In early February, I met with a SLU Women’s and Gender Studies pre-med junior. For the purposes of anonymity for medical school applications, the student’s name will be Jane in this piece. As a woman and as a feminist, Jane has been attentive to the sexism within her years in a premed education program.
The week I interviewed Jane, she was preparing for a projected two hour-long interview with a member of a board of SLU’s faculty that would then write her a letter of recommendation for medical schools. With a good interview, the future letter written by the board has the power to decide which medical schools Jane could be accepted into. It was a high-stakes week, and I am so thankful to have spent time with her during this time to learn a little more about what it’s like to study medicine and to critique it simultaneously.
One of the questions for Jane to prepare for was “what are the two greatest problems for the American health system today?” Jane opens this discussion with novel virus and with foreign-born illnesses, reflecting that the way Americans have responded to Coronavirus highlights deeper issues in medicine. When we don’t have the language to talk about things, we hurt each other.
After I stopped the recording being taped on my phone, Jane laughed and said “I feel like none of this is useful or cohesive.” Reading back our conversation now, Jane’s insight into medicine and gender is anything but scattered. Jane sees where medicine and STEM education fails, how education feeds into medicine, and how medicine feeds into education. In discussing her future, Jane raves about passions in all three of these rings: clinical work, STEM and continued provider education,
Anyway, here is the interview:
Jane: Two big public health issues that really reveal the true colors of the nation are illness and illness that we don’t necessarily see in the United States. It’s one thing how you deal with your own people, which is already scattered and terrible in aid, and it’s another thing how you project and frame other things.”
Annie: And it goes back into American imperialism, that we have to control everything and if we can’t understand it we’re gonna freak out.
Jane: It’s an attack and it’s also counterproductive. We have to control everything but if we can’t control it we ignore it, and it’s such a horrible system. Answering that question (of the two health issues in the US for medical school recommendation letters) has been so hard because I have been having to walk the line of saying something that is palatable versus something that is more critical of the US. The palate is based on the person I’m interviewing with.
For Capstone in Women’s and Gender Studies, we have been reading Living a Feminist Life by Sara Ahmed. In thinking about foreign illness, I always think about her text. Ahmed talks about being feminist in organizations that necessarily aren’t. At what cost does this bring people? How do people that are feminist kind of get to that space? I have learned that it’s by downplaying it and by swallowing your pride until you can get into a room where you can make that presence known.
A: So, your capstone is about how feminism is maintained in community?
J: And specifically like where disheartened, hopeless feminists go. I do science related work and often am met with hostility when I try to provide a feminist perspective, and those times remind me that I’m in a space that accepts me reluctantly. I’ve encountered people who belittle me and fall into the rhetoric of “I don’t want you to be mad” and “I don’t want you to think I’m mean” and then would say super sexist and racist stuff to me about women, that they knew would make me angry. For a while my presence was encouraging people to hold back these comments, but it’s gotten to a point where people no longer hold back but now they say it and just apologize for the comment before they say it.
A: So what you’ve said in the classes that we’ve shared is that there’s a lot of animosity in science-based communities towards feminism, justice or progressive politics.
J: I think for everyone it’s an afterthought and for some people it’s not a thought. For everyone, maybe they’ll add something related to social justice but for some they ignore it. Social Justice isn’t the forethought of everyone’s education, which is enforced by it being scarcely included in pre medical classes. Omitting social issues kind of pigeon holes pre medical students into becoming someone who doesn’t have to think about all those things. But this is counteracted by the fact that when we’re doing these applications were expected to have like 15 different cultural and communication competencies, all of which I have developed exclusively from my Women’s and Gender Studies education and my volunteer experience. I mean these are huge lecture halls so maybe that’s why but I think people aren’t necessarily against including these issues but many genuinely have yet to understand that it’s relevant. To feel justice and feminism as deeply as I feel it and then to be met with people who don’t think about it ever, much less every day, is really hard.
A: Do you feel comfortable talking about your experience with one of your professors and the article that she shared in class?
J: In one of my chemistry classes I had this really awesome teacher who, on the last day, put up this slide of a current research paper with the title “When Making the Grade Isn’t Enough: The Gendered Nature of Pre-Med Science Course Attrition.” She was talking about how she feels responsible for educating all of her students and for making sure that it was possible for all of her students to learn and not just the students who do well in typical lecture classrooms. Her teaching style was super interactive, she was always having us problem solving in class, keeping us engaged. She followed that paper up by reflecting on course evaluations, which are understood and researched to be incredibly biased towards anyone with a marginalized identity.
A: How so?
J: She was explaining, and from where I have looked into this, that women are usually evaluated based on things like the clothes they wear or their tone of voice or if they are bossy. She was explaining that students would also comment that “she was very caring” or “she was like a mother to me” which are more about her behavior as a woman and not her teaching style. She said she was frustrated by comments on her femininity or outfits because she wants constructive comments, she didn’t want to be called nice or fashionable. When she put that article up I sighed, because it was the first time gender had been mentioned in any science of the classrooms I had been in. It was so cool.
We’re always told “professors are so busy” so I’ve historically never gone to office hours. I’m changing but I used to never go to office hours because I didn’t want to take their time. I realized that who goes to office hours is an incredibly racialized and gendered experience based on the fact of who feels entitled to a professor’s time and who feels entitled in the world.
I wasn’t going to say anything, but at this time I was really excited about combining science and Women’s and Gender Studies, so I talked to her about the article. Talking to her, I remember saying, “Thank you so much, this has made me feel really seen even though it was on the last day of the semester.” She explained that she had gotten some comments prior to my own by students that were negative,saying that the research paper didn’t belong in the classroom and that it was irrelevant. That’s what I’m hit with the most, that gender is just irrelevant. It’s alarming because I think that that would not be the sentiment that students express in their interviews. It’s hard for me, because how do you get to pick if gender is relevant? For me that shows a level of privilege. I also have a level of privilege in my own way. But thinking that you’re allowed to choose to engage with such a sensitive issue is a really privileged way to go about your education or career.
A: I think course evaluations, especially in STEM, are so interesting because it’s so hard for folks of any oppressed identity to even get into that space into which they are a professor for a “reputable university,” whatever that means. It is so hard to maintain having folks of those identities in those spaces in systems that show racism and sexism, such as through course evaluations. If a university gets a bunch of negative comments about a professor from students paying hundreds of thousands of dollars to be there, the business is going to not want that professor.
How else has your premed education been sexist, been misogynistic? Where do you see gender or race in class?
J: I think for me, just because I don’t feel comfortable speaking for other people, I think it’s more where I don’t see. With my combination of identities I’m able to be really palatable to my environment, because I’m a really outgoing person and white. There are a lot of things about me that make me less disruptive. My ideas and my mind is disruptive, but they’re just quieter because they are in a 500-person lecture hall.
There’s time constraints and material that has to get through, but I struggle with there not being any emphasis on identity.
There’s not a class that’s required on social determinants of health, or how people’s identities impact their health. Where are we expected to get over that learning curve? If I didn’t find Women’s and Gender Studies I think would be moving quite slowly on understanding cultural sensitivity and understanding how people’s experience outside of the exam room impacts their health.
A: Wow. So what was it like engaging with like Gender Studies–
J: Also, what is this article about?
A: I don’t know yet. No, I’m just trying to pick your brain and then I’ll figure it out later.
J: That’s okay, that’s okay.
A: So you began in Women’s and Gender Studies (WGS) because of this immense interest you had in gender and culture?
J: Well I came in as a Neuroscience major and I picked up my WGS minor when I discovered the clinical trials thing. In 1989 the National Institute of Health said women and, they used some word for folks with any marginalized and oppressed identity, said that they had to be included in clinical trials. It was in 1992 and 1993 that women and folks of marginalized identities were required by federal law to be in clinical trials. I was like holy crap, my body is not represented in a field that is supposedly going to help maintain my health.
A: Like, how does Advil impact women, we have no idea.
J: So after I found that out, I wanted to go into Neuroscience to research gender and figure out how these things interact. At the time, people close to me were going through pretty serious mental health stuff. How did their medication impact them? They were struggling with doses, and just trying to figure out how it impacted them. I was like, this is probably evidence that we don’t know how medications impact women. Granted there are multiple levels of caveat, like everyone’s body reacts a little differently to things. But there’s a difference between variability and an entire institution not understanding half of the population’s bodies.
I picked up a WGS minor because I was like “well, I gotta know the words to do the stuff.” I learned a lot more than the words, but that definitely did help. I ended up trying to get involved with neuroscience research but it was not my thing, it was too small and too insular for me. I loved my Introduction to Women’s and Gender Studies class and I had read The Egg and The Sperm by Emily Martin. The article is this really cool feminist critique of the process of fertilization, which was incredible. For me the process of fertilization was so engrained because I had learned it by that time three times.
A: So what is that message that you got?
J: when you read typically about fertilization you learn about this active sperm penetrating this passive egg. The egg, through this process of oogenesis or the creation of ovum or eggs , we had learned about it as being wasteful, produces one egg and two polar bodies. Whereas with sperm they produce four sperm for one spermatocyte, but I have to double check my biology on that. I had learned that there was this active and passive process where there is this moving, fluid sperm and this passive egg.
At this time I was learning in Molecular Biology about how the egg has all of these active enzymes in a layer on the surface on the egg that are necessary to facilitate the transfer genetic material with the sperm. It’s not an attack, fertilization is a transfer of genetic material. Both things are doing things and neither of them are human.
A: They don’t feel, they’re not trying anything.
J: They’re not trying anything. They’re both moving because they are in fluid. The narrative had been so anthropomorphized to be this heteronormative thing that ended with this aggressive penetration. This was wrong, and not accurate, going down to the depiction of the sperm as being the same size as the egg which is horribly inaccurate.
A: So this experience was such an incredible moment for you, being like, “I care about this (medicine) and I care about this (women) and they’re talking to each other and neither of them are happy.”
J: I think I had been at this point where for me gender mattered in medicine at the people level, and I was forgetting that gender matters at the anatomical, molecular level. Those are both true, and sometimes science likes it more at the molecular level, but it’s powerful at both levels.
I get a lot of science understanding as a premed, but I desperately wanted to be a more whole person than just constantly studying. Which has that changed? I don’t know. But I have definitely expanded where my brain goes with my Women’s and Gender Studies classes. I loved writing, and I wasn’t ready to give up being critical of what I was learning. It was a semester of crying on the phone with my mom, deciding to pick up WGS as a major, debating if it was a marketable to medical schools, specifically boards who make acceptance decisions.
I think now people are like “oh, this field of study makes this student more diverse.” Not that I think that’s wrong, because I definitely gain a more well-rounded perspective, but I don’t like getting that “stamp” for my major.
A: You have all of these critical thinking and communication skills and all of this super super tactile knowledge about medicine. How do you see your feminism engaging with your life as a medical professional?
J: I’ve been thinking about that a lot. It floats in a couple different spheres, and I think of them all equally because I don’t know what I want to do with medicine right now. One sphere is working with the transgender community, with endocrinology and hormone therapy in their transition. One is working with and against the things in place that make people go through all of these hoops to transition, especially in being in an exam room and not being believed by a doctor about transitioning. Another thing is working in family practice and working with families and people for their whole lives.
A lot of good medicine happens when people are proactive, both doctors as providers and when patients are able to be proactive. Patients can’t take initiative on their own health if they don’t know anything about their bodies. I want to have the knowledge to share with other people, and to be able to put things into words that are able to be understood and for people to be motivated by. I think it’s ridiculous that providers spout out all of these technical words and diagnoses to people and expect them to change. If you don’t understand or have autonomy over your condition, you don’t think you can change it.
I don’t expect people to be motivated if they are not given the language or understanding to know where they’re at right now much less where they could be.
A: This goes back to what you were talking about earlier. About bringing language that you’ve learned from this super feminist frame of thought into any sort of clinical treatment of anyone ever.
J: Which leads me into my third sphere– which is provider education! I dont think I’m the authority on anything, I always want to be more educated. Medicine has historically moved at a slow pace behind society, always trying to catch up. I think we’re really behind right now. I think a lot of that comes from not having the language to discuss these issues with any type of sensitivity, care, or compassion. Doctors just aren’t equipped. There’s a good amount of people that have gone through medical school in a time where social determinants of health, much less any of the “-isms”, were not considered relevant. And that’s changing , but you’re still dealing with people who don’t have access to those words.
A lot of providers are willing to be more accommodating to their patients. They want to learn. But they don’t have a way to access that knowledge that feels non-threatening, that they’re not being accused of not being above that learning curve. Obviously, we don’t want to be pandering to people and to be holding their hand through it. But you can’t expect people who have been dedicating their whole lives to something to abandon how they do medicine.
I think I have a kind of unique perspective on medicine, because I don’t think of it as “all good.” Granted no one should of any profession, but I can see that if that’s all you’ve been focusing on since you were 18 years old, the purity of medicine is a lot to give up. Something that you’ve put thousands of dollars and thousands of hours into might have some inherent issues and that you might be contributing to them, god forbid? That’s a scary reality.
A: And now someone is saying that your patients are being hurt by that.
J: And you love them so much. And you don’t want to hear that you’re hurting them. You get angry. You push back. I think it’s a hard balance.
Provider education is my end goal, my third sphere. But, in medicine, it’s demanded of you that you’re so forward thinking that you ignore the now. I am learning to be content with where I am in medicine. Even if you get the M.D., you still have residency, and then you are always proving yourself through boards. You are never done. I realized recently that I need to find a way to be satisfied with where I’m at in the path. For me, being a good doctor means you’re constantly learning. This is a really cool thing, that’s what draws a lot of people to medicine. Enacting that , however, means that you don’t have security that you’ve learned it all.
Or, you’re always going to think that you’ve learned it all. But, that’s a whole different issue.