Excited by the prospect of treating myself to bananas foster French toast (yes, you read that right) after a 12 mile run, I coaxed myself out of bed before 6:00am on a Saturday. Proud that I was actually out of the house before 7:30am, I was mentally congratulating myself for the first mile and dreaming of well-deserved carb goodness when a slightly abnormal sight hit me five minutes later. I slowed down to see an elderly woman lying face down on the sidewalk, not moving, with both her arms at the level of her head. A young couple was standing around her, and I asked if everything was Ok. In a less than confident tone, they said that they had called her husband. I mentioned I was a doctor and started a slow jog out of there when they changed their mind and suggested that I should come take a look.
As I approached the woman, I could tell things were not good. A brief survey of her ATLS-style showed that she had an open left wrist and forearm fracture, a right closed forearm fracture, and there was blood on her chin. At that point, I did not think it was a good idea to move her without precautions as this 79yo woman clearly had multiple fractures after tripping over an upheaved sidewalk. I then called 911 and explained who I was, the situation, and her injuries.
Twenty-five minutes later waiting for the ambulance, I had learned her medical history along with her entire personal history including where she was born, why she moved to New Orleans, her career path, children, her children’s jobs, etc. As her shock was now wearing off and the pain was starting to become a reality, I called back 911 and explained that no one had arrived on the scene yet. The 911 dispatcher in an unhelpful way said that they were coming. When I started to tell her that I was going to call back every 5 minutes until an ambulance was on the scene, she hung up on me. Strike 1 for the doctor.
The ambulance showed up about 3 minutes after that. The head of the EMS team got out of the ambulance with another paramedic and a student. Now, let me preface that I know I look young on a good hair day with attention paid to my appearance. On a running day with a goal of getting done as early as possible, not that much attention is paid to getting ready. So, without glasses, no make-up, hair in a pony tail, and a sparkly head band (an unfortunate choice for this day), I could tell that I passed for late 20s/early 30s at best. So, when the paramedic came up, I explained who I was, where I worked, and gave a brief history of the woman and her injuries. I saw the flash, quick as it may have been, of disbelief when I told him that I was a surgeon. If I was telepathic, his thought was likely “medical student at best.” So, I thought I was doing him a favor by letting him know that I had some education behind what I was saying. As he went to pick her up without examining her, I said “I think that she needs to be in a C-collar.” He replied her neck wasn’t bothering her (apparently through amazing, no contact assessment). I replied that she has 2 distracting injuries and blood on her chin, so it would be within guidelines to put a C-collar on her. From that point on, I was completely ignored. He asked someone to help him pull her to her knees and then feet (like you would do for a drunk person) – no backboard, no precautions. As both her arms were sticking out at odd angles and she asked them to slow down, he made her stand on her own weight and then sit on the stretcher that was at normal height. He then took her into the ambulance without another word to me or the two bystanders who had stuck around this whole time.
Now a solid hour later, I started back on my run. And instead of enjoying the run or even feeling like I accomplished a good Samaritan task for the morning (even while knowing French toast had turned into a pipe dream), I ran ANGRY. Angry that I was disrespected and discredited in the field by the paramedic. Angry that I should have spoken up and done more for the patient. Angry because I knew if that had been my family member, I would have laid my body on top of her until the paramedic got a C-collar and handled the situation correctly. Angry because it takes 5 seconds to put on a C-collar so why not just do it if someone is requesting it. Angry and breathless I ran, and my run sucked. And that made me even more angry.
So, I couldn’t let it go. Once I got home, I set to task putting that anger to rest, which meant making a lot of calls. First was the complaint to the supervisor of the 911 dispatcher. The next was figuring out who was over the paramedic since his name had been burned into my brain by that time. So, I called one of the female trauma surgeons and told her the situation. And, to my horror and my naïve disbelief, she had had a similar experience. She is a cyclist and on one of her bike days with her friends, one of them took a nasty spill with a helmet on and lost consciousness for a few moments. He also then proceeded to sit up and vomit. When the paramedics arrived at the scene, she encountered a similar situation that I had just experienced. She stated who she was, what she did, and where she worked in her cyclist attire. She gave his history, what happened, and suggested some type of stabilization. And she was also completely ignored, discredited, and devalued in the field. So, she understood my anger, frustration, and desire to see this through.
Here is where the street education comes in: has really nothing changed? In light of all the hype for women’s right in the past year, speaking out about the gender gap and unequal pay, and with the #MeToo movement, have we really made zero progress? I still feel devalued and disrespected at work with division chiefs mansplaining and talking over me in tumor boards regarding cancers they don’t even treat. If I am a little too direct with recommendations or with comments about a cancer case, I am reminded that I should “watch my delivery.” And if I discuss my management decisions with reference to the literature, I am told not to “hammer people over the head with my point.” At that same time, I see men talk much more arrogantly and demeaning to me and my colleagues in conference, but no one says anything to them. In fact, I have quite frequently heard comments like “well, that is just his personality” or “he likes to have the last word.” Are there special exceptions to male communication that I am not aware of?
It saddens me that I do not think we have come as far as we would like to think. That is the street education the paramedic taught me. Four years of medical school, 10 years of surgical training, and he still thought he knew better than me. Why? Ego, pride, gender discrimination? Does it even matter? And as I quickly found out, I am not the only one experiencing it. It is mentally and physically exhausting for women to deal with this on a daily basis, and we should not have to continually prove ourselves or watch how we talk as “men have fragile egos and they need to be stroked a little.” At least, that was the latest advice given to me. I guess no one gives a rat’s behind about my female ego, as demonstrated by the paramedic.
But let’s end this story on a high note. I did get to complain, and the paramedic was called in from the field to be “re-educated.” As for my trauma surgeon friend, she went up to the paramedic in the trauma bay one day and made sure he knew exactly who she was. Most importantly, the patient got treated appropriately and efficiently once at the hospital. I got a call from the husband who told me that his wife was doing well – taken for surgery on the open shattered left forearm fractures that day and then planned surgery for her right forearm fractures on another day. I will always wonder what she thought of the situation and what was happening. There is a 40 year age difference between us, but is she shaking her head and thinking the same thing I am: has nothing changed? I hope our paths cross again one day so that I can ask. Or maybe we should cut out the middle man and just go out for French toast.