When he was one and a half, my son was hospitalized.
(To get to the punchline: he is okay. He is more than okay. He is a thriving, growing, mischievous, curious little kid. Thank God, this is not a story about serious illness. This is a story about medical education, and how its culture distorts and warps what is truly important: patients’ well being.)
I remember the day clearly. It was fall, but warm enough to eat dinner outside at a restaurant on our street. My son liked eating the fries. He had a runny nose, but that wasn’t unusual, he always did. We put him to bed, went to sleep.
Around midnight, he woke up crying, something he hadn’t done for months. I had a sense something was wrong; he just couldn’t get comfortable. We fed him, soothed him, eventually he settled. I went back to sleep and had a vivid dream. I was working in the emergency department of the Very Prestigious Children’s Hospital where I had worked in medical school and residency, but I was locked out. I couldn’t sign my patient notes. I couldn’t get inside to finish the work I needed to do. Doesn’t take a psychoanalyst to interpret that dream.
He woke up again around 3, and it was clear it was hard for him to breathe. He couldn’t stop crying. Later, after I described what was going on to the emergency room doctor, she said he was “auto-PEEPing,” a term I had struggled to understand as a student, something about pressure keeping the lungs inflated, yet another physiology concept that seemed amorphous and complex when I was learning about it years ago. Crying allowed him to breathe.
We strapped him in the car seat, still wailing, and drove to the emergency room.
We were quickly ushered to a room – he was sick enough to rapidly bypass all the sniffly kids languishing in the waiting room at 4am – where a resident came to see him. The resident seemed fatigued, and he was having a hard time getting our story straight. The attending showed up shortly after. A respiratory technician fiddled with tubes and wires in the background. “Tell me what’s been going on,” the attending said, addressing both me, my husband, and the resident.
I remembered the attending clearly from medical school and residency; we had worked together several times. I’m not sure if she remembered me – she seemed to realize I worked in health care – but I definitely knew who she was. So many of my former teachers loom large that way in my memory.
As the resident repeatedly botched my son’s HPI (that’s the history of present illness, the summary of what brought us in), I took a perverse pleasure in interrupting him. I neatly, concisely, efficiently explained exactly why we were there. I had given a perfect presentation on my son, coughing and crying in my arms, and the third-year medical student in me was proud.
What does that mean, that part of what I remember so vividly from that night was sounding smart to someone who had graded me 7 years before? I still, somehow, in this awful scenario in which my son was quite sick, wanted that ER doctor to think I was a good student.
My son got better quickly, for which I am deeply grateful. He tested negative for influenza, COVID, and RSV – it was a nasty cold, an unknown virus that made him gasp for breath. It was a kind of fragility I had never experienced before, watching him with high-flow oxygen running into his nose, smiling at Sesame Street on the computer in the ER exam room. His arms were strapped into plastic braces called “no no’s” so he couldn’t bend his arms and rip out the nasal cannula.
After only a few hours on the high-flow oxygen, he got better. He was almost back to himself by the time we finally got admitted and left the ER for a room inside the hospital. It almost seemed like a formality that we were going up to the medical floor.
Upstairs in the hospital, we barely saw any doctors. The ones who kept checking on him were the respiratory therapists, putting their stethoscopes on his little back, laughing at the way he fell asleep with his butt in the air. So much of the work of being a doctor, in the 21st century, is looking at a screen, interpreting data and orchestrating treatments from a computer in a windowless little workroom. This is not some kind of false modesty for being a doctor – I’m glad I’m one, usually – but from my perspective as a parent, they seemed like minor characters.
Still, I couldn’t help but wonder who the doctor would be when she finally graced the room with her presence. When she did come in, to discharge us, I knew her immediately. She was a well-known teacher at my medical school, and I remembered crying in her office, upset over a bad grade. I remembered the way she had handed me a box of tissues as I sputtered and sniffled. I remember her telling me that I had “received a lot of useful feedback” in my evaluations, including the one where I was described as “pushy.” It all seemed like a distant memory until she was there in our hospital room, leaving me wondering if I were a bad mom for worrying more about my grades from medical school than the situation at hand.
She looked exactly the same, wearing cute leopard print flats. She seemed to have a flicker of familiarity when she saw me, but if she remembered me, she didn’t acknowledge it. She started talking about how my son had RSV. Again, as I had felt interrupting the resident the night before, I felt a disturbing sense of pleasure when I stopped her and said, “But my son was RSV negative. And negative for flu and COVID, too.” She looked flustered for a minute. She had made a mistake, a minor one. She apologized and moved on, talking about how to suction his snot.
See, I wanted to scream, even perfect pediatricians at the Very Prestigious Children’s Hospital make mistakes! I wanted to tell her that years ago, she had made me weep, had made me feel mediocre, had made me question whether or not I would be a good doctor.
It reminds me of another story I often retell, of an infectious disease doctor I had worked with, who gave me the following unhelpful feedback: “You should be more detail-oriented.” He sat me down on a Friday afternoon, at the end of a week working together, to tell me this.
“Thanks for the feedback,” I remember saying, trying to appear grateful and perky – anything but pushy.
Later that evening, he sent me a text: “Hey babe. What are you up to?” We had exchanged numbers so we could find each other in the hospital. The text, I realized, was intended for his wife, and he quickly realized his error and messaged me to apologize. I knew it was a mistake, and didn’t make a big deal of it. He had been professional and respectful the whole time we had worked together.
But I felt that same urge. I had wanted to write back: Maybe YOU should be more detail-oriented! His mishap, had I been feeling vindictive, could have cost him his job, or at least some kind of investigation into his conduct with students. How could he dole out criticism to me when he clearly was capable of errors himself?
We came home from the hospital. My son got better. The team there took wonderful care of him; I trusted their expertise and recommendations completely.
But the run-ins with my former professors lingered with me. Had they done something wrong, years ago, when they tried to help me fit in to the culture of medicine? Or had I, by being not good enough? Did medical education have to be this way, that a competent and established physician like me would remember these encounters, years later? Or is it good that continuous improvement is part of the culture of medicine?
Now, I dole out the feedback more than I take it, and I’m the one who makes an outside impression on my students.
I was struck by this recently when I got a teaching review from one of my students, who had arrived at my clinic during my lunch break, right before I went to take a walk outside. “Dr. Gordon didn’t seem to want me to be there at all. She left me alone in the workroom while she went to take a walk,” the student wrote. Two out of five, on the scale of my teaching abilities.
I was initially upset, but now I can see how medical school culture primes students to be sensitive to a professor’s every move. We’re obsessed with grades. They’re woven in to everything we do in medical education; my inbox bursts with requests to evaluate everyone and everything, all the time.
And for students, it all feels so high stakes – a mediocre grade for this student could be the difference between being a dermatologist and a pediatrician, between having a choice of geographic location for residency and matching in a part of the country without any family or friends. In her unflattering teaching review, this student was grasping for a sense of control in a situation where I had appeared to unfairly judge her. (For what it’s worth, I gave her a great evaluation.) It reminds me of the Black Mirror episode called Nosedive, where social media reviews haunt every interaction. In medical education, we’ve evaluated ourselves into oblivion.
I’m not sure I learned much from the episodes I remember so vividly, the episodes where I felt humiliated and wronged as a student. They’re stories I now tell as funny anecdotes to illustrate how absurd – be detail-oriented, babe! – or sexist – you’re kind of pushy – medical culture can be. They’re benign compared to the truly malignant racism, sexism, homophobia, and fatphobia that exist in medical culture. They’re harmful in that my professors thought they were actually giving me helpful advice.
So how did I actually learn? From unglamorous, often tedious, repetition. Through watching others do a good job, and occasionally watching someone do a bad job. From feeling safe enough to make mistakes and talking through how to correct them. From not fearing that a mistake would cost me my grades, or my career.
Hey, guys! I was on TV!
What a trip. For under two minutes of the show, it took almost a full day of my time – not to mention the time of our communications team at my medical school and the CBS crew! It was quite different from my experiences in print and audio. (I don’t usually put on makeup to write a Substack post.)
But I’m so glad that I was able to talk about fat positive medicine, at least briefly, for a huge national audience. A friend emailed me these kind words: “I think that’s the only time I’ve heard the word fatphobia on cable TV!” Little by little, the body acceptance movement is doing the hard work of fighting fatphobia, and I’m honored to be a part of it.