We Do Not Deserve Hospitals

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On a night in my early teens, I went to the Pediatric Emergency Department at Montefiore’s Children’s Hospital for intense cramps. I was expecting my period in a few days, but had never felt that way before — like a heat lamp was burning into the meat of my pelvis.

My mother and I spent the better part of nine hours in a tiny room with speckled vinyl floors and too-bright fluorescent lights. At one point, I was sent to another room nearby that was a little larger and had no extra chairs. My mother was told to stand outside the room and wait because the doctor would be asking me about matters that required privacy. A nurse told me to undress from the waist down and wait for the doctor.

My doctor came in and asked me — in a few different ways — if I’d ever been “penetrated.” I had not and said so — repeatedly. She referenced the development of my body, implied the crudeness of the boys around me. It was an unsaid question, but one that still required an answer. “No,” I said. “I’ve never put anything in there.” She said, “If you say so,” before telling me to lay down, scoot my butt toward the end of the examination table, and spread my legs so she could “take a look.”

I didn’t know what that meant, but she was the doctor, so I did what she told me to do.

Have you ever screamed “no!” and “stop!” at the top of your lungs while being penetrated by an unidentified object that scraped at your most intimate insides? Have you ever been told to “be still” and “hold on” like your pain was the most mundane thing that had ever happened? Have you ever heard a doctor say “wow, you really weren’t lying!” as your “please, stop” got swallowed by the sharp snapping of a speculum? Have you ever redressed yourself afterward with shaky hands and legs and raucously laughed about it to your mom who was just a few feet away getting a cup of water when she heard the tail end of your screams? Has a nurse ever asked, “What did you think was gonna happen?” while you bled onto a nondescript menstrual pad from the hospital’s supplies?

I was sent home with instructions to take Motrin and “stay out of trouble.” My mother and I rode the bus while she angrily pondered whether I was still a “virgin.” I wrapped my arms around my middle and tried to protect something that felt like pierced cellophane. The tests for STIs came back clean.

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In stowing this and other difficult memories away, I deluded myself into thinking that I first became interested in health when my mom was diagnosed with cancer — a cliche that I complied with for too long for the sake of admissions committees and the comfort that comes with being a cliche. I told myself that I enjoyed taking care of others, that I liked the intricacies of the icky, sticky bits we hide on our insides. I told myself that I wanted to be a medical doctor, first, and a public health professional, later, because I wanted to make sense of what made some people healthy and what made others sick.

These are all lies. I wanted to become a doctor because the fat girl I was had not been safe in a hospital. I would give anything to drape myself over her. I am different now — strong, dependable. I could take it. I could fight for her.

Then I wanted to be in public health because I wanted to change her environment so she wouldn’t have to go to the hospital in the first place. If I could change enough in the world around her, I could keep her safe.

I am still here — a year into a public health program that feels too small for me — because I do not want there to be hospitals.

We do not deserve hospitals.

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I know some of you cannot imagine what I mean by “we do not deserve hospitals.” Many will read this and not be convinced. But I do not care to appeal to your sense of what is possible and what is necessary. I am not writing to convince or persuade.

I am writing to dream, to manifest.

Not long ago, I was like you. A few months ago, I was working on a Health Communication class project. Research shows health care providers hold both implicit and explicit negative attitudes about fatness and fat people. Fat stigma perpetuated by physicians results in a host of consequences for fat patients, who receive less patient-centered care, less health education and direct communication, and other kinds of harmful and superfluous treatment that forces less engagement with care services. The goal with my project was to set the foundation for a program that I could eventually bring to providers to train them to be less stigmatizing to fat people. It would be a bandage on an ugly wound, I thought, but a bandage that could potentially save lives.

My work involved interviews with a few primary care providers to get a better sense of their professional values, priorities, and experiences. I needed to understand the factors that could facilitate or hamper a campaign intended to target fatphobic care provided to fat patients in large, public Northeastern hospitals.

As a visibly fat person, I let my thin male project partner handle the interviews using a protocol I developed. I wanted the providers to be open during the interviews and felt that may be compromised by my presence. Here is an excerpt from the interviews:

Time constraints are the biggest individual cost to changing provider care practices. Professionals are managing “unmanageable workloads,” working too long hours, seeing too many patients, and placing too many orders to think about adopting new clinical practices. Systemic challenges to adopting new practices involve the complexity of the health care system, such as complicated medical billing, prescription routes, and variations across insurance companies…
The push to maximize medical reimbursement or maintain federal funding through measuring certain vital signs such as weight contributes to the stigmatization of higher-weight patients. In this way, adopting less stigmatizing policies can have monetary costs for organizations and personal costs for medical providers.

I have not yet become numb to hearing or reading my humanity posed as an inconvenience or a “new clinical practice” or a “cost.” But these are the realities of hospitals and of medicine. Destigmatized treatment in health care is an extracurricular. Those who are already vulnerable in the grips of historically harmful health institutions have more than just recovery and monetary costs to contend with when they decide to go to a provider for a health concern.

Amber Isaac tweeted about the poor health care she received from Montefiore Medical Center doctors four days before dying during childbirth in one of their facilities. Joyce Echaquan filmed her death while she writhed in pain in a Quebec hospital and was told she was stupid, only good for sex, and better off dead by hospital staff. Michael Hickson’s Covid-19-related treatment was terminated by St. David’s South Austin Medical Center, who decided his disabilities meant he had a low quality of life and a life less worthy of being saved.

These stories often feel like the ugliest of what hospitals have to offer. But they’re not. They represent the regular, mundane harm that happens around sterile walls. They are the tips of the metaphorical icebergs. There is patient dumping. Coercion. Race-based medicine. Care-denying fatphobia. “Trans broken arm syndrome.” Neglect of patients who don’t speak English.

There is too much violence for there not to be blood.

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I initially believed in that class project and its capacity to make change. I planned to look for funding and collaborators that would help me implement a series of workshops on fatphobia and weight neutrality for providers in real hospital settings. I thought I could change violence in hospitals with education and endless grace and backflips through federal mandates and making space for humanity within a system that has literally priced human survival. I was wrong.

My dreams are different now. My vision for change doesn’t start in the hospital. It doesn’t even include a hospital. It starts further away in a place where the smell of antiseptic doesn’t reach. In this place, I feel safe laying on my back with my knees up. I don’t worry about being pried apart or perforated. When my legs feel weak, there is something to hold me steady. No one will pose my pain as a certainty.

Perhaps, in a place further than my dreams stretch, there will be a place for the hospital again. It will have a new name and doctors who look like me. They will not think to make the choice between my humanity and their well-being. They will not be suspended in a timeless, dayless space consumed by whiteness. They will step out and see the sun and home. No one will die before their time.

But until that time comes, we do not deserve hospitals. We deserve more.

First published on Human Parts.