Unwomen
Keywords: gender equity, sexism, discrimination, sexual harrassment, microaggressions
Author: Lisa Reynard, MD
In Margaret Atwood’s The Handmaid’s Tale, “Unwomen” are the sterile women, the unmarried women, lesbian and bisexual women, vocal and politically dissident women: women who are incapable of integration within Gilead’s strict gender roles. The House of Medicine, in particular academic medicine, is its own Gilead. Women have a clearly defined set of roles as well as a set of rules, behavioral and clothing standards that apply only to them. Both the roles and the rules were dreamed up by men. Anyone who does not comply is an Unwoman.
Marthas do the grunt work in academic medicine, churning out research papers that men’s names get attached to, participating in committees chaired by men, setting up venues and catering for Residency events that the male faculty just show up to. Despite their productivity, Marthas are not respected or appropriately financially compensated. The gender pay gap still exists. Most importantly, Marthas are not promoted, and the leadership pipeline continues to hemorrhage women.
Our female residents are Handmaids, owned and controlled by the House. The average Handmaid has hundreds of thousands of dollars of debt and must endure whatever abuse is thrown at her in order to pay it. While we are miles away from the atrocious work hours of the 1980s, residency is hard work coupled with emotional labor. Handmaids navigate a minefield that can vary from frankly egregious sexual harassment, to more subtle microaggressions that happen in plain sight and become so ingrained in residency culture that they become routinely accepted. A Handmaid who speaks up is promptly muzzled, burned or otherwise scarred. We carry those scars out of residency and into our professional careers.
And then there are Unwomen. The women who dare to question the status quo. Who speak up when they are interrupted or talked over, who refuse to start every sentence with “I’m sorry” or “Is it ok if...”, who make no apologies for their voices or their femininity. And the women whose situation prevents them from speaking publicly, but who do important work on the inside. The women who are reading articles such as Dr. Erica Kaye’s and getting angry that a profession built on the foundation of “do no harm” is rotten to the core and riddled with systemic sexism.
Gilead exiles Unwomen to “the Colonies”, areas both of agricultural production and of radioactive pollution. Medicine exiles us to a peculiar limbo where we are viewed with suspicion by the majority of men, as well as some of the women who choose to follow the rules. Our lifespan is uncertain. We are allowed to stay in the Colonies as long as we are able to reach the required level of clinical and academic productivity. Our work is made more difficult than that of a Martha, and we do it in a toxic environment in which our physical and mental health slowly declines. We are painfully aware that even if we don’t succumb to the unacceptably high levels of radiation, we are always just a few steps away from being sent to the Wall.
The Wall is reserved for those of us deemed resistant to correctional therapy in the form of “Professionalism” seminars, HR write-ups, and mansplaining about how we should be “more approachable” and “less intimidating”. Anyone who dares to call out the behavioral double standard, verbally or in writing, gets sent to the Wall. Question a high-up Commander’s leadership style? Yup, the Wall. Once we are hung from the Wall, we get labeled “troublemakers” and put on lists that deem us unhireable. We are railroaded out of academia and our voices silenced with the chilling and swift effectiveness of a noose around the neck.
As I meet another new class of interns, I wonder not only how many future Unwomen I am welcoming into the Colonies, but how to prepare them for the path ahead. I also wonder whether I am doing them a disservice by teaching them to speak up and call out the microaggressions, the double standards, and all the other sexist delights the House of Medicine has to offer. I have been thinking about this question for some time, and the best answer I can come up with is to be transparent. I will never lead someone blindfolded into the Colonies, but will welcome with open arms anyone who enters willingly. The more of us there are, the louder our collective voice. And realistically, they can’t send all of us to The Wall.
About the Author: Lisa Reynard is an Emergency Physician and faculty member who writes under a
pseudonym due to the very real threat of being canceled.
