1. So much of medicine depends on maintaining silence. Doctors are told secrets, taught over a period of years how to respond. The expression on a face transforms “stranger” into “patient.” We bear witness, not turning away from any form of suffering, even if it triggers us. This is how we protect patients.
This silence extends to all relationships at work: nurses, counselors, admins, secretaries, other doctors. One of my psychiatrist colleagues, training her residents, uses the phrase “think of yourselves as 50,000 feet above whatever’s happening.” At first, everything in me resisted this idea. By comparison, “down to earth” was an Americanism I found appealing, a testament to having warmth, guts, energy, courage. Closeness is risk; risk, dedication. But quickly I saw how true my colleague’s words were: Cool distance is a soothing thing. This is how we protect ourselves.
When I was younger, I watched as my mother, a pediatrician in a community clinic, came home and immediately flopped down on the couch. Sweaty, annoyed, she’d ruminate silently until the day’s indignities wore off. Eventually, she translated her years of daily practice into pithy advice for me when I neared the end of my medical training: “Never say anything about yourself to anyone you work with at the hospital. Never tell anything to anyone.”
Even without my mother’s instructions, I learned in medical school and residency that so much of being a doctor, even with no patients in the room, would involve obeying a repressive code. We’d be expected to be as neutral as possible so nothing would impede the machinery of care that depends on us yet dominates our lives. We’d be expected to nod silently, always, rather than launching impassioned defenses of any idea that might get in the way of the reality of the patients’ needs before us, of the system’s demand that we simply perform.
A doctor’s friendly, watchful, generous silence is one instance of self-effacement, among many. Another involves keeping your voice and face free of outrage. This, no matter how egregious others’ microaggressions can be, especially for a woman of color in medicine. This, no matter how many times, and by how many different authority figures, we might have been promised that such transgressions, such racist or sexist or intersectional indignities, would not happen again. This, no matter how much we might have invested in ideas such as “equality.” This is how the system protects itself.