“How many other times had any of us subjugated and dominated patients simply for our learning? How many times had we wasted someone’s time in a medical appointment just for our learning? How much extra anesthesia had to be given so we had extra time to close the patient’s skin? How many materials were wasted that we dropped on the floor and got billed to the patient’s insurance?” – Micaela Stevenson
By Micaela Stevenson •
Re-published on Afroféminas on November 7th, 2021 •
Colonialism has been defined by scholar activists as the process in which a group of people is dominated or subjugated by another group of people. This most commonly occurs between two ethnic groups or tribes, but may also occur between different genders or sexuality. Colonialism often involves the erasure or denial of experience which reinforces the power which ruling groups have. The field of medicine is not immune to this despite its moving toward an increasingly racially, ethnically, socioeconomically, and gender diverse field . At some point during one’s medical career—and it can be quite different for every person – some of us begin to realize that something here is not quite right. We don’t know why, but we wonder why some of us get in trouble more frequently than others in medical school and residency, why some of us get promoted and others don’t, and some of us start to wonder why so many of our Black women die on labor and delivery wards and others fear coming to the hospital at all. We wonder why our patients don’t trust us despite feeling like normal people. We wonder about rampant alcoholism in various indigenous communities as well as depression and anxiety among LGBTQ youth. There is nothing biological about any of these differences and yet we notice that they do inherently exist.
But it’s not just the disparities which have bothered me—those were familiar to me before I even started my journey in medicine. It was more how we came upon these careers and how we interact with the world. It is the very foundation of how we are taught that began to bother me. I was often unable to put a word on the discomfort, but it is inherently a colonizing system. A system in which we take away autonomy from our patients, treat their bodies as playgrounds for our intellect, and guilt people into feeling poorly when they choose not to do what we think is best for them.
This became obvious to me when I was assisting in performing a hysteroscopy on a patient to diagnose infertility. A Chinese woman was laying in front of me and asked before we started the procedure whether it would be painful. Having participated in hundreds of hysteroscopies at this point, I told her it would likely be very similar to cramps with menstruation. However, as we continued to do the procedure in multiple parts, she began to cry. We reached a stopping point and I leaned in and asked her if she needed a break. She sobbed and said that she did. However, my attending continued the procedure, examining her anatomy as she sobbed in pain and squeezed my hand. The examination of the anatomy was less for diagnostic clarity for the patient and more for examining normal anatomy that is infrequently seen and provided me with an opportunity to learn.
It was not the first time someone sobbed on me and I felt an unearned closeness to a patient. Nor was it the first time I’d heard a patient ask for a break in between parts of an elective procedure that did not occur and caused undue stress and pain. It was not the first time I had wondered how this was different from assaulting someone. However, it was the first time I thought about the collective identities of a person and how my participation manifested as colonizing someone else’s body. As a young Black woman who experienced poverty, it was uncommon for me to wield much power and privilege. I never considered myself to be part of a system in which I not only victimize people, but do so for my own personal gain and education. In which I explored their bodies not for the sake of treating them or anyone else, but for the sheer knowledge of knowing what these things looked like. This is akin to the Tuskegee Syphilis experiment, the Guatemalan Syphilis experiment, and radiation fall out experiments on folks living in the Southwest United States. It is akin to vaccine trials in underdeveloped nations. This information we gather is not unknown, it is voyeuristic and harmful. I walked away from this situation wondering what had happened and what this really meant for me. I knew she would never sue us—she believed that pain was part of the experience. In fact, she even apologized to me afterwards because she felt she had been “too dramatic” and that it was “just physical pain”. However, I wondered about that subjugation. How many other times had any of us subjugated and dominated patients simply for our learning? How many times had we wasted someone’s time in a medical appointment just for our learning? How much extra anesthesia had to be given so we had extra time to close the patient’s skin? How many materials were wasted that we dropped on the floor and got billed to the patient’s insurance? I spent so much time wondering what I had done so far to other people and how much of it was irreversible damage. How much more time and resources would be spent? And when would it end?
I wanted badly to end this article with methods on how to combat colonialism in medicine. In fact, I started out this article desiring to write specifically on ways in which we could talk about this problem and prevent it. But with the white supremacist nature of medicine being well known and the indoctrination, which is inherent to medical training, I am not sure I will be able to escape it. I am afraid that the voyeuristic things I recognize now will become second nature to me and my instinct to buck and protect patients will wither. I lie awake at night thinking that the physician I become may be unrecognizable to the activist I am today.