Severity: 8/10

Over my past few placements I have come to the realisation that I have a serious case of ‘invisible medical student-itis.’ This is a widespread disease affecting MBBS students everywhere regardless of their age or intellectual aptitude. The diagnosis is upon observation where a lone med student is avoided by a minimum radius of 2 meters by all health professionals. The cure is not entirely known – proactivity helps in some cases, however in others it’s largely unresponsive. There is no vaccination  and like any viral illness one must wait until the illness passes – this can take 4 to 7 years depending on what form of the disease/degree is acquired.

It’s that time of year again – uni holidays – which means for us pre-clinical medical students its placement time. Getting to put all the knowledge we have learnt into practice. Seeing real patients, doing real procedures (cannulas woah!), answering questions and being all medical-like. Sounds amazing right? Well that depends. You must be careful as to avoid the contagious bug that causes “invisible medical student-itis”- for once you have it, placement will be as exciting as watching a cactus grow. And unfortunately for me, I got infected in my placement at ICU. G-R-E-A-T.

Let me set the scene – enthusiastic Nimmy bounced into ICU at 7:45am on a Saturday morning (yepp I got rostered on the weekend) and introduced herself to the doctor sitting at reception. Within 5 minutes of meeting me, Dr Reception-man (as I will refer to him)  told me to go straight home because ICU on a weekend sucks. But Nay – I wished to stay for a little bit for I had already made the effort of turning up – this was my first mistake. The moment I said I’d stay, I began to become invisible to Dr Reception-man.

The rest of my day panned out like this:
I asked questions and was super enthusiastic but the doctor couldn’t have cared less, and proceeded to ignore me for the entire morning. When he saw patients, he introduced himself only and never told the patients about me. Consequently, Nimmy had to loiter in the corner of the room awkwardly smiling at the patients. It was like if the doctor pretended I didn’t exist then maybe the patient would forget I was there too. Talk about deflating. Other times the doctor would walk across the room, and if I was in his path, he’d look at me as though he was wondering where on earth I had come from (dude I’ve been here all day!).

Don’t get me wrong, there are very many clinicians (nurses, allied health and docs) who love having students with them. These professionals are absolute legends because they know the only way students can learn is by being given the opportunity to learn. As students, we are put into completely alien environments with no one we know, so to have someone show you how things work is so refreshing and helpful. When health professionals get us involved, we begin to gain skills that we can then use to help others later on in our placement. Taking a history, quizzing us about what we’re seeing, hearing or feeling on examination or even telling us how to do documentation – these are all things we want to see but can never do if no one can see us.

So what am I trying to get at? If you’re a doctor for whom medical school is a distant memory, just a refresher: if you see a medical student in front of you, we have made an effort to be there to learn from you so please don’t pretend we don’t exist. I’m not saying you have to pat us on the back for turning up. Heck, don’t even bother learning our names if you don’t want to. If you’re too busy, just point us in the direction of a person who does teach – we understand. But if there’s time to teach us, please do it – we will forever remember you as the doctor who cured our “invisible medical student-itis”.

 

 

Bilingualism ain’t so Bad!

I’m a lazy kid – not going to lie. I use abbreviations where possible, “to kill two birds with one stone” is my life mantra and if it requires more effort than making a cup of tea I will use all my energy in contemplating whether to do it or not. Needless to say I don’t love doing extra work. So when mini-Nimmy had to sit at the dining table with extra books around her, Mumma in the background, learning something all her friends didn’t have to, she wasn’t thrilled. Oh the joy of learning another language. Different sounds, different letters, different words – why did I need this added level of complexity in my already hectic grade 4-er life? Writing out 10 sentences in English for homework was pain enough; to dictate Kannada proverbs in my playtime was a violation of my kiddy rights!

Kannada – pronounced Cun/na/da not Canada – that’s the language I speak, my mother tongue. Never heard of it? I’m not surprised. It’s a South Indian language that is spoken by people who come from the state of Karnataka. None of my friends ever know of it and usually my first conversation with them about it goes like this:

Friend: Oh you know another language. What’s it called?

Me: Kannada

Friend: Canada?! What they have their own language!?

Me: No I speak Cun-na-da

Friend: Nup never heard of it

Great all that hard work, hours of monkey bar time given up to learn a language no one has even heard of. Thanks mum. Growing ever disgruntled I would strut up to my mother and demand to know why she insisted on teaching me a language that no one knew about, and her answer was always, “So I can get mad at you in the grocery store and no one will know I’m yelling at you.” – Charming, glad to know all this effort is going to good use. Once again, thanks mum.

 

What Mini-Nimmy didn’t know was that there were going to be advantages later in life from knowing an unknown language. Gossiping is a girl’s best friend (ammirite?) and every girl knows that the best person to gossip with is her Mumma (I am so right!). But what is the biggest problem with gossiping? People listening and then telling Mary that you think her new short hair looks like a poodle. So how could we ever solve such a problem – bilingualism! Huzzah! You have no idea how often Mumma will point out a far too short skirt, or a crazy haired person or a crazy friend all while using the intonation of a thorough literary discussion. The woman is seriously brilliant – give her an Oscar. However, the benefits of bilingualism (and multilingualism) go far beyond idle gossip. Studies have shown knowing multiple languages delays the onset of Alzheimer’s, allows better recovery after brain damage, improves one’s cognitive capacity and is a darn good party trick. But what makes being bilingual so good for me?

My immediate family is in Australia but everyone else is in India – the reason why I love my bilingualism is that it has allowed me to become close to my family who live half a world away. Being able to speak the language they use every day makes me feel like I don’t live across the Indian Ocean in a totally different continent. It gives me a sense of identity, it keeps me firmly tethered to my roots and it makes India feel like home. When I go there, I truly feel local. I can go to the shops and buy sweets from roadside stalls, I can tell the auto driver where to go and I can scold the tailor when he hasn’t finished making my clothes on time. It’s great! For this I cannot thank my Mumma and Papa enough – it is one of the best things they have done for me. In fact, I now wish they had taught me another language! Preferably Hindi – people know of that one, plus it would make understanding Bollywood movies so much easier.

 

So… believe it or not, older-Nimmy is now getting her Mumma to teach her Hindi. (What would mini-Nimmy have to say about this!?). It’s not easy, and I’m not very good at it. There is a lot of Mumma repeating the same phrase at me, with me staring at her with the hope that I’ll miraculously understand what she’s saying. However, what is helpful is the fact that my little 4 year old cousin has only a slightly more advanced Hindi-ability than me so I can use his pre-loved Hindi colouring-in books to learn from. They will go well beside my medicine books – looking like David and Goliath. It is an ever-so-painfully slow process and I’m nowhere near the gossip level. So in the meantime if you hear two females talking in Kannada behind you at the grocery store, chances are we are talking about you.

Why I chose Med? Not really sure…

To most people a career in medicine conjures up visions of Grays Anatomy – doctors in scrubs saying intelligent sounding words, using defibrillators, driving BMWs and saving lives all before lunch. But before we can become Dr Shepherd (a.k.a. McDreamy) or develop the next bionic ear, there is a little hurdle that we must jump; and that hurdle is called med school.

 

The most common question I am asked is, “Why did you choose med school?” and to be honest I never feel like my answer is a great one. For me, medicine was the logical choice. It was like choosing salad over cake. Your heart wants the cake but your head goes with the wiser choice – salad. While a chasing a career in performing arts is what I would love to do, becoming a doctor is the more practical option; job security, good pay, helping people, accumulating knowledge (and the list goes on). While this end goal seems great, no one ever tells you just how torturous the insane obstacle course to get there really is. As the Tumblr saying goes “Med school is like a walk in the park, but the grass is on fire, the trees are on fire, you’re on fire, everything is on fire. Welcome to Hell”. You are constantly surrounded by hundreds of over achievers who will do anything to be the best. The few normal people will inevitably be converted into nervous wrecks over the next five years of slavery (aka our degree). Hours and hours will be spent slaving over textbooks to learn facts real doctors could not care less about. You feel like you are constantly drowning and your peers are the only ones there to help you – but chances are they suck at swimming just as much as you do.

 

For me, it is often difficult to remember why I started the whole journey in the first place – especially when you are perpetually surrounded by paper work, empty coffee cups and bright pink histology images (all of which look the same because I have no idea what’s happening). It’s hard to see when or even if any of this will be worth it in the end. I often find myself in tears asking, “Why can’t I just give up on the salad of a choice that is med school and eat my cake?” Even if performing isn’t a stable career at least I’ll enjoy it right?   When I reach this place, I remind myself of the things that performing can never give me. The things that never fail to turn me around from my storm of self-pity. It is these things that make all the hard work and sacrifice worthwhile.

The feeling of fulfilment I get when looking into a patient’s eyes and knowing that I made a difference is one that cannot be emulated by any audience. And it’s not just how I can help patients – oh no! The feeling I get when a patient believes in me and is thankful for the job I have is one that cannot be paralleled by any amount of stage time. I still remember an 80 year old lady who so kindly let me suture her nose up after a particularly tricky biopsy. I was nervous, I was scared and I was apologetic. However, most of all I was astounded that she even let me near her after I had almost fainted at the sight of her blood, dropped the forceps (that were attached to her nose) and failed to stop the fountain of blood coming from the incision. Nonetheless, when it came to suturing, she calmed me down and told me that she believed that I could do it. In fact, once I had finished she proudly announced to the whole treatment room that I had done a wonderful job and she couldn’t wait to show her grandson her sutures. Even though the procedure had gone far from planned (and the doctor was not impressed by me), I felt so proud and happy that a patient believed in me and was happy with the effort I had put in. A week later when the patient returned to get the sutures removed, she brought me a box of chocolates and a card – that was my round of applause!

 

Ultimately, I know I need performance and medicine in my life. So, I have made a promise to myself: throughout medical school I will endeavour to satisfy my cravings for performance but stay true to my desire to help those in need. I choreograph Bollywood dances while studying muscle physiology. I learn about haemolytic anaemias during the day and transform into Shakespearian characters at night. It’s hard work and takes blood sweat and tears (sometimes literally) but I do this in the hope that someday I am be able to devour my life’s cake while enjoying the salad too. But for now, I’m only in my third year of med school, so guess I’ll have to keep munching on that lettuce.