Wonder Woman Act I
The first time I recall exercising my personal power, and realizing it could have an impact – even on adults – was in 3rd grade.
Mrs. Akron, my 3rd grade teacher was a bit of a tart. Always pinched, always stern. But I was smart and one of her ‘pets’ nonetheless. She loved my artwork, and requested – or more accurately, insisted – that several paintings I’d done be displayed in the glass cases lining the halls of PS 201, my elementary school. Mrs. Akron had promised me that I could take my artwork home at the end of the school year. But on that fateful day in late June she flat out refused to give my paintings back, saying they belonged to the school, not me.
I was outraged. OUTRAGED. I planted my 3rd grader hands on my 3rd grader hips, feet hip width apart (my first ever, though unintentional, invocation of the Wonder Woman pose) in her classroom and refused to leave until she handed over my paintings. I mean I wouldn’t budge and was ultimately escorted, somewhat forcefully by the elbow, to the principal’s office down the hall. My single working mom had to leave work to fetch me from the principal’s office. When she arrived, nearly an hour later because of her commute, she asked the now very disgruntled Mrs. Akron, still at work because of me, if the artwork was, indeed, mine. “Yes, said Mrs. Akron, she painted those pictures.” “Did you tell her she could have her paintings back at the end of the school year?” my mom asked. When Mrs. Akron said yes to that, my mom said, matter of factly, “Well then, give them back to her.”
I left school that year both with my artwork and the value of being a badass when needed.
Wonder Woman Act II
As a homebirth midwife, my belief in self-efficacy served me well. At times I had to protect my clients from unnecessary medical procedures or tough interfaces with what was at that time a homebirth averse medical community.
Tina was one such mom. Tina had to have her baby in the hospital due to a serious medical condition called Rh-Isoimmunization and asked me to be with her for labor – and moral – support. Because of this complication, Tina required numerous tests and interventions throughout the pregnancy, which she accepted graciously to protect her baby. But she didn’t want interventions she didn’t need – including an episiotomy – when she gave birth. At that time, episiotomies were done in 90% or more of women birthing in hospitals, and they were almost never necessary.
When Tina was moments away from pushing her baby’s head out, after a peaceful 8-hour labor, the obstetrician, now sitting on a stool at the foot of the bed, between Tina’s legs, picked up his episiotomy scissors from his instrument tray and prepared to cut her. I quickly and gently reminded Dr. Green that Tina had requested no episiotomy, at which time he looked me squarely in the eyes, scissors in hand right there at her perineum, and said “Miss, I’ll do one if I damn well please.”
My inner Wonder Woman spun into action faster than I could think.
I immediately, instinctively, and decisively put my hand, like a shield, right over Tina’s perineum, blocking the path of the scissors, and looked Dr. Green resolutely back in the eyes, and said, “Well, then you’re going to have to cut through me to get to her.”
It was like a she-bear with cubs possessed me. He gulped, immediately put his scissors down, and Tina gave birth moments later to a health baby over an intact perineum. I was told that weeks later Dr. Green invited some midwives to join his practice because he was so impressed by my grit.
Why I Won’t Stand Down: A Painful Lesson
As a medical student I started out much less fierce. At first, I tried to fit in and not make waves. I was polite, even contrite, and didn’t argue with my professors’ and attending doctors’ decisions. After all, I wasn't a fully-fledged doctor yet, and I was taking care of patients who were ultimately their legal responsibility. So initially, I took a respectful backseat.
I quickly learned just how many medical errors really do happen in the hospital and doctor’s offices, how many are overlooked, sometimes because nobody wants to be the one to make waves – nurses, family members, patients, other doctors, and doctors in training.
In my final year of medical school I learned, in a most painful way, that I have to speak up for my patients and go against authority. I’ve spoken up since.
Akiko was one of the loveliest women I’ve ever met. A gentle, soft-spoken but strong woman in her 50s, she raised orchids, had 2 sons in their early 20s who adored her, and a tender relationship with her husband. Akiko had been in the hospital for weeks after a bone marrow transplant for the cancer that was being successfully treated. On strong immunosuppressive medications, she was weaning off and was to finally be going home at the end of the week.
On Monday afternoon Akiko spiked a high fever. Her oncologist, a world famous liquid tumor specialist, said it was from her treatment and that I just should't worry about it though my instincts and clinical judgment told me otherwise. On Tuesday morning she again spiked a fever and was started on antibiotics, but they did nothing. She also began reporting upper right abdominal pain. I told my supervising resident and the oncologist that I’d like to order an ultrasound of her gallbladder, thinking she had a gallbladder obstruction or infection in the tubes that enter the gallbladder. They said no, and when I pushed it with the resident a few hours later, when Akiko's temperature was 104 degrees, the resident told me that if famous oncologist thinks nothing is wrong, then nothing is wrong and I should back down.
This scenario went into Wednesday, with fevers spiking and falling and the abdominal pain worsening. Akiko was now coughing and having difficulty breathing so I ordered a chest x-ray when neither my resident nor famous doctor were on the floor.
The results came back: She had developed Acute Respiratory Distress Syndrome (ARDS), a severe, sudden injury to the lungs caused by a serious illness – in her case, a necrotizing infection in her gallbladder that was also seen at the edge of that x-ray and that was causing the abdominal pain and fevers. Life support with mechanical ventilation is usually needed to survive until the lungs recover. I was patted on the back (literally) by famous oncologist, who said, “Good catch, doctor” to me. Akiko was taken to the ICU. She never left the hospital. She died the next day. Her family thanked me for my loving support.
My inner Wonder Woman became my inner guide as a result of Akiko's unnecessary death, and it became easier for me to call on her in the future.
The “Bad Girl” and the Brain Hemorrhage
Just weeks later, on the same hospital rotation, but with a different attending oncologist, my patient – a trim, good looking, silver-haired English professor in her mid-60s with a pixie cut, who was also being treated for cancer – noticed that she was slurring her speech very slightly. She brought it to my attention on my morning rounds, so I did a routine neurologic exam at her bedside, noticing a subtle but definite deficit in what is called the rapid-alternating motion test on her leftside. This can indicate a problem in the cerebellum of the brain.
I quickly told her doctor – another famous oncologist (my medical school was filled with the docs who wrote the books) and he said, “Oh, it’s just the chemotherapy probably causing her to have a little brain fog – we call it chemo-brain.” “I don’t think so,” I said, “it’s a definite change – she and I both notice it.” Again, he said it was nothing.
Like I did in third grade, I stood there, hands on hips, feet firmly planted and said, “Look, just a few weeks ago a patient died here because her symptoms weren’t explored quickly enough. I’m sorry, but I am going to have to go on record that I think something serious is wrong and you’re refusing a test.” As a medical student, I couldn’t authorize the test without his consent.
He looked at me shocked and barked, “Ok, get an MRI.” I ordered one STAT and soon after received an emergency page from radiology – radiology calls only come back that quickly when something is really wrong. The radiology resident at the other end of the line said “Hey, I just want you to know that I’ve alerted the neurosurgery team about your patient – they will be on the floor in minutes to bring her to the OR – she has a hemorrhage in her cerebellum.” My patient had a hemorrhage the size of an orange in the back of her brain. Emergency surgery saved her life and her brain, and she recovered beautifully.
Why It’s Good to Be A Bad Patient
This article is not about how clever I am as a diagnostician. Or how fierce I am. It's about how not speaking up can cost someone their life – and less extremely – can leave us feeling victimized and incompetent.
From our earlier years we’re taught to be “good girls.” We’re told to be polite, be good, to not interrupt, to say thank you and fake appreciation even when we don’t like something, to be pleasant, not make waves, to be seen and not heard, to not question authority, not stand up for our rights, not be bossy, share when we don’t want to – the list of how we’re taught to “be good” is endless. I’m not saying we shouldn’t be decent citizens with good manners, but that’s different than not speaking up for ourselves and accepting what just feels wrong. Our inner “good girl” usually starts at home, follows us through school, and stays with us in our jobs, relationships, and business dealings.
And she comes with us into the doctor’s office and the hospital.
That’s what I’m talking about here.
You see, the good girl thing translates into being a good patient. Good patients don’t question authority. They don’t challenge the need for the test, the diagnosis, or the treatment. They don’t say no, I don’t want you to examine me. Or thank you, I’ll just leave my clothes on for the Pap smear and I’ll cover with a drape, rather than wearing that insulting paper gown with my rear flapping in the wind. They don’t say I think I’ll labor for a bit longer, thank you – we can revisit the cesarean later. And while we’re at it, I’d like to walk around to help my labor move along rather than being strapped into this bed by a fetal monitor and an IV. Or hey, this symptom is not all in my head, it’s not just depression; I really am tired, losing hair, and am gaining weight for no reason. Many a good girl has suffered for months – even years – with symptoms of depression, weight gain, hair loss, low immunity, dry skin, constipation, and postpartum problems – because she didn’t know she could insist on further testing or another opinion or a different medication that might reveal or improve a thyroid problem.
Doctors and nurses, just like parents and teachers, favor the good girl patients and they dread those that are known in common medical parlance as “difficult patients.” “Compliant” is the word used to describe cooperative patients who do what the doctor tells them.
And I promise you, it comes out in how patients are treated. Eyes quite literally roll and groans are audible when a “difficult” patient comes into the office or hospital. Difficult translates as the mothers who question whether the antibiotic is really needed for the ear infection, or whether the vaccination should really be given when their child has a fever; the pregnant women who ask for chemical-free glucola for prenatal blood sugar testing instead of the kind with chemicals that have been banned for human ingestion in Europe, or who come into the hospital with a birth plan. Or any of us who even question the need for a test, medication, or surgery. How many of you have been bullied into a set of dental x-rays, for example, you really didn’t want or feel you needed, just because we couldn’t say no to the dentist? These things happen every day in medicine. It’s happened to me, too. It’s bullying, and we get victimized because we’re afraid to speak our truth and hold our ground, which can be done politely, but often needs to be done firmly and definitively.
The Wonder Woman Pose and Other Power Tools for Girls and Women
Learning to say no or insisting on something we really feel we need (for example, the right thyroid tests, to eat during labor, to wait until our child doesn’t have a cold or fever to vaccinate) isn’t easy. It takes practice. It’s uncomfortable. People might not like you. Your doctor might seem irritated. You might sweat or feel nauseated before you say no or have to insist on something the first few times you do it.
But remember, fear is a primitive reaction that can fill you with the energy and the mojo you need to save your life!
When you feel fear rising, do the following:
- First, take several deep breaths. You can do it subtly, but do it. Breathe deeply into your belly, letting your belly rise and fall with the in and out breaths. Close your eyes if you need to (unless you’re doing something that requires them to be open, like driving… or surgery!). Calm your racing heart by using your breath to get into parasympathetic mode. Yup, right then and there.
- Now, get into Wonder Woman Pose: This pose has been proven to increase testosterone and along with it confidence and courage. Ground yourself to the Earth by feeling your feet where they are planted firmly on the floor. Really consciously feel your feet on the floor. Feel the strength of the Earth and the power of all women on the Earth rising up in you. Put your hands squarely on your hips. You can do it either before you have to speak up for yourself, or during. It’s also great before public speaking events and applying for a job. Sometimes doing it while public speaking or in a job interview can make you appear overly intimidating. If you’re sitting you can stand up, or take the position in your mind if you’re in a chair or for example, on an exam table in the doctor’s office (as in you want to say no to something during a pap smear but can’t just jump into Wonder Woman pose). If Wonder Woman doesn't resonate with you, that's cool. Find what does. Beyonce has Sasha Fierce, her powerful, not so good girl alter ego. Find your inner badass and learn how to invoke her when you need her.
- Next, take a big deep breath and say what you need to say. Strongly, clearly, firmly. Easing into icy water is never as effective as just jumping in. so imagine you are jumping into cold water – and just do it!
Practice with small stuff, for example, speaking up about overly salted food that you really want to send back in a restaurant, or honestly telling the person giving you the pedicure that you’d love a quiet moment rather than hearing about her love life, or saying no thank you the next time you’re invited to something that you really don’t want to go to rather than going and wishing you were anywhere else.
It really does take practice telling the truth, and even more practice to do it kindly. But it can be life saving for you or someone else. You’ll get there. I know you will. But it means you have to get over your inner good girl – and she’s probably been with you for a long, long time.