“Thank you for letting me know”

8 03 2012

Fact:  Bullies exist in the adult world.

I feel like I was bullied significantly less than your average socially awkward, ugly duckling type in elementary school.  Part of that was probably attributable to the Montessori school’s tiny class sizes (my 6th grade graduating class was 5 people), so if one kid tried to bully more than one kid they would have ended up with no friends.  Middle school and high school were about the same; I didn’t really have close friends, but that was really more shunning than overt bullying.  You know how teenage girls are.

I remember settling into college, meeting a lot of friendly people who were cool with each others’ differences, and thinking, “Wow, I really got a sweet deal with this bullying deal,” and preceded to enjoy the rest of my college years in relative peace and surrounded by people who, even if they weren’t close friends, weren’t blatant tools.

Since then, somehow, things seem to have undergone something of a behavioral regression now that I’m a medical student.  This realization was a shocker for me, because I’d been telling myself since middle school that if I could put up with the immature shenanigans of my peers, things would be much more tame in the adult world, and I’d thought that grown-up people handled problems in a grown-up manner.

Pretty laughable assumption, right?

The gossip thing didn’t surprise me much.  That’s pretty much all that the nurses do in the maternity ward here, and the residents often join in.  I know of one attending who for sure contributes to the gossip pool as well, though this may be because she was a resident at this program just last year and is chummy with 75% of the current residents.  And it goes without saying that when somebody gossips to you, it’s certain they are gossiping about you as well.

What I did not expect from a group of grown adults in the medical profession was the amount of blatant bullying that occurs day-to-day.  Maybe it’s just my perspective, but it seems to me that the medical students are the only group of underlings to endure this abuse.  Nurses, Physician’s Assistants, RTs, radiology techs, none of them seem to find it acceptable to bully their own students, and they certainly don’t let other medical personnel do so.  Medical students are a little different.  Because residents and attendings find this open belittling of us to be acceptable practice, not to mention a tradition as old perhaps as the practice of medicine itself, others learn by example that they can be unabashedly mean to us as well.  This includes belittling us even in front of the patients.

As the wise philosopher Tina Fey once said in the movie Mean Girls, “You’ve got to stop calling each other sluts and whores, it just makes it okay for guys to call you sluts and whores.”  Different context, clearly, but the same idea.

Take the scrub nurses, for instance.  Often times they are pushed around by surgeons enough themselves that they feel the need for an object of aggression.  Other times, there’s really no excuse—they are simply sourpusses.  I’ve given an example already of a junior scrub nurse using me as a scapegoat for her mistake (the suture needles kept jamming in the laparoscopic trochars because she’d repeatedly forgotten to flatten them; I was blamed because I was actually the one trying to put the needles into the trochar).

Another example:  I’d been asked to scrub by the resident, and had diligently gathered my gown and gloves from the cupboard to set aside before scrubbing.  I waited for a good time to interrupt one of the circulating nurses t ask where I should set the gown and gloves.  She rolled her eyes, tutted loudly, snatched them out of my hands, and tossed them onto one of the rolling carts. Sensing she wasn’t the best person to ask, I found a different nurse and asked where I could find the glasses they use for eye protection.

“Maybe,” she said, peering down her nose at me and looking irritated, “If you don’t know, you shouldn’t be scrubbing in.”  I smiled, said ‘okay,’ and went to look myself.  It took a few minutes, but eventually I found the goggles, scrubbed, and went back into the room.  I stood there with my arms in front of me, still sterile, while the scrub nurses bustled around and ignored my presence.  I asked where a good place to stand was; one of the nurses pointed to a corner of the room behind the robot console (out of visibility of everyone and everything else in the room).  And I stood there.  For 20 minutes.  With my arms in front of me.

Then I asked one of the scrub nurses would be able to help me gown (I can put on the gown by myself, but not the gloves yet).  She snorted, gave me a belittling look, and continued to ignore me.  At that point, the docs still needed someone to help manipulate the uterus, and at that point decided that I was taking too long.  So I watched as a different scrub nurse came in, picked up the gown and gloves that I’d set out for myself, and put them on.  The first scrub nurse gave me this nasty look (I imagine the rest of her face looked nasty; I  could only see her eyes and forehead) and told me I should have set out more gowns and gloves, and if I wanted to scrub I should get my own.  Which meant breaking sterility and going into the cupboard before re-scrubbing, but I shouldn’t bother because they didn’t need me anymore anyway.

I was not happy, but I sucked it up, smiled, and said “thank you for letting me know.”  Then I watched what I could see of the remainder of the surgery from the footstool at the end of the patient’s bed.

Fact:  “Thank you for letting me know” is what you say when what you actually mean is “I heard what you said, but I don’t give a rat’s tail.”

We are specifically taught by the residents to say this to health care workers—like the scrub nurses—when they get snippy or belittling.  This is because it’s easier to suck it up and act appreciative even when these people are total jerks because they have the ability to make the remainder of your life in the O.R. miserable if they desire.

Fact:  Residents do not appreciate when you tell them “Thank you for letting me know.”

One morning at the beginning of the week, my classmate and I had been told something by the intern on our team that conflicted with what we had previously been told by the other residents.  This new bit of information caused us to scramble one morning to do things that weren’t actually our responsibility. So the R3 comes in, sees us, and starts getting snippy about “You should know by now that you only see Gyn Staff patients and patients whose surgeries you were involved in.  This is your second week, get it together, I can’t believe you haven’t figured this out yet.”  (Meanwhile, we’d just been told by the intern that we should be seeing a bunch of other patients as well).  Of course the intern is sitting in the room and listening to this resident go off on us.  Doesn’t say a darned thing in our defense—he might lack a spine, who knows.

While my classmate and I could have argued that we’d been told something different, that what she was telling us was what we had originally thought anyway, and that we weren’t morons, I just smiled, nodded, and said “Thank you for letting us know.”

She was not amused.

The point here is that you really have to choose your battles.  While I don’t like to allow people to use me as a scapegoat, to think that I’m an incompetent fool, or to groan and grump at me about things that I have zero control over (and stomp down both my dignity and my self-esteem a little in the process), these people have a lot of leverage.  Every person who has pushed me around plays a crucial role in my medical education.  If the scrub nurse is ticked off, I don’t get to scrub in to—and thus, usually don’t get to watch—the surgeries.  When this happens, I’m not in close enough proximity to the actual docs to ask any questions, and I don’t learn.  And heaven forbid you get on your resident’s bad side.

When other physicians have witnessed this behavior, they always fall back on one of two excuses for it:  1. She’s just trying to do her job and look out for the best interest of the patient, or (my favorite) 2. Don’t take it personally, that’s just how he/she talks.  Both of these excuses are chock-full of baloney.  There are enough nice scrub nurses (I’ve met 3) out there for me to know that nobody needs to be a three-decker sauerkraut and toadstool sandwich in order to do his or her job well.

I was talking to a friend about this earlier today.  She’s got a normal job in which she, as one of the youngest in the office, holds one of the higher leadership position, and has received a fair amount of verbal abuse from the older ladies in the office for that success.  She was able to file a complaint, talk to one of the managers, and the bullying stopped.

This will never happen in medical school, unless there’s blatant sexual harassment involved.  It’s like I said before; stepping on medical students is a part of the culture, and many of the physicians probably treat us this way more or less because it’s how they were treated themselves.   This behavior is most certainly not fair, but it is tolerable.  As mothers everywhere will tell you, life isn’t fair.

So all I can do is suck it up, pull on those big-girl panties, and pray for the strength to keep my hot-headed stubbornness in check and my tongue firmly tucked into my cheek.

And hope to high heaven that I evolve into a decent physician who doesn’t inflict damage on my own med students.

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One response

18 04 2012
Cranbrook Doula

My only hypothesis is that this is the only time in your career that the nurses are able to bully you. Once you’re a resident, they won’t dare, and they’ll have the satisfaction of remembering that at ONE point, they were above you, and at ONE point, they were able to make you feel very small. They just expect that all doctors will treat THEM poorly, so it’s kind of like prequel revenge.

So, what do you think?

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