Tough

Tough. We as women have to be tough. As a matter of fact, tough as nails to be able to do it all. I had dreamed of being a doctor since I was 16 years old. I worked my ass off to get into one of the top undergrads in my state. Passed up partying like the other kids to get good grades and get in to my choice medical school. The hard work paid off. I got in. Only to find out the work had just begun. 

Medical school was hard. Sitting in a classroom full of overachievers set the bar high. I had been used to soaking everything in. School came easily to me. I toughed it out, and was eager for third year clinical rotations. A glimpse at the real rest of my life. 

I didn’t notice it much back then because you become used to doing whatever it takes.

Doctors take years of pushing through it to get it done. It wasn’t until residency that it became clearer, but even then I thought “It’s the community. This is this population’s culture. Nobody else seems to mind it”. But I also had tough as nails female attendings. They did not let anything slide by them. No funny business. No friendly banter. I thought they were dry and maybe over it. 

Fellowship is when it started to become more vivid. What is the “it” I keep referring to? Hang tight and it will become apparent too. 

In fellowship we had drug rep lunches as a way to keep us up to speed on what was new and available as therapies to our patients. One said lunch was about a new drug targeted for overweight/obese patients. After the rep finished her lecture, my arrogant program director says

“Well, with the way you presented your data, you’re implying all of us this room qualify. Even you (pointing directly at me). You surely have gained a few pounds since the beginning of this year.” 

The room turned more awkward than you could image. My only male co-fellow threw out a smirk and giggle in solidarity. Little did they know I was wrapping up my first trimester. I was terrified to disclose sooner due to cultural beliefs that disclosing pregnancy before the second trimester was a bad omen. 

So I disclosed my pregnancy just a week later. It was in private during rounds. His face turned pale and jaw dropped. You could see that immediately he felt stupid for his previous comment. I thought all would be well, but it got worse. The following day at clinic, his wife, the practice manager, called me into his office. She then began to scold and belittle me.

“How could you do this?

Do you think it is appropriate timing to be pregnant?

This is very irresponsible of you.

How will this be fair to the other fellows?” 

That’s right. A working woman shunning me for daring to be pregnant. I put her in her place and told her it was none of her business to tell me what I could do with my personal life. My choice to have a family would not affect my training AND I would do the same work my fellows would do. I don’t have to tell you that the remainder of my training was very unpleasant, but after I’d have a job and it would all be over. 

So I’m an attending now. Working for a large hospital-owned group. Getting the work done. Surprise, baby number two. I knew this would be different, because after all, I am an attending now.

So I worked covering the office and hospital for three doctors up until 12 hours before going into labor.

I took pride that I didn’t leave a minute before “I was allowed to”.

I tucked all my patients in so that no problems would be there when I came back. 

My return to work was hard, as it always is. Leaving a tiny ten week old at day care for twelve hours hurts inside, but I knew he’d be alright. Shortly after my return I noticed it. I had been written up for poor coding. Poor coding? How could this be? I took pride in doing my due diligence with my billing codes. I asked what had I missed and I was told I wasn’t billing for CMS screening questionnaire that had been implemented. I asked my co-workers. None had been billing either and they hadn’t been told to bill nor did they get written up.

Ok, brush it off move on. 

A few months later, I was called in for a quality meeting with a regional director for under production. How is this possible? I reach my goal each month and am usually well above the goal.

My 10 weeks off during maternity was being counted against me. I was “behind by 3 months” even though my leave was unpaid. When I questioned why they would count these months the response was:

“You chose to bring a miniature carbon life form onto this planet chica.

That choice meant people had to pick up your work.

Staff still had to be paid.

And if in the future you choose to bring more miniature life forms onto this planet it can have dire negative impacts on your career”

Speechless? So was I. He left. I felt sick. My first thought was, “they are trying to fire me”. 

Eventually my emotions settled and I decided I didn’t want to work for a company who would allow this sort of behavior. It never dawned on me that I had spent my entire training watching women being treated poorly and down right discriminated against. 

During rounds there would be sexually charged comments, but I blew it off as cultural. Having my weight thrown out as a public criticism felt like it was okay because he was an ignorant old man. It took the threat of job loss to bring into light how much women are treated differently. 

This ladies is why I say be tough.

From the beginning, be like my old female attendings. Tough.

To my younger self, do not let anyone devalue you.

To all my female colleagues, do not let anyone try to make you feel less than you are.

You are just as worthy as your counterparts.

Stand up for yourself.

Fight for your equality in all aspects of your career, because you fought just as hard as your counterparts to be there.

We are more than men, we are women.

#howwerise

#womeninmedicine

#maternaldiscrimination

#sexisminmedicine

#thematernalwall

#SheMD