Behind the mask
Through a shielded medical mask, I was looking at one of the most powerful images I had ever seen—the human heart inside a patient’s chest surrounded by small, blackened lungs and retracted ribs. The beauty of seeing these seemingly strong vital organs and structures up close was blunted by the reality of their diseased state. We were already a few hours into the lung transplant surgery with several more hours planned. But, time didn’t seem to matter—as a medical student I was just in awe at being able to witness such a life altering procedure.
I realized the value of these experiences and was embracing each minute. As the hours went on, however, my mask became foggy, my stance weak, and my forehead beaded with sweat. What’s happening? Was the temperature in the operating room warmer than before?
Looking around, no one else seemed to be uncomfortable. I looked up at the operating room lights—it was unbearably warm. I was growing increasingly frustrated. The surgeon asked me to come closer to the table; he wanted me to see the dilated alveoli in the lung tissue that was being removed, which was an image I had only previously seen in textbooks.
I gazed at the lung tissue as he described the pathology. He looked up at me; at this point, I was completely drenched in sweat. I was focusing on my breathing and shifting my feet. I tried anything to stop whatever this was from happening.
“Are you okay?” He said.
“I’m great.” I responded.
“Can you see through your mask? It’s completely foggy.” He replied with a concerned look.
“I’m fine, I can see.” I replied through the fog.
Finally, the surgeon looked at me and said, “Why don’t you step out and cool off. “
Walking into truth
I walked out of the operating room. Before I could remove my mask and gown, I collapsed into a nearby chair. I was seven months pregnant, near the end of my surgery clerkship, and in part because of the generous sizes of surgical scrubs, I had been able to hide my pregnancy from everyone until that moment. The nurses and a resident aided me and sat with me as I recovered from my vasovagal episode. I was devastated. I could have made it, I thought. I can go back in. I’m ready. I can do this. In reality, I knew I couldn’t.
Why am I telling you this story? As minorities and women in medicine, especially as black women in medicine, I think we struggle with reconciling the perception of what a physician should be and the reality of what we can handle. We’re taught from a young age to be strong. Always smile. Never complain. Be helpful, selfless, give. Never ask for help. Always offer help. Never say no to someone in need.
When we enter the field of medicine these expectations are reinforced. Go harder. Exude power and toughness. These feelings have been described as a concept called the Superwoman Schema. This framework, which disproportionately affects women of color, describes perceived obligations to (1) project strength, (2) suppress emotions, (3) resist being vulnerable or dependent, (4) succeed despite limited resources, and (5) to help others before oneself.
This schema has classically been used to describe why women of color underutilize health services, but I would also argue that the women of color in medicine who are delivering this care are particularly susceptible to striving for the superwoman ideals. Our efforts to try to live up to these unrealistic ideals, and try to have and do it all, can have long-term consequences on our perception of our successes as well as on our own emotional well being and health.
Pregnancy and medicine
When I think back about why I hid my pregnancy, I realized it had everything to do with these standards and my own struggle to counteract the negative societal stereotypes of African American women. Unfortunately, a pregnant black woman historically evokes negative images. There are stereotypes about single moms, welfare use, and incompetence. We’ve heard recent news stories about the increased mortality rates associated with being pregnant and black. This discrepancy in mortality is in part due to how these stereotypes work to delegitimize African American women when they advocate for their own health.
Even though I was happily married and had planned my pregnancy, I felt an incredible amount of shame and I struggled with sharing the news with my professors, advisors, and peers. Unfortunately, my fears were not completely unfounded as I subsequently faced microaggressions (and at times overt racism and sexism) once I was no longer able to hide my belly. One of the senior residents likened my pregnant belly to a “beer belly” commenting, “Wow, you’re pregnant! I just thought you had a few too many beers last night.” Before returning to the OR, I was constantly asked if I “was up to it,” or if I wanted to “sit this one out.’”
I faced new and different skepticism about my abilities, career goals, and intentions. “Why now,” and “are you sure this is the best time?” were common responses, as if the decision was not one that I had carefully considered.
Everyone had an opinion.
With patients, it became increasingly difficult to gather a clinical history because many wanted to discuss “how [I was] balancing it all,” or how I planned to be both a mother and a doctor. A female administrator once told me when deciding how much leave I would take with my daughter, “it would be difficult to arrange, but sure, I guess you can take an extra week if you think you need it.” The concept that another woman in medicine thought that an extra week with a weeks old infant might not be needed embodied the devastating lack of support that exists for expecting student doctors and the sad state of maternity leave in our nation today.
…I am deeply confident that the more women of color educate themselves on who they are, how they are perceived, and the realities of navigating the world of medicine, the more powerful that makes us.
– Caroline Nyenke Robinson, MD
The true power pose
It was not easy; in fact it was really, really hard. In a way, it required a different level of toughness. I had to move past a place of caring deeply about how I was perceived to a place of not caring what many people thought. I realized that I had the clearest vantage point of my life and my future and that other people, no matter how empathetic, were literally incapable of seeing the entire picture from where they were sitting.
I don’t have all the answers, but I am deeply confident that the more women of color educate themselves on who they are, how they are perceived, and the realities of navigating the world of medicine, the more powerful that makes us. I also think that the solution lies in increasing the number of minorities and women in medicine. If we increase our presence then the diversity of our experiences and values will become the norm and not the exception.
Recognize that power is not in how you carry yourself or in the accolades on your resume; the power is in how unwaveringly grounded, centered, and in touch you are with your values, visions, and goals. As a group, we need to be more comfortable in sharing our stories, without inhibition or fear of judgment, in the hopes that we will empower others with similar experiences to share. We need to feel more comfortable in leaning on each other for support and reaching out when we need support.
Dr. Caroline Robinson, MD
Dr. Caroline Robinson is a dermatologist in Chicago, IL. She received her undergraduate education from Cornell University and her medical degree from University of Louisville. She completed her dermatology residency at Southern Illinois University serving as Chief Resident in her final year. She is clinical faculty at Northwestern Medicine and Director for Diversity Initiatives for the Department of Dermatology.