Consented, p.2
Consented, page 2
The city ER was an hour and a half away. I had always hated sending people to the ER. It felt like admitting I couldn’t take care of my own. As a country doctor, I took pride in keeping my patients out of the hospital and managing things myself.
Many doctors send their patients off without a call. Others, like me, always make one. I do it out of professional courtesy because charts get lost, notes go unread, and patients deserve to be backed by a physician’s voice before they’re judged. But every call is a gamble. And I never know how the person on the other end will respond.
After Katie and John left for the ER, I took a moment to see my waiting patients and organize my thoughts. Then I made the dreaded call.
“Eh-lo, Dr. Wilson,” the ER doctor answered. He sounded like he was in a hurry. He probably was.
“Hi, this is Dr. Zha from XXX Clinic. I’m sending you a patient with severe back pain and leg weakness.” I sat up straighter and lifted my chin. It was my version of a power pose.
Dr. Wilson gave a noncommittal “Mmm hmm.” Either he was clearing his throat, or that was my cue to begin. I forged ahead with my patient presentation.
Patient presentations are how doctors talk to each other. And they are high stakes. In just a few clipped, clinical sentences, we’re expected to summarize a human life: their current condition, medical history, physical findings, labs, and imaging results—before offering an assessment and plan. A good presentation helps ensure the patient lands in capable hands. A bad one can confuse the picture, delay care, or lead the team down the wrong path entirely.
But it’s not just about the patient. It’s also about us. A good presentation earns you respect. A bad one brands you incompetent. From the very beginning, we’re trained to follow a rigid formula, a ritual of reduction: “[Name] is a [age]-year-old [race] [sex/gender] with a history of [chronic disease 1] and [chronic disease 2], presenting with [key symptom or complaint].”
In medical school, we practiced this over and over, from the day we arrived until the day we graduated. English isn’t my first language. I’m not even a fast talker in Mandarin. But medicine trained me to speak supersonic English with an almost-vanished Chinese accent, cramming urgency, credibility, and clinical shorthand into ninety seconds flat. It had to be fast, focused, and fact-filled. There was no time for nuance and no space for emotion, especially for an immigrant woman of color like me. Touchy-feely doesn’t land well when you already sound like an outsider. Still, years of perfecting the format had made me confident. I knew how to give a tight, all-encompassing presentation . . . until recently.
A few months ago, I took my mother to meet her new doctor, Ron, who was my colleague and friend. Half-jokingly, I presented her the way I’d been trained:
“Ms. Wang is a sixty-five-year-old Mandarin-speaking Asian woman with a long-standing history of insulin-dependent diabetes, hypertension, and hyperlipidemia, presenting in clinic for establishing care.”
Ron looked confused, as if waiting for a punchline. Then I followed his gaze to my mother—bubbly, vibrant, thin, glowing a decade younger than her age. The woman on the exam table looked nothing like the version I had conjured with my clinical summary: a sickly, medicated person weighed down by disease. I wished I had started with something far more accurate: a former business owner, a national athlete, a fiercely independent woman in a patriarchal society. My amazing mother.
That was when it hit me. This format doesn’t describe a person. It describes a problem. It tells you nothing about who someone is, only what’s wrong with them. It flattens identity, erases vitality, and trains us to focus on pathology over humanity.
But when I called Dr. Wilson about Katie, I hadn’t realized any of that yet. I was still in efficiency mode, determined to get it “right.” So, I gave him my Ivy-League best, totally unaware that in a single sentence, I was about to give him everything he needed to dismiss my patient:
“Katie Garcia is a sixty-five-year-old Hispanic female with a history of diabetes and obesity who—”
“What’s her BMI?” he cut in.
Damn it. “Um . . . 46.”
“Hmm mmm.”
This wasn’t a Hmm mmm, I’m listening, tell me more. This was a Hmm mmm, fat people have back pain; what’s your point?
I had barely begun, and he had already reduced Katie to his own biases: a fat, older woman of color.
I had to reroute him. Fast. Before he could speak again, I launched into the rest of my presentation and unloaded everything I had rehearsed to make the case for Katie. Then I heard his muffled voice, speaking to someone else in the room:
“The outside provider is sending us a big, fat, drug seeker.”
Everything I had said, every bit of clinical insight, every data-driven decision, all my best efforts, dissolved in those few stigmatizing words. My heart slammed in my chest. Outside of medicine, I would have let him have it. But here, I swallowed the insult. Because beggars can’t be choosers.
“Dr. Wilson, I can assure you this patient is not a drug seeker. She needs an MRI and a neurosurgery consult, urgently. And I have neither here.”
He sighed. “Okay, we’ll look into it.”
“Wait—” But he had already hung up.
That’s it? No follow-up questions? No clarification? No explanation or apology after I called you out?
I imagined him rolling his eyes, griping about these “outside providers.”
Technically, outside provider is a neutral term. It refers to a clinician from a different facility. But in practice, it’s loaded. For example, when a smaller facility (the outside facility) transfers a patient to a larger one (the inside facility) for care they can’t provide, it’s not just a logistical exchange. It becomes a power dynamic. Ethically, if there is capacity, the larger facility should accept the transfer. But in reality, the inside provider grills, and the outside provider pleads. The assumption is clear: Outsiders are lesser, incompetent, and not one of us.
I used to be an inside provider. During residency at Mayo Clinic Health System–Franciscan Healthcare, a regional referral center, I was the one fielding calls like this. I grilled. I drilled. I judged.
Now I was tasting my own medicine. And I finally found out how bitter it could be.
A Nameless Monster
Five hours later, I called Katie for an update. I was nervous.
“Hi, Dr. Zha,” John answered, sounding defeated. “They sent Katie home.”
“What?” I asked, my stomach dropping. “What did Dr. Wilson say?”
John hesitated. I could hear Katie shushing him in the background.
“What did he say?” I pressed.
“He, um . . . said you didn’t know what you were doing . . . suggested maybe we should ask you about a psychiatry referral or weight-loss surgery. Katie got really upset when he said that. So, we left.”
No MRI. No consultation. Just an insult toward the patient and her doctor. And more Tylenol. I thought about calling Dr. Wilson back or writing a stern email to his administration. Then I laughed bitterly at myself. If I sent a letter every time someone dismissed me as an outside provider or as a woman in medicine, I’d never get home before dinner.
Here’s another secret: Each time my competence is so casually questioned, my identity as a physician cracks. After the initial cocktail of anger, disbelief, and humiliation, I have to slowly piece myself back together, rebuild my confidence, and remind myself who I am.
After hanging up, I found myself hunched over, breathing shallowly. This isn’t about you, I whispered. I forced myself to sit up straighter and reviewed Katie’s chart again. I consulted a few trusted colleagues, who offered good ideas. But ultimately, we all agreed: We needed more help. I had to send her back to the city ER. I hated the idea. It felt like patient abandonment, like giving up. And I dreaded speaking to Dr. Wilson again. But I had no choice.
It was nearly 10 p.m. the next day. I was standing in front of the bathroom mirror, still in my scrubs, about to wash my face, when my phone rang: unknown number. To my surprise (and dread), it was Dr. Wilson.
“Dr. Zha, um . . .” he began, his tone oddly hesitant.
My heart stopped. Was something wrong? His voice was polite, even soft—a sharp contrast to the brusque tone from our first call. Was it bad news?
He continued. “We got the MRI. There’s a good-sized soft tissue tumor near the nerve roots. We can’t operate here, so our neurosurgeon is arranging a transfer to a higher-level surgical center.” He sounded so . . . reasonable and patient. For a moment, I wondered if it was the same Dr. Wilson from before.
“But . . . is Katie okay?” I asked, almost afraid of the answer.
“Yes. She’s stable. And I just wanted to . . . ” he paused, voice even lower now, “thank you.”
Thank me? I echoed internally, stunned.
“For caring so much about this patient,” he said, his voice soft, as if he were the one speaking a foreign language.
Caring about this patient? It was surreal. This was the same doctor who had dismissed me, fat-shamed my patient, and implied we were both incompetent. Now he was thanking me for . . . caring? About my patient?
How dare you, I wanted to say.
“No, thank . . . YOU,” was what came out.
Yeah. Thank YOU for not caring, for not believing us, and for being a jerk. And thank YOU for making me doubt myself.
After we hung up, I stared at my reflection: eyebrows twisted, lips pursed, eyes wet. I barely recognized myself.
That call was a first. Inside doctors don’t call outside doctors late at night to say thank you, especially not ER docs. It had never happened to me before, and it hasn’t happened since. Did Katie and John demand he call me? If so, did that add to their emotional burden? Was this his version of an apology? Or did he finally realize what it meant to care?
More importantly, why was I crying?
Katie’s surgery went well. After rehab, she returned to walking daily with John. During those weeks in the hospital and inpatient rehab near Seattle, John checked into a hotel nearby to stay close.
“I wonder how Katie is doing,” someone on my team would say every now and then. We’d all nod, sending our silent well-wishes.
One day, my assistant spotted Katie’s name on my schedule: hospital follow-up. She was coming back! We cheered quietly. I could already hear her voice in my head: “Hi, Dr. Zhaaa!” I almost said aloud, I bet Dr. Wilson doesn’t care this much about her. But something stopped me. And I had a feeling that something was the strange tears I’d shed.
Something about the way we practice medicine, how we divide ourselves into sides, how we mistrust each other, and how we forget our shared purpose, felt deeply wrong. At the time, I didn’t have the language for it—only tears.
Katie’s story isn’t unique. If you are a woman, a person of color, in pain, disabled, fat, gender nonconforming, neurodivergent, older, chronically ill, not English-speaking, or any combination of the above, you probably know what it feels like to be powerless in the healthcare system.
And my part in the story isn’t unique, either. Anyone who has struggled with impostor syndrome, who’s been undermined or underestimated, knows that same powerlessness. And judging from Dr. Wilson’s tone that night, maybe no one in medicine is immune.
It’s as if we’re all trapped in a nightmare, fighting the same monster, just not together. Worse, we think we’re on opposite sides. We shout, but only at each other. We can feel something broken in our bones, but we don’t know how to fix it.
We don’t even know the monster’s name.
I, the Monster
I entered the nightmare seven years before I became the monster.
It was 2014. I was a third-year medical student in my early twenties, on my OB-GYN rotation. Like most medical students on their first clinical rotation, I was intimidated, unsure of myself, and invisible.
Perhaps that’s what I had in common with Susie, the nineteen-year-old patient I met that day. It was her first pregnancy. She’d been seeing Dr. Jones, my attending, since the beginning. And for some reason, she always came alone. Unlike the excited couples or extended families that typically crowded the OB waiting room, Susie was quiet. She never asked questions. As her belly grew, her silence deepened. I started to wonder if anyone in her life supported this pregnancy at all.
At her thirty-nine-week checkup, the nursing staff asked her to undress from the waist down and sit on the exam table, covered by a thin paper drape. They anticipated the doctor might want to check her cervix to see if she was close to going into labor.
“She’s okay with a cervical check?” Dr. Jones asked casually as he picked up the chart. I quietly trailed behind him.
“She didn’t say no?” a nurse replied with a shrug, her voice lifting like a question.
“Good enough,” Dr. Jones muttered.
When we entered the room, I searched for Susie’s eyes but couldn’t find them. She sat hunched, lips bitten, gaze fixed downward like a child afraid they were in trouble. I wanted to hug her and tell her it was going to be okay, but I didn’t know what was about to happen. And even if I had, I wasn’t empowered to say anything. My fingers curled tighter around the hem of my short white coat, the uniform of a bottom dweller. Short-coated medical students weren’t meant to be heard or invited to intervene, only to observe.
“Ready for a cervical check?” Dr. Jones asked Susie, already pulling on sterile gloves. Susie nodded obediently.
“Okay. Lay down, feet together, knees bent, open your legs.”
The commands came like rapid-firing bullets. I wanted to yell, Slow down! but no words came out. Snap, snap. The gloves went on. The paper on the table rustled. Dr. Jones spun in his rolling stool toward Susie. He finally looked at her for the first time and found her still sitting upright, frozen. He tilted his head, as if to ask, Well?
Susie obeyed. She lay back, brought her feet together, bent her knees. The paper drape tore open as she parted her legs, making a sharp popping sound. Her cheeks flushed. So did mine. When Dr. Jones touched her, Susie’s knees began to close. Without pause, he wedged his left forearm between them, his hand pushing down her left knee and his elbow pinning the right. The movement seemed second-nature to him.
“RELAX your legs,” he said, fingers pressing in deeper.
“Ouch! Stop!”
At first, I thought the low-volume cry came from me. But it was Susie. I hadn’t been watching her face or observing Dr. Jones’s hand. My eyes were glued to the crinkled paper on the table, as if my tight grip on my coat was somehow responsible for the sound the paper made.
“Almost done,” Dr. Jones announced, his forearm still pushing down her legs.
Susie said nothing. Neither did I.
The short distance between the exam table and where I stood divided two realities. In Dr. Jones’s reality, Susie was a body attached to a task at hand, whose consent had been fully surrendered once the task was started. “Stop!” didn’t mean the withdrawal of consent but rather a cue to finish the task faster. It was a reality where denying a doctor access to one’s body was unthinkable and absurd. And when my short coat grew long, would my own reality—where bodily autonomy was sacred—disappear? Would I disappear?
The exam may have been “almost done,” but for me, the nightmare had just begun.
As we walked out of the patient’s room, Dr. Jones peeled off his gloves and tossed them in the trash. He turned to me and said, “Well, if she had kept her legs closed nine months ago, we wouldn’t have been here today. Right, Zed?”
Sometimes I replay that moment and imagine the perfect comeback: something sharp, feminist, devastating. But all I said was, “Right.”
Right.
Back in 2014, as a disempowered medical student, a new immigrant, and a young woman, I was horrified to witness what happened to Susie. I felt ashamed. All I could do was vow silently: I will NEVER become like Dr. Jones.
Yet less than a decade later, I did.
A few months after Katie’s surgery, a twenty-one-year-old woman came in for her first Pap smear. Just by the way she sat—legs crossed tightly, fingers clutching the paper drape—I could tell she’d been dreading it. But for me, it was just another day: thirty-two patients scheduled over a ten-hour shift. One person in labor at the hospital. Calls, notes, students, nurses, precepting, paging, and an endless stream of next tasks.
I introduced myself, explained the procedure, and showed her the speculum. “I’ll say what I’m about to do before I do anything, okay?” I told her. She nodded.
I put on gloves, applied lubricant, and touched her thigh. “This is my hand,” I said gently. We’re trained to do this to “ease” the body into the moment before the instrument enters. Most people respond well to this “nice touch” technique. But her whole body jolted.
Oh boy, I thought. This is going to be a long visit.
As expected, when I inserted the speculum, she tensed immediately. Her pelvis lifted from the table, everything clenched. It was nearly impossible to advance the instrument.
“Just relax your butt into the bed,” I said automatically.
She softened slightly. I took the opportunity to move the speculum forward. She tensed again. I considered stopping or slowing down. But then I glanced at the corner of my computer screen: forty-seven clinical tasks still undone, and anything over twenty gave me heart palpitations. My Apple Watch buzzed with a possible call from the hospital; I might have to deliver a baby soon. Footsteps passed by the door, and I imagined my assistant knocking: Doctor, your next patient is getting impatient. I shook my head and advanced the speculum.
After the exam, I walked out feeling unsettled. But I was too busy to sit with it. My assistant followed me down the hall toward the next patient’s room. Instinctively, I asked:
“Was she consented before the procedure?”
“Yes,” she confirmed.
I let out a sigh of relief as I reached for the next chart. And then I heard myself say, with a strange chuckle, “Well then . . . why did she act like we just raped her or something? It couldn’t have hurt that bad, right?”
