It was sometime around two in the morning on a wintery Monday in one of the small satellite towns that orbit Edmonton. I was in my first year of med-school, and was frantically trying to take in the experience that is a busy rural emergency department while following the staccato actions of the real doctor I was learning from. My short white coat still had the creases from the years it had spent on the shelf before it became my most prized possession, well, second most, nothing says “doctor” like a stethoscope. I was only a few months into this new world of medicine and already I was working on the next step; what kind of doctor do I want to be? Like everyone else in my class, I had emergency medicine on my radar, so I thought that I had better do some research and see firsthand if it was for me. So there I was, already tired from being at a light sprint for 8 hours with no end in sight, and then it happened.
I read the chart for the next case while my preceptor (the doctor I was following) was scribbling out her orders from the last. The chief complaint was non-specific: twenty-three year-old woman with lower abdominal pain, nothing special there. I mean I had already seen three of those that night, so was half way to becoming an expert. What I didn’t know before we hurriedly walked into that exam room that night was that was going to be the first of a long series of occasions where I was to be tossed into the hallway to sit it out because of my gender. Of course, I don’t mean tossed literally, that only happens in surgery, and only if you at least partially deserve it… usually.
The case started off like any other: Identification, confirmation of age, a half sincere apology for the wait, and the classic “tell me what brings you in tonight?” I’m not sure what it’s called, or even if we have a word for it, but there is a feeling that I can only describe as a combination of walking into the girl’s bathroom with that dream you have where you go to school naked (the Germans probably have a word for it like “ubersupershamen” or something like that), but that was me at that moment. The patient wouldn’t look at me, the doctor wouldn’t look me, and I was wishing that the patient’s mom would stop looking at me. “The… problem… is… down… there” the patient reluctantly and ever-so slowly answered. I have since learned that that is secret code for “Kris could you please excuse us and tell the nurse I need a speculum”.
The impact of what happened didn’t sink in right away. I was born in Canada, and am a true child of the 90’s. When I started public school we still started the morning off with the “Lord’s Prayer” and my high school only had three computers. I was taught that boys and girls are different, they have separate washrooms and everything, and up until that point I had never questioned the fundamental truth that I shouldn’t be present when women I hadn’t married yet were naked. But wait a minute, I’m a doctor! Well 1/16th a doctor! It still counts doesn’t it? I have a white coat; I’m wearing the cool green scrubs underneath. I even brought my good stethoscope (yes I have more than one but let’s not focus on that right now). So why was I hanging out at the nurse’s station trying to hide my embarrassment for being a 31-year-old, married, father (of a baby girl) who was just subjected to the last true form of acceptable discrimination?
As I said this was only the first of many times to come. I continued shadowing in the same emergency department two or three times a month during my first, and into my second, year. Sometimes I was allowed to stay in the room, others not-so-much. I wasn’t keeping an honest score but looking back I think it was about 50/50. I became adept at knowing when I was about to get the old “greet-and-toss” and saved myself the embarrassment most times by excusing myself first and using the time to wolf down a granola bar or go to the washroom. I can’t say when it started but the resentment began to grow. How was I going to learn anything about “down there” if this kept up? As a simple cure, I tried doing some shadowing at other sites; maybe it was just the country girls. Same problem. I talked to older students and the only encouragement I received was that at some undetermined far-off point in your training they won’t be able to refuse. “Great! Until then I will just fill the gaps with YouTube videos” I thought.
The low mark came in second year during our reproductive medicine block which I affectionately referred to a as “chick medicine” in honor of the fact that dudes didn’t appear to be welcome. I hit a stretch where I had been getting tossed out of a lot of rooms, and to make matters worse I was really enjoying the material we were learning about. Obstetrics and Gynecology, O and G, obs and gyne… (I can only think of those three). What an awesome specialty. I mean high risk, high impact, two (sometimes more if there’s twins) patients at the same time, half surgeon, half doctor, all superhero in white. An obstetrician I later shadowed summarized it best: “no one remembers the jerk that yanked their appendix. And what shows do they have on TLC? Is it the Lap-Chole story? Hells-no! It’s the Baby Story (he intentionally left out Tales From the ER)!” But how on earth could I get into a specialty that focuses specifically and entirely on “down there” if I can’t make it past the hallway half the time?