Saturday, September 22, 2012

we're in the wrong band

Before I tell these stories, let's just acknowledge that it is 2012. There are now at least as many women as men in medical school. You know, it's not like women are completely suffering in silence in medicine these days. However, can I just tell you a few things that I have witnessed?
  • A classmate of mine in medical school was already accepted into a surgical training program. Her director actually said, "I've never had any women in my residency program have babies, and I don't expect to start now." Keep in mind that her surgical training is a five year program.
  • Another classmate of mine wanted to defer a clinical clerkship in his third year, because his wife was having their second child and he wanted to be home with the children. He was fine with making up the time later, possibly even graduating later. One of the deans told him, "you've already seen one baby born. There's really not that much for the dad to do." He ultimately got the rotation off, but had to argue with three different male administrators before getting it approved.
  • In residency, two of the women interns in my program are pregnant. While male residents who have children have been congratulated and slapped on the back, these women have been called 'thoughtless', 'inconsiderate' and 'deceptive' (though of course behind their backs)- and some of the people making the comments were other women.
Now, again, I'm not saying that women are downtrodden in medicine. But I've been thinking about these issues lately, and it blows my mind how messed up the whole thing is. It's an institutional, structural problem, and it's so deep-seated that even the women within the system are supportive of it. The problem is that, if you do the math, women who are in medical school and then residency are going through these things during their child-bearing years. Why are they expected to set aside that reality and deal with the consequences later in their lives? I feel like I can speak about this since I quite certainly have no dog in this race. But that decision has nothing to do with my career decisions, nor should it really.

Men are congratulated when their wives have children. Women are whispered about, painted to be selfish. There's no other way to describe it but wrong. The problem is that residency programs and medical schools do not account for people making very natural life choices during training. They don't staff residencies with enough trainees to cover if one or two people go out for maternity leave. Of course, the programs can't legally forbid women from having children, so instead, they just create this untenable burden on all the other trainees when the women need that time off. This in turn breeds all kinds of resentment, and, in the end, what you have is massively messed up thinking.

I'm sort of amazed, because I worked for so long before I trained, and in the workplace, a friend of mine and I used to joke about inventing made-up children, because women who had children were always excused to go pick up their children from daycare or working late or traveling to places they didn't want to travel. And maybe that extreme was no good either. But on the other hand, we were just kidding around, whereas my co-residents are quite dead serious when they take big objections to women having children during residency.

This all sounds like a completely a-political problem. But consider this- Medicare and the government subsidizes the large chunk of residency salaries and thereby controls the number of spots residency programs can offer. It's funny because when the soundbite came out about Romney and the 47%, I thought 'well, I'm not part of the 47% and Romney doesn't really care about my vote either.' But then I realized that I am part of the 47% because I am a resident. And if you think a resident salary is a handout, hahahaha- that's all I've got to say about that.

In other news, I went nuts last week, and baked a cake. A friend of mine invited me to his house for dinner, and I haven't seen him in a while. Last time I went to his house, I brought over an experimental sorbet that had a little too much ginger in it, and he had to politely swallow it down, so I became obsessed with making a cake beyond reproach. Well, it wasn't a pretty cake. You bake a really big cake (15" x 11" or so) and then you cut it into strips. Then you rush around frosting it because you've gotten home from clinic at 6 and you have to be at dinner by 7:15. Luckily, I'd made the frosting in advance- there are layers of caramel and dark chocolate ganache, and a pillow of milk chocolate buttercream to top it all off. Even though I warned him it was rich, my friend RS demanded a second slice, and then clutched his stomach, pregnant now with cake. Here it is, in all its messy glory:

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