(For context, read A Letter to the Country from an Emergency Physician)

I won’t lie, I’m not going to try to deliver an apolitical message here.  Taking a passionate stance on an issue is almost certainly going to raise someone’s political ire and to attempt to lead a controversy free existence is both impossible and apathetic.  To participate in a profession whose roots lie in a desire to preserve human life and not feel passionately about that cause is surely criminal.

Not only that, but I respect your intelligence as a reader enough not to try and convince you that any stance on health care is not inherently political whether you intend it to be or not. 

This morning I saw patients in my outpatient office.  It is a large university-based practice with many physicians and many affiliated specialists.  My job includes seeing patients in both the inpatient and outpatient setting as well as teaching residents and medical students.  It is often difficult, I rarely work less than 50 hours a week and it can be emotionally-draining on a regular basis. 

I love it.  I am one of the luckiest people on earth to do what I do.

The stories that my patients share with me, the daily struggles of work and kids and school, the life-changing signposts of birth, illness, death, the terror and hopelessness of depression, the elation and trepidation of a first pregnancy and, always, the constant companions of chronic illness or addiction or the prevention of disease that provide the foundation upon which our relationship was first built; being allowed into my patients lives in this way is truly a privilege and an honor that humbles me every day.

To reduce these patients to anecdotes or use their personal stories to support my own perspectives is not fair to them.  They open their lives to me, trusting that I will only ask what I need to know to take care of them.

The problem with that is that a story that talks about people in generalities is never as powerful as one that boils all humanity down to a “good guy” and “bad guy” example.  Just ask any politician from any party.  It’s why we all know about that plumber of whom Sarah Palin was so fond.

If I wanted to, I could tell you heart-wrenching stories about some of my patients and their fight to get the care they deserve.  I spend hours arguing with insurance companies to get medications approved, filling out prior-authorizations and scanning preferred drug lists and Walmart 4$ alternatives.  My nurse spends many more hours.  My patients though, nothing compares with the time and effort I have seen them put into fighting for health care: stacks of paperwork to get into free clinics and sliding scale fee programs, tax returns and endless applications for patient-assistance programs from drug companies and, when all else fails, letters to their senators and congressional representatives begging for a helping hand.

I’ve seen them fighting in more subtle ways:  doggedly checking their sugars, counting their calories, walking 30 minutes every day just like I told them to, chewing their nicotine gum and rolling up their sleeves for the latest vaccine I have convinced them to get. 

Other struggles are anything but subtle.  I’ve witnessed the helpless fear of an actively suicidal patient desperate for a way to save themself.  Drug addicts have sat across from me with their hands shaking begging for referral to rehab so that they can just be allowed to see their kids again.  Mothers of children who just can’t seem to connect at school or who still aren’t speaking in full sentences come demanding that appropriate testing be done so these kids can get the help they need when it can still make such a difference.

A thought I have never had during any of these encounters:

“Does this person deserve this?”

People love to talk about our “entitlement culture.”  I won’t deny that there are certainly aspects of that concept with which I agree.  No one can guarantee you wealth or the exact job that you want or fame or a fancy car.  Success is built on hard work, tenacity, sacrifice and, let’s be honest, a fair bit of luck sometimes.  It’s also not always fair, and no one can fix that in every case.

But some things, we can fix.

The idea that it promotes mediocrity to provide equal treatment and care for all people is something that boggles my mind.  If you don’t want to give every kid on your soccer team a participation trophy, fine.  I think we are all comfortable with the concept of games and winning and losing. But none of that comes into play when any rational person is discussing health care.

All people deserve health care.

Let me state that another way..

No, wait, there isn’t another way. Let me just state it again.

All people deserve health care.

All basic human rights should be freely offered to all humans. How that makes those rights mediocre is beyond me. You don’t need to be special to have the right to health care. You just need to be.

The government mandates that I take care of all patients that step into the ER at the hospital where I work. Would I take care of them either way? Of course. I’m a doctor. That’s my job. Any physician who would argue otherwise wasn’t paying very close attention in medical ethics. They certainly aren’t the kind of physician I would want my family member seeing at 3am in an ER and they shouldn’t be speaking for the profession I worked so hard to join.

I shudder to think what patients must think of us when doctors take the time to write about their distaste for their jobs. How can patients trust us when members of our field speak out against caring for them? And how can they continue to open up their lives to us when they have to worry that some physicians will then use their personal stories to sketch crude caricatures of “screamer ladies” undeserving of care?

Did I work hard to get where I am? Sure, I won’t deny it. I pulled my 30+ hour shifts and studied for weeks on end and missed holidays, birthdays, vacations and family celebrations in pursuit of this job. I am in six-figure debt and will likely remain so for sometime.

Did I do it alone? No, I wouldn’t dare claim it. My parents supported my every dream, sat up with me before every test, helped construct every science fair project. My grandparents read every poem, cheered every school performance, read me every book. My husband has encouraged me for every board exam, remained patient through every long night away, picked me up when I was too tired to drive home post-call and lived on student loans with me through our early married years. And my loans? Thank you, Uncle Sam. I may have been blessed with a wealth of love and support, but certainly not a wealth of dollars. If my government didn’t allow me the opportunity to go to medical school, I would never have been able to afford the career of my dreams.

There is a concept of personal responsibility that is a vital part of our economic and policy-making conversation today. I am not denying this. However, if, as a healer, you want to accuse us of developing “a national mindset that expects others to take care of us,” you picked an awfully awkward pulpit from which to preach. I expect to take care of others. Others who cannot care for themselves for whatever reason that may be. Whether it be physical, mental, psychological, social or that they have simply lost the will- which is likely indicative of a larger problem anyway. That expectation is why I became a doctor. If you are a physician and you cannot connect with that concept, I have a question for you.

Why did you become a doctor?

I think we both know that the money is not what it used to be. The hours are certainly less than desirable. If you want to be rich and have weekends off and get to spend every Christmas with your family, this is certainly not your best bet.

So there has to be another reason.

I would hope it was because your fascination with medicine was only matched by your passion for serving others, leaving no other career option desirable. I can assure you that is what brought me here. And it is what continues to get me out of bed at 2am to answer a call from OB triage, knowing that what waits on the other end may well be another night spent away from my warm bed and my husband.

If these ideas: that all people are equal, that health care is a basic human right and that entering the medical profession is akin to entering a covenant by which you pledge to work tirelessly to serve others; if these ideas are uncomfortable for you, please do not go to medical school. The medical profession always needs strong minds, but those minds have become a poison to our very health care system when they lack the strong hearts to support them. There are other ways for you to make money and feel superior to other people. This is not where you belong.

To our patients, you deserve better from us. You deserve equal treatment and equal care and equal consideration by us. You can’t always have everything you want, that’s just life. But there is a basic standard of care that should be freely given to all people. You do not have to be special to get it and it doesn’t make anyone mediocre for others to have it as well.

Is our system broken? Yes. Who can fix it? That’s more complicated. All I know is that no one can do it alone. We need the government’s support, we need to call out corporate greed for what it is, we need patients to tell us what matters most to them and we need doctors to sit down at the table and make our lawmakers see how critical it is that something be done. This has to be a group effort. This has to involve us as well. If you think you can criticize a system and then sit back with your arms folded and demand that someone “fix it,” I find it especially amusing that you accuse others of selfishness and entitlement. Health care is my life’s work. If it is broken, it is, in part, my job to fix it.

Oh, and as for those who would claim that the crux of the problem lies with poor parenting and how it has created a culture of self-absorption: this is just lame. Would you prefer our uninsured patients just die humbly in the streets rather than bother you with their illnesses? When someone is drowning, we don’t stand on the bank and ask them how they ended up in the water, we throw them a rope. If it turns out that they threw themselves in, we don’t regret pulling them out, we ask how we can help them so that it doesn’t happen again. This is the model you should use for health care. It’s not an iPhone. It’s not something that you only get if you save up and don’t fight with your brother and get good grades on your next report card.

In the end, all these arguments really boil down to whether or not you believe we should look out for each other. Sometimes, taking care of other people isn’t fair. Sometimes, you will feel like someone isn’t pulling their weight. Sometimes, people lie and cheat and steal. None of these are reasons to stop caring for others. I’d always rather err on the side of kindness. It’s why one becomes a doctor.

Or, if you won’t take my word for it, here’s part of that pesky oath you took:

“Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice.”

And just one last bit to remember for the future:

“What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself holding such things shameful to be spoken about.”

This profession, no, this calling, is bigger than you or me. As a community of physicians, let’s try to do better. We all have some fixing to do.

My idol as a young, angry female college student was not an original one.  Not that I ever could have claimed original estrogen-filled icons.  I loved Alanis when I was in middle school, moved on to Gwen Stefani, Fiona Apple, Liz Phair.  I had quotes from Eleanor Roosevelt on my walls and I invoked Elizabeth Blackwell and Madame Curie as my trailblazers.  I even bemoaned, as if I was the first to ever do so, the fate of Rosalind Franklin, the true discoverer of the double helical structure of DNA, forever forgotten due to her lack of a Y chromosome.
In college, then, I predictably embraced Gloria Steinem as my new feminist ideal.  Our birthdays were a mere two days apart and I had a round table discussion as her in an honors seminar.  She even came to my university and spoke to my Women’s Studies class, taking one precious second to shake my hand before she left, sending me into fits of ecstasy and admiration.
She gave another speech that evening, open to the entire university, and I naturally attended that as well.  During her talk, largely about the tendency of major universities to ignore any history that is not white and male, she stated that young women today didn’t even know what the glass ceiling is.  She went on to insist that this was a failing on our part, as the older generation, and we needed to rectify it.
This was the day I stopped readily identifying myself as a feminist. 
My sister is 11 years old and she wouldn’t understand the concept of the glass ceiling if you tried to explain it to her.  She sees no boundaries for herself as a female.  She aspires, with equal passion, to be both a doctor and a Broadway star.  To insinuate to her that either is improbable due to her gender would sound as absurd to her as it is. 
The fact is, I ‘m glad she feels that way.  Why would I want her to know that there are still people in this world who would try to deny her her dreams on account of her ovaries, when the overwhelming majority of people recognize that there is no reason a woman can’t do everything a man can do?
I refused to join the American Medical Women’s Association in medical school for this very reason.  I don’t identify myself as a “woman in medicine,” I identify myself as a physician, period.  I don’t know why my sex has to enter into it.  I don’t think of myself professionally in terms of being a woman.  I don’t expect my patients or my colleagues to differentiate me on that basis, so why should I?
At the same time,  I embrace my gender wholeheartedly outside the office.  I feel comfortable in sweats and a t-shirt, but I feel pretty damn lovely when I take the time to put on a dress and some makeup.  I won’t apologize for either.  If a man holds a door for me, I consider it common courtesy.  This is not because I am a woman, but because I am a person.  I would hold the door for him too.  And I do. 
I don’t think about the fact that I am female all day long.  I don’t dwell on the strengths or the weaknesses traditionally assigned to my gender.  Frankly, I am to busy to spend time looking for offenses in popular culture or the daily news.  I usually come down on the side of the offender when I do become aware of some dispute.  I am so rarely offended, that it is hard for me to understand offense taken by others.  My inclination is to defend the right to free speech, and, in general, to encourage everybody to stop being so damned sensitive about everything.

This is the perspective from which I write this now. 

I woke up this morning feeling like a girl.  I felt young and vulnerable and unsure.  I am painfully aware of the lack of upper arm strength that I possess, the weakness of my biceps and the overall frailty of my frame.  I’d probably be easy to restrain.  Probably easy to pin down. 

I’m ferocious when I’m angry, and I feel strong when engaged in witty repartee, but, let’s face it, all my angry flailing would likely amount to nothing in the face of a stronger, equally determined, male opponent.

Yesterday, I walked to my car with my keys gripped between my knuckles, as my mother taught me to do when I was young and lived on campus.  I glanced nervously under my car and in the backseat before I climbed in.  My hands shook while I sat through a subcommittee meeting for the second year medical student curriculum at work. 

I am not a person who is afraid.  I DO NOT live in fear.

Except that now I do.  Because someone took the time to remind me that I am limited by my gender.  I am naturally weaker than the average male I may encounter.  I have less muscle mass and a smaller upper body.  I may kick and scream and bite and struggle, but I would likely lose.  I don’t own a gun.  I’m a doctor for christsakes.  I can’t shoot anybody.  I preserve life for a living, I can’t imagine trying to take it. 

What am I supposed to do?  Go take self defense classes?  Get really buff like some pissed off woman in an action movie? 

Do I intrinsically have to live at the mercy of my gender?

I guess so.

And, more frighteningly, at the mercy of the other gender it seems.

I don’t stand for limiting anyone’s right to say anything.  But that doesn’t mean people are always right to say anything.  I may not condemn, but I will not support.  Because words have power.  I felt the anger and the violence oozing through the messages that I received yesterday.  I felt the rage of someone who wanted to terrorize another person.  Someone who wanted to send the message “you are not safe.” 

And this person succeeded.

I’m sure I will feel safe again in the future.  I’m certain that, as time passes and I remain undamaged, I will recover my feelings of strength and vitality and fearlessness.  Feelings that, in part, have defined me in the past. 

But for now, I’ll drive to work instead of walk.  I’ll avoid staying home alone.  I’ll sleep a little closer to my husband at night and I will let him go in first when we get home in the evenings.   I’ll feel very aware of my long hair, my painted toenails and my preference for skirts in the summer.  I’ll feel a little more “girl” for now.  A little more what society defines me to be and a little less what I had defined Sydnee to be. 

Words, especially words that we take the time to put down, words that we assign to our names and our faces, these words will define and outlast us. 


Use them however you want. 

But, if you use them recklessly, don’t have the audacity to be surprised at the outrage that may ensue. 

The world is already hard enough.