What it REALLY Means to be a Woman in Medicine
The cryptic array of numbers that somehow translate to a “healthy” human-being is blurring on the screen in front of me. “Please don’t cry, please don’t cry,” I desperately urge my sub-conscious.
“How’s it going, Maddy?” my always positive and proactive nursing colleague politely enquires from the computer next to me, unaware of the oncoming emotional outburst.
My silence prompts him to turn his head in my direction. I don’t want to imagine the ugliness that he is met with. My fingertips have become stained by the cheap, evidently not waterproof mascara, that I don each morning in an attempt to distract from the dark rings below my eyes. Black tears trickle now down my cheeks. Just the slightest sense of interest in me as a person has suddenly prompted a uncontrollable release of emotion.
My voice breaks as I try to mutter something comprehensible. “I’m all good, sorry.” I shake my head, embarrassed by my disproportionately emotional reaction to a simple workplace request from my boss: just call the team and get this patient admitted. It is something that I do all day, every day - refer patients from the Emergency Department to admitting teams. It is one of the core components of Emergency Medicine, something that I am very familiar with and relatively competent at. However, after a day of working tirelessly to discharge the worried-well from the Short Stay Unit, the final task seemed like being asked to summit one of the world’s 8,000-meter peaks without any remaining oxygen.
Tears persist despite my insistence to my colleague that I am fine. Clearly, I am not fine. However, I do not quite know what I am. I seem to have found myself in an unfamiliar landscape between being more than stressed, but not quite depressed. I don’t want to harm myself, but I also don’t want to be here. Primarily, I am just exhausted.
My colleague kindly offers a tissue in my direction. I accept it and dab my eyes. “I just don’t think I’m cut out for this job.”
~
Various iterations of this sentence circle around my mind on a nearly-daily basis. I don’t have the emotional resilience to cope with this work… everyone seems to manage except for me. My perfectionistic mind means that since I started my job as an Emergency Medicine Registrar six months ago, such thoughts have always been synonymous with work-days. It has only been in the last six weeks or so that they seem to have invaded my life outside the department and into my days off, my social life and my dreams.
When I signed on a dotted line nearly ten years ago, pledging north my intellect and finances for the foreseeable future towards a Bachelor of Medicine / Bachelor of Surgery, I believed I was signing up for an eventual career that was progressive in terms of its support of women. Statistics do not lie, and the statistics at the time showed that 45% of practicing doctors were (and remain) female. What is more, I knew that my personal traits - a high level of emotional intelligence, diligence, strong work ethic - would make me perfect for the job. Medicine, in my naive eyes, was the perfect opportunity to blend a love for science and a love for people. Little did I know that I was about to enter a world that not only relies, but pries, on the relentless need for high-achieving women like myself to please others to function.
~
The inner workings of a hospital is an ecosystem of its own, heralded by an overflow of Type A personalities. Those who find themselves in the boiling pot of the medical field - by either their own volition or by virtue of their family’s name - are, more often than not, acclimatised to having succeeded academically throughout the entire course of their lives. Since the late 20th Century, it has been recognised more astutely that perhaps the qualities of a good doctor run deeper than academic intellect alone. Shockingly, character traits such as empathy, compassion, kindness and patience are highly valued when telling an individual that their loved one has suffered an unsurvivable brain bleed, or that they themselves are unlikely to live beyond 18 months as a consequence of the indolent cancer gnawing away at their liver. The modern day doctor is not only expected to be, but absolutely must be an equal balance of E.Q. and I.Q. Cue: the female doctor.
It had been documented (by men) that female doctors demonstrate more classically feminine traits, not only in terms of interactions with patients, but also their clinical practice. Female doctors are seen to be more empathetic, spend more time both with their patients and working in patient charts behind the scenes, and communicate with both staff and the community in less technical language. Paradoxically, these traits - emotional intelligence, diligence, patience and compassion - repeatedly have been linked to high rates of burnout in female physicians. The type of female that medicine naturally selects for is also the type of individual that is more likely to suffer burnout in a system that was built by, and for, men.
Women are expected to practice at somewhat of a higher emotional and intellectual level compared to their male counterparts, without being afforded the appropriate allowances from a systematic level to do so. The tax on the emotional and mental wellbeing of females is compounded by society’s expectations when they encounter a female physician. In the words of Lizzo’s hit PINK, women - inclusive of those in medicine - are expected to been P.I.N.K (pretty, intelligent, never sad, KOOL). All day, every day, often in environments where the days never end.
The result, when not met with appropriate time to decompress, is burnout - an occupational syndrome characterised by exhaustion, depersonalisation and emotional instability. It is a trend that has become somewhat trivialised since the working-from-home days of the COVID19 pandemic. However, from my experience, it is more than being uninspired or overwhelmed from work. It is a whole-body response to working within a system that demands too much from an individual, resulting in a paralysing inability to function appropriately in any facet of life. Whilst the stressors are occupational by definition of the word, the consequences are felt outside of the workplace first and most heavily.
Burnout is reading a text message from your best friend, and being too exhausted to muster a two-sentence response.
Burnout is eating butter and toast for the third night in a row, because walking into a supermarket seems too overwhelming, let alone putting together a grocery list for a somewhat nutritious dinner.
Burnout is driving two-hours to your parents’ house in silence, because your brain cannot handle any more sounds.
Burnout is crying when asked to perform a simple, every day task, because your brain feels like an overflowing bucket and the potential for.
Burnout is believing that you are deficient, rather than knowing that your response is appropriate given then extreme stress of the environment.
~
What it really means to be a woman in medicine, is to be understand that simply by being female, you are more likely to sacrifice yourself to the constant cycle of burnout and rebuilding. It is to understand that the consequence of working for a system that relies on your own goodwill, empathy and clinical acumen is the constant depletion of your emotional tank, leaving only the dregs for yourself or those around you. Without an understanding of this risk, it is very possible to be broken down completely - it has happened to thousands before my time and will continue to happen to many of those that follow. Unfortunately, the systemic issues that plague the public hospital system in Australia and New South Wales are unlikely to change promptly. This leaves the only solution to combating the pandemic of females leaving medicine (or at the very least, struggling to work within it) within the individual themselves. Women in medicine need to be vulnerable enough to recognise the traits within themselves that may one day destroy them. Then, they need to be brave enough to advocate for themselves, know that they do not owe a hospital or department anything, and that they are enough - despite their worst day at work.
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