Death by a Thousand Cutting Remarks

In medical school we learn that the approximate blood volume of a human being is somewhere around 5L. If in order to be in danger of bleeding to death, a person needs to lose over half their blood volume, then I am approaching the path of no return. I’m tachycardic and pale. My mentation has slowed and I’m drifting in and out of consciousness. If someone doesn’t intervene soon, I’ll be gone. Figuratively, anyway.

I haven’t suffered a horrible accident. There has been no procedure gone wrong with significant injury to an aberrant artery. Instead, this has been a slow transition. A drop escapes here and there as a papercut I didn’t even know I had. A small stream of red trickles from my finger and gets wiped away. The only evidence of the cut I have is the stinging from the Purell I use in and out of every patient’s room on morning rounds.

A random nick shouldn’t be too surprising. After all, I deal with sharps by nature of the job: a 15 blade for a skin incision, an 11-blade for a neck abscess, 30-g for an infraorbital nerve block. I am navigating a surgical world. My attendings, the majority of them white males, have hands that are thick and calloused from their own versions of needle sticks and paper cuts. After all, we see the same patients, do the same procedures, though I perform them much less adeptly at this earlier stage (which may be a contributing reason for my lower hematocrit). I seem to suffer from a different barrage of miniscule trauma leaching my precious red blood cells. Is it because I am a woman? Or is it because I am black? Because I am a black woman?

I’m bleeding, and it’s because I’ve been noticed.

“Do you have a self-confidence problem? Because you write like someone who does.” That was the observation made after reviewing my life story on a piece of paper. That was how the interview at my state medical school opened. What had I written in my personal statement that had tipped this middle-aged white man off? A story about a young and black woman traversing the unfamiliar terrain of academia as the first person in her whole entire family pursuing a doctorate degree, despite having been told she should consider a different career? Or was it just because I was a 21-year-old and black woman, which then, and now, is enough to make one second-guess herself. My hemoglobin dropped 1 unit. Needless to say, I did not matriculate into medical school there.

“Cystic duct?” I knew that was the answer I read in my textbook while preparing for my general surgery rotation. But the way I said it came off more as a question than an answer. Uptalk.

“Don’t talk like that.” She demands.

My facial expression turns to puzzled.

“Like that? You know?” Her sentence ending with an inflection that mimicked mine.

“Women surgeons should not speak like that,” she concluded.

Blood splatters on the floor and our eyes dart at the crimson fluid. We both know it’s mine, probably 150cc or so escaping from the stab wound she had created while reminding me there is no room for a young, millennial woman like me in surgery.

A surgeon must become intimately aware of her patient’s body. This patient may have a left level three node, which you must be sure to include in the neck dissection, while the next patient may have some anatomic variant you’ve never seen.

Unfortunately, something about the way I look—the apparent youth of my dimpled cheeks, the hooding of my eyes, or the texture of my hair— gives each patient just enough courage to forego the social niceties taught to them by their mothers. My patients have seen my full lips, my freckles, my tawny skin, my height and have become so familiar with me in a single meeting that they must tell me their observations of my body...