So here you go. Enjoy.
The entry on Whatever immediately previous to this one makes this next Reader Request question all the more relevant. It’s from Sarah, who asks:
Why are you glad to have been born male? What do women get to do that you envy? I’ve really enjoyed your discussions of male privilege, so if you have more to say on the topic, I’d be thrilled to read it. That said, there are several ways you could address my question without touching upon privilege: peeing standing up vs. wearing skirts; freedom from menstrual cramps vs. gestating, birthing and nursing a baby, etc. etc.
Are you kidding? I’m glad to be male because no one fucking cares what I do with or to my body. And we’re not just talking about politicians and their nonsense, although they are the most obvious examples of this recently. I’m talking about everyone, in almost every circumstance. No one cares what I wear. No one cares what I weigh or what I eat. No one cares whether I brushed my hair or shaved when I came out of the house. No one cares that I’m having sex, or how much sex I’m having, or what I do with my body as a consequence of having sex. No one cares. And if they do care, they keep it to themselves because I’m a guy and it’s not their fucking business anyway.
And, you know, there’s all the other stuff too: Don’t have to deal with people sexually harassing me because I’m a guy, my chance of being raped or sexually assaulted is spectacularly low, I get paid more because I’m a guy and don’t even have to ask (and when I do ask to be paid more I’m not thought to be out of line), I get to express my opinion and not be classified as an mentally unreasonable person because of it, people default to listening to what I have to say, and so on.
I’ll just come right out and say it: being male is easy. Being male, white, educated, able-bodied, well-off and attracted to women? Shit, man. Easier still. It’s perfect for me, you know, because I’m lazy. All these unearned credits and passes and wave-offs from ridiculous shit are perfect for someone like me. Why would I want to be anything else? Anything else is work.
This is all, obviously, horribly unfair in my favor. I am not opposed to — indeed, actively encourage and work toward — things becoming less negatively unfair for everyone else. Unfortunately, this idea makes many people of my kind twitchy, I suppose because they assume that making things less unfair for everyone else means that things get worse for them. The idea that everyone having the same rights and privileges isn’t a zero-sum game where someone has to lose apparently doesn’t compute. It makes me sad that a class of people who have so many advantages can still be in aggregate that completely stupid.
What do I envy women? I don’t know that I envy women anything, short of the ability to give birth, and I’m not sure “envy” is the right word there, since the idea of growing another human in my body scares the crap out of me for all sorts of reasons. That said, I would like to know what it’s like to be a woman, because — for all the reasons noted above and lots of others that I have not touched on — I don’t really know what it’s like, and it means that despite my efforts toward empathy, there’s a lot I just don’t get. I wish there were a way for me to know, and while I’m at it, I wish there were a way for other men to know, too.
Actually, if I had a choice there, I’d rather some particular other men would spend time as a woman. I have a list. I don’t know if it would actually do any good. But in their cases, it certainly couldn’t hurt.
A friend of mine is a physician who wants to speak about transvaginal ultrasounds but whose position makes it precarious to speak publicly about it. So I’m letting this doctor borrow my site for an entry to speak anonymously on the matter. Obviously, I will vouch for the doctor being a doctor and being qualified to speak on the subject.
Update, 9:14pm: This post is being linked to far and wide, so we’re getting lots of new readers and commenters. It’s important that before you comment you read the site disclaimer and comment policy. I delete comments I find particularly stupid. Try not to write one of them.
Update: 12:13am, 3/21: I’m going to bed, so I turned off the comments for the night. I’ll turn them back on when I get up tomorrow. Night!
Update: 1pm, 3/21: As a head’s up to people, at 8pm eastern time tonight, I will turning off the comments for this thread permanently. The reason for this is while I can spend a day moderating the thread, I can’t spend the next week doing so. Sorry, folks, I have a book to write. So consider this fair notice. Thanks.
Update: 8pm, 3/21: Comment thread is now closed.
I’m speaking, of course, about the required-transvaginal-ultrasound thing that seems to be the flavor-of-the-month in politics.
I do not care what your personal politics are. I think we can all agree that my right to swing my fist ends where your face begins.
I do not feel that it is reactionary or even inaccurate to describe an unwanted, non-indicated transvaginal ultrasound as “rape”. If I insert ANY object into ANY orifice without informed consent, it is rape. And coercion of any kind negates consent, informed or otherwise.
In all of the discussion and all of the outrage and all of the Doonesbury comics, I find it interesting that we physicians are relatively silent.
After all, it’s our hands that will supposedly be used to insert medical equipment (tools of HEALING, for the sake of all that is good and holy) into the vaginas of coerced women.
Fellow physicians, once again we are being used as tools to screw people over. This time, it’s the politicians who want to use us to implement their morally reprehensible legislation. They want to use our ultrasound machines to invade women’s bodies, and they want our hands to be at the controls. Coerced and invaded women, you have a problem with that? Blame us evil doctors. We are such deliciously silent scapegoats.
It is our responsibility, as always, to protect our patients from things that would harm them. Therefore, as physicians, it is our duty to refuse to perform a medical procedure that is not medically indicated. Any medical procedure. Whatever the pseudo-justification.
It’s time for a little old-fashioned civil disobedience.
Here are a few steps we can take as physicians to protect our patients from legislation such as this.
1) Just don’t comply. No matter how much our autonomy as physicians has been eroded, we still have control of what our hands do and do not do with a transvaginal ultrasound wand. If this legislation is completely ignored by the people who are supposed to implement it, it will soon be worth less than the paper it is written on.
2) Reinforce patient autonomy. It does not matter what a politician says. A woman is in charge of determining what does and what does not go into her body. If she WANTS a transvaginal ultrasound, fine. If it’s medically indicated, fine… have that discussion with her. We have informed consent for a reason. If she has to be forced to get a transvaginal ultrasound through coercion or overly impassioned argument or implied threats of withdrawal of care, that is NOT FINE.
Our position is to recommend medically-indicated tests and treatments that have a favorable benefit-to-harm ratio… and it is up to the patient to decide what she will and will not allow. Period. Politicians do not have any role in this process. NO ONE has a role in this process but the patient and her physician. If anyone tries to get in the way of that, it is our duty to run interference.
3) If you are forced to document a non-indicated transvaginal ultrasound because of this legislation, document that the patient refused the procedure or that it was not medically indicated. (Because both of those are true.) Hell, document that you attempted but the patient kicked you in the nose, if you have to.
4) If you are forced to enter an image of the ultrasound itself into the patient chart, ultrasound the bedsheets and enter that picture with a comment of “poor acoustic window”. If you’re really gutsy, enter a comment of “poor acoustic window…plus, I’m not a rapist.” (I was going to propose repeatedly entering a single identical image in affected patient’s charts nationwide, as a recognizable visual protest…but I don’t have an ultrasound image that I own to the point that I could offer it for that purpose.)
5) Do anything else you can think of to protect your patients and the integrity of the medical profession. IN THAT ORDER. We already know how vulnerable patients can be; we invisibly protect them on a daily basis from all kinds of dangers inside and outside of the hospital. Their safety is our responsibility, and we practically kill ourselves to ensure it at all costs. But it’s also our responsibility to guard the practice of medicine from people who would hijack our tools of healing for their own political or monetary gain.
In recent years, we have been abject failures in this responsibility, and untold numbers of people have gleefully taken advantage of that. Silently allowing a politician to manipulate our medical decision-making for the purposes of an ideological goal erodes any tiny scrap of trust we might have left.
It comes down to this: When the community has failed a patient by voting an ideologue into office…When the ideologue has failed the patient by writing legislation in his own interest instead of in the patient’s…When the legislative system has failed the patient by allowing the legislation to be considered… When the government has failed the patient by allowing something like this to be signed into law… We as physicians cannot and must not fail our patients by ducking our heads and meekly doing as we’re told.
Because we are their last line of defense.
You never know what you’ll find when you go to the cafe down the street — that is, if you take Nick Harkaway’s word for it. His latest novel Angelmaker owes a debt to what he found in a cafe… and more importantly, what that found thing did when it met a delightful but dicey character rolling around in Harkaway’s head. Let’s get right into it, shall we?
Picture an English gent in middle age, round-faced and fleshy. Fix a glint of mischief in his eye and give him an almost soldierly bearing, for it’s true, he did enlist to serve his country, though life conspired – as he will tell you with some sorrow – to keep him from active service. At one stage, in an effort to repair this deficit, he stood as a candidate for parliament and was defeated only by a campaign of slander and slurs. He is an intimate of aristocrats and celebrities, of famous sportsmen and even of famous criminals, because in this year of Our Lord nineteen sixty something a mobster can still be a species of hero in London. The Krays, it’s widely known, keep crime off the streets. Banks may get robbed, but little old ladies can walk in safety down quiet residential lanes. This portly fellow lives in a world of corduroy and shag pile carpets, stuffy clubs in St James and swinging bars in Soho. He’s a regular at St Moritz. He’s a veritable man for all seasons. Just don’t invest your money with him.
His name is Ronnie Cornwell, and he was my father’s father: a con artist so fluently persuasive that at least two published autobiographies of well-known men make reference to being fleeced by him, and hotels around Europe lost fortunes to his charm. Ronnie could roll up at a grand establishment with an entourage of dozens and gull the manager into giving him an entire floor for his court, the best service and the best champagne, and a fortnight later they would vanish in a carefully choreographed magic trick leaving the Maître holding the tab. But that isn’t the clever bit. The clever bit is that six months later he’d be back and would somehow, against all reason, contrive to run the game again on the same people. He was never a gangster, though he knew them, but Ronnie was a genuine dyed in the wool crook – and not, in the end, a very nice man.
Fast forward to 2008: in a small café around the corner from my flat, I saw a broken clockwork toy skitter across a table and drop to the floor. To the child who owned it and to his mother, the toy was on its way out. It had gone from a plaything to a piece of rubbish, the weird, wiry spiderlegs twisted out of shape so that instead of walking it now bounced and juddered, pathetically syncopated and wayward. When they left, the toy stayed where it was.
To me, it was perfect. It was a machine which made you care about it; its very flaws were what made it special. Rowland Emett, whose kinetic sculptures were something like Rube Goldberg’s, once said that ordinary machines perform a function and therefore excite fear and loathing, whereas his creations performed no function of any use and thus excited only love. The skittering thing bounding gamely around on the floor felt like a kindred spirit, and I asked the waitress if I could take it home. In my mind it was already growing, becoming part of something larger, something huge and unexpected and weirdly 19th Century: a machine which could make the world better, not indirectly like a washing machine, but directly, by action upon the mind of mankind.
Ideas like that have been around for a while, products of the Enlightenment: better living through knowledge. The seductive idea of the Big Fix, the single solution which sorts out the world’s problems, keeps coming up. This year it’s quantum computing and biotech. A few decades ago it was industrial-scale agriculture to feed the world and Mutually Assured Destruction to save it. When you come to it, nothing quite pans out the way it’s supposed to.
Those two concepts – the crook and the machine – were zinging around in my brain, knocking over the furniture and throwing parties for all sorts of other little ideas which had been around for a while quietly awaiting their time: a fabulous, heavily-armed old woman, John Ruskin’s Arts & Crafts movement, mad monks and war elephants so on. But there was still a piece missing: the right villain. The wrong bad guy, or a bad guy who isn’t wrong enough, can kill a story stone dead. You can’t admire a hero who defeats a merely ordinary threat. For the hero to shine, you need an antagonist with real teeth.
All right. A gizmo which changes the world – a revolution machine, whatever the precise details of its function – is the territory of the high concept villain. Well and good, but I needed someone who would be scary rather than laughable. Where would such a man come from? Well, inevitably, from Britain’s imperial past. That’s where most of the real life enemies we deal with come from: old, bad choices. And there he was, waiting for me: a monologuing monster who understood that he risked being ridiculous if ever he failed to deliver on the promise of atrocity, and wasn’t going to. And all I had to do was let him loose.
So truthfully it wasn’t one big idea, it was more than that, all woven together – which is the cheat of writing, at least the way I do it: simple enough thoughts, produced one at a time, woven together until they look impossibly complex and spectacular. It’s like being a stand-up comedian, except that you get eighteen months to be funny that onetime, and as many redos as you like.
So… how does it all come out? Well, it turns out that machines which change the whole world all at once are maybe a little dangerous; that elephants are not universally good sailors; and that sometimes you have to be a crook to be a hero.