138 Becoming a Patient
He said,‘‘ This one here has some mysterious illness where she can’ t take overnight call.’’ He was very mean to me throughout the rotation.‘‘ It’ s obvious that you’ re running at a slower pace than everybody else. I hope you’ re not considering pediatrics.’’ His section of my dean’ s letter stands out from all the rest:‘‘ Her performance is: good. Interacting with her was: fine.’’ No actual words.
Suzanne indicates the potential subtleness of discrimination— that it can even result from silence, from what is not said( e. g., in letters of recommendation). As a result of these experiences, she decided not to disclose her illness at the hospital where she was now a resident. Trainees faced particular problems because they were beholden to supervisors and evaluators, and hence had less power or autonomy to defend themselves. Peter, the HIV-positive medical student, said:
I had to tell my dean why I was leaving. But I was a guinea pig in policy-making. A cloud always hung over me. What restrictions would be put on me?... Supervisors weren’ t told that I was positive, but that I had‘‘ a blood-borne, communicable disease,’’ which is one of very few things. If they pushed, they could figure it out. My classmates didn’ t know. So when I had to refuse to do a procedure, my classmates didn’ t know why. It looked like I didn’ t want to learn. Residents would say,‘‘ Why doesn’ t he go do this?’’ The attendings would say,‘‘ He can’ t.’’ My resident would say,‘‘ Why can’ t he?’’ I was constantly walking on eggshells. Sometimes I did things I probably shouldn’ t have, according to their rules. I wanted to show them that I wanted to learn! My intern used to say our medical school was very lax. The attacks were indirect. If it weren’ t for my status, I wouldn’ t have had to deal with this. It always made me look like the bad guy.
The secrecy made it hard for Peter to counteract this antagonism. Even in the absence of disclosure of a specific diagnosis, partial information or silence could provoke discrimination. In the competitive world of medicine, colleagues reacted to illness-based work excuses with hostility, not sensitivity. Yet to abandon the field entirely as a result was hard, in part because medicine bolstered self-esteem.
These forms of discrimination occurred, too, because of blurrings of boundaries and conflicts of interest. Supervisors and coworkers who knew