Well before I started medical school, I thought I wanted to be a gynecologist. I remember being absolutely obsessed with reproduction and reproductive health. I remembered learning about periods when I was 9 years old, and I knew I wanted to figure out how to be the doctor that did that work. When I stumbled on Black feminism as a young African American woman in a small college at the ripe age of 18, so many aspects resonated with me. Looking at every aspect of the human condition and knowing the inherent connections between race, gender, sex, sexual orientation, class, ability, reproduction, and reproductive health was absolutely fascinating, understanding that all of these things work together to define the human experience. I knew I had to be a doctor to help care for Black women in inherently poorer situations in the United States. And of course, like all of the young people who started medical school and assisted in a delivery in medical school, who understand the inherent magic of deliveries, I knew I had to be an obstetrician-gynecologist. I don’t know that any of my desires, background, or understanding of inequities in the world ever would have prepared me for what I would do to a woman.
I was on a rotation in an inner-city, which I will allow to remain nameless for patient privacy. It was late at night, and I was with my senior and junior residents, eating Chinese food and talking about my career aspirations. The labor floor was quiet, and I was sipping water, hoping we might get at least two more deliveries that night. My junior resident received a page saying that one of the patients who had delivered approximately 36 hours prior was experiencing vaginal bleeding.
I pulled my mask back over my face and headed to the patient’s room with my team, and our attending physician met us there. The patient appeared to be completely fine, but her nurse was concerned as she pulled a soaked chuck pad out from under her body. She explained to us that the patient’s uterus has felt firm. I watched as, with no warning, my resident inserted her hand directly into the patient’s uterus and began giving a fundal massage. The patient began screaming, crying, kicking, and begging my resident to stop. There was no response, and my resident continued to massage and pull clots from the patient. My resident looked up at me and asked me to hold down her arms and legs. I wasn’t sure what to do—as a third-year medical student, I didn’t have any power, and I continue to have limited power in decision making. I have to do what I am told, or else there are concerns about my ability to follow directions and work well with the team. I grabbed hold of the patient’s arm and leg as she continued to kick and scream. She scratched me several times and tried to bite me, begging all of us to stop. Her cries fell on deaf ears, and no one ever explained to her what was happening or even asked her if it would be okay for us to continue. No pain medication was offered. No social support was provided. A room full of masked medical persons, strapping her to a bed against her will as she screamed and kicked against us, begging us to stop hurting her.
I walked out of the room with my sparkly pink shoes covered in blood. I felt a strange sensation in my stomach. I was not sure what was happening. I was happy that I knew I had been involved in a potential life-saving treatment for someone, but I was fairly distraught about how this may have impacted her. I couldn’t help to wonder if this woman had been white and in a different institution with fewer patients who used Medicaid to pay for her care if she would have been offered medications to ease the pain. I wondered if someone would have even tried to explain why we were doing what we were doing. I wondered if someone would have thought to help console her or explain what we were doing to her partner. I also wondered how I had betrayed myself and my own values by not asking to explain to her what was going on or even doing it myself to ensure her consent in this care as we knew she was capable of consenting.
I also wondered to myself how we got here. In a country which spends millions of dollars annually on health care and knowing that many people go into medicine wanting to be healers, how did we get to a point where so many good-hearted people had done something so egregious? And why weren’t there checks and balances to prevent this from happening? Did we all fail to recognize that we viewed this woman—due to her gender, her race, and her class (which we assumed based on where she was) less worthy of knowledge about her condition, consent to treatment, and therefore agency over her body? It felt like we were giving the same care that J. Marian Simms gave to his slave patients Anarcha, Betsy, and Lucy. Of course, he provided care to them, but it was suboptimal and grossly different from what a white woman of a different class in a different location might experience.
I also wondered where we go from here. I continue to wonder, and frankly worry, where we go from here. How does the medical community acknowledge the disparities that Black women experience in life and those at the hands of the medical community? How do we promote clear communication with Black patients, like we would with any White patient? How do we ensure that the medical community gives Black women agency and consent? And furthermore, as people who believe in the inherent equality of all people and fight for equity in health care and many other arenas, how do we allow these values to hold true in challenging situations, especially when power differentials are ever-present? I hope we have answers to these questions someday. And I hope that we continue to strive for completely destroying the health disparities we see today.
Micaela Stevenson is a medical student.
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