Womens

The book The Cure For Women and the featured Dr. Mary Putnam Jacobi stimulated the following recollections and thoughts:

My experience traveling to the third world on “medical missions” taught me some lessons related to expectations as well as real-life experience. I had a similar insight following three months in the confined quarters of a ship while serving as physician on the Semester at Sea program; those clients, young American “adults,”unlike those in the third world, were from a world that was very secure.

What links these very different experiences?

A touchy subject, that’s what. This relates to the battle my friend Mary Putnam Jacobi fought: assumptions about women. I am no Victorian and, as liberated as I would like to think I am, my experience has  led to awkward perceptions and judgements, not to mention communication. Mid career, easily two or three people out of every four seen in my clinic were women. I was confronted by women seeking health advice virtually all the time. I suspect that observation was true back in 1880. Our culture seems to find men seeking their answers to health concerns in other places than a doctor’s office. Women are not any less healthy on average, than men. Jacobi demonstrated a version of that when studying the effects of menstruation on daily function.  Women are healthy and capable of work, thank you very much. So why do women seek medical advice 3-4 to 1 compared to men?

A corollary: If you think women are, “messed up,” men are just as fucked up as women!  I promise!

Female physicians would often say things I never could about some of their female patients. In fact, Dr. Jacobi had strained relations with many female students because she always expected more from them, and let them know it.

Female physicians, it turns out, are a magnet for unhappy, anxious, or depressed women. Those descriptors are often tied to difficult conversations and expectations in the office. That has proven true for men and women physicians alike and we don’t always rise to the highest therapeutic standards when facing it. When we do, we pay an emotional price.  It is hard work.

Both the doctor and patients have expectations, often not shared, and often danced around in the history taking. When preparing for a medical mission in Chiapas, I studied malaria, treatment of scorpion bites, how to remove tics, and exotic infectious diseases. Cool stuff! When in the room with a poor rural Mayan speaking indigenous woman, the translation would be, “I have warm blood” to the question, “What can I do for you today?”  Colloquial phrases expressed a sense of illness and all the specific technical questions in the world would not leave me with a sense of what exactly was wrong. I considered that some of what I was seeing was exactly what I was seeing in my Olympia office: women whose expectations of life were disappointed, raising loved children with questions about how they were actually doing, a husband who was gone, abusive, or simply disconnected working a life of hard manual labor. Many populations of patients have had physical problems but confidence regarding them being simply inconvenient or serious is often lacking. With that insecurity, the symptoms often feel magnified even when my feedback is that they were not serious. And treatment? Thank God for curanderos as they were accepted by people in Chiapas unlike personal therapists in Olympia when in fact, I could find no serious medical problem to be treated.

Semester at Sea (SAS) provided a similar experience. As the trip would explore three continents much of it touching the third world, I repeated my study of exotic tropical disease. I provided short medical recommendations face to face the night before we docked at each port and I spiced up this talk with the exotic disease to be wary of after I discussed bottled water and peel-able fruits. For Venezuela, I outlined Schistosomiasis, acquired while bathing in tropical ponds and lakes. The student from Caracas later took me aside noting that she had never heard of such a thing. The health care reality of SAS was this: Three women for every man. Four people to a 10x10 foot cabin. There were no reliable private spaces. Guys were on the make and women were trying to be true to whomever they had left at college. The student body congregated in this environment having traveled from all over the US and some foreign countries. We had lots of URI’s (colds) epidemic in the ship for the first several weeks. With time, loneliness and the lack of privacy led to increasing stresses. Many students, “acted out.”  Expectations about what an MD on this ship could do were not realistic (the company set me up: the label for the clinic was “operating theatre”). Knowledge of basic health was sporadically found, at best. Accepting reassurance was mixed. I could have been in a third world village other than I did not require a translator……

Anecdotes:  One coed swooned in her cabin and I was pulled from dinner to assess her in her room. The Victorians would have easily labeled here neurasthenic as she had an anxious air, was exceedingly thin, pale, and lying on the floor barely awake with a sheen of sweat covering here.  Her blood sugar was below 50 making a diagnosis of hypoglycemia clear. I ran to the clinic for a dose of glucagon (elevates blood sugars quickly) only to find that the box had been put back in its place with no medication inside. Some sugary sweets did the job.

Another coed became despondent and threatened suicide in the middle of the Atlantic crossing. I walked with her to her room to gather her rather large collection of prescribed medications only to have her, “ditch me” and take an unknown quantity of one of her tranquilizing medications. Gotcha! She spent the night in the clinic with RA’s in attendance after a dose of ipecac. She did fine.

One woman presented to the nursing staff with pubic lice. We were four days out of port. She denied having sexual relations with anyone while on SAS now weeks since embarking. Her room mates (four to a room!) denied having lice and agreed to an inspection by the nurse.  None were found. This led to a ship wide warning about the possible contagiousness of the lice and the patient was treated. No other cases came forward.

Men did come to clinic. Or waited. One night in port, at 2AM I was awakened by a, “frat boy” of whom I was not fond, based on his behavior in the student union. He had gotten super glue in his eye. When asked how that happened, he said, “You don’t want to know.” He would not tell me. Treatment was minimal and he did fine. There is not much you can do for that………Another presented for stitches on his head having fallen down a hill while drunk in port.

Like all doctors, I have been capable of being uncharitable in my judgements of patients. My female colleagues have shared this trait. Living in a nation with increasingly diverse cultural norms, I was able—I am able— and continue to refine this.  To outward appearance I usually do not appear to judge, doing my best to meet people on their terms. How different that might have been were I born a hundred and fifty years ago where the assumptions were often shallow or stereotyped, accepted at face value, and the culture more uniform regarding assumptions and expectations—about women.

Don’t think that we all don’t have some version of that Victorian mind-set within us though. For every person judging a drug abuser harshly, there is another who will protect that “abuser’s” right to be themself.  For every person thinking kids will learn to be potty trained or learn to read, “when they are ready and want to,” there is another with a clear schedule of exactly how that is supposed to go. I think vaccinations are clearly the most important technical advance of medical care when considering lives saved in the history of man. The state of Alabama has expressed willingness to put Anthony Fauci on trial for the deaths of millions of people. Judgements—just like those of our great grandparents link to those differences.

As it was and ever shall be, Amen!