‘‘They Treated Me as if I Were Dead’’ 137
physicians were threatened with being forced out of their professional
role did they see how much their field failed to address fully the issue of
death. Deborah herself did not understand the problem—she didn’t view
herself as dying, even though colleagues did. As we shall see, her denial
may have in part been healthy.
In addition to the kind of diagnosis, the type of job can also shape
discrimination. In medicine, job security can be precarious a priori, often
based on verbal, rather than written, contracts. One radiologist’s position
depended on ‘‘a gentlemen’s agreement: that once you make it to ‘mem-
ber,’ you’re a member until you decide to leave.’’
Trainees were particularly vulnerable to discrimination. Suzanne had
disclosed her bipolar disorder to her medical school dean, which helped
reduce overnight call. But the information threatened to impair her fu-
ture career when it almost appeared on her school’s letter to residency
programs.
I told one of the deans. So they all knew. I never could have gotten
through medical school unless they did know, because we had to
do a lot of call, and I had a lot of episodes. In one, I was out of
school for six days. I got a lot of support from them. All the
overnight call I was doing in surgery, ob-gyn, and pediatrics was
precipitating symptoms. They knew I wasn’t going into any of
those fields, so they said I didn’t have to do overnight call anymore.
But when I applied for residency, they were going to put that in my
dean’s letter. I argued that they never told me that it would show
up down the line: ‘‘I’m going into psychiatry. I’ve chosen this
career specifically because it doesn’t require much overnight call—
I have enough sense to know that. So please do me the respect of
not putting that in my dean’s letter and sabotaging my career.
If I had known that you were going to put this fact in there,
I probably would have just forced my way through, and gotten
sick a lot.’’ They decided not to put it in.
The dean appeared unsure of how to handle this situation, feeling awkward
accommodating a disability and maintaining confidentiality versus follow-
ing the school’s usual requirements and standard operating procedures.
For a trainee, even partial disclosure (e.g., of the existence, if not the
name or nature, of a diagnosis) can engender reproach. Earlier, Suzanne
had faced unpleasant reactions, if not outright discrimination, from her
pediatrics supervisor, whose comments might even be actionable.