The medical ward is often continuous with the world around it. One would like to think of it as an insulated space, because of the role it plays in keeping disease out. But social prejudices and apprehensions we carry do not stop at the threshold. Neither can they be wiped clean with an antiseptic. They seep into the clinic with the medical staff, with the patients, with visitors. The clinic then is another space where the body must renegotiate its identity and its sense of control over itself. But who exactly owns this body in the medical ward and who takes responsibility for it? Infirmity often dictates that patients resign some or all of the control, and trust it to another person. The caretaker is then expected to treat that body with dignity. But does the caretaker know that the body’s gender identity, its gender experiences and sexuality are integral to this thing we call ‘dignity,’ even if the disease itself has little to do with sexual or reproductive health? Do they know that gender is constantly negotiated in the way a person’s body is viewed, spoken to and touched?

Recently, Scroll carried an article about the physical and emotional abuse of women in labour rooms. Doctors expect female patients to bear the pain that comes with natural delivery, hit them and scold them if they are unable to put up with it. This is not an uncommon sight across the country, and so the author of that article wonders if this is the result of the rapid shift of deliveries from homes to hospitals. However, that shift is the new reality. Hospitals are quickly turning into the most preferred sites of medical intervention. As more patients come to the hospitals we are fast becoming aware that social prejudices and gender assumptions seep into these spaces as well. After all doctors are cut from the same cloth as the society in which they practice, and very often, cultural discomforts guide the medical eye.

It is challenging to ensure that social prejudices stay out, while social histories and narratives remain relevant in order to provide holistic health care. The sooner we recognise the need for doctors and health care professionals to be aware of gender and sexuality – not as yet another chapter in a textbook – but as identities they too negotiate, then we will perhaps create spaces that feel safer and concentrate on ‘care.’

I have fished out a few stories from my years as a medical student to unpack the negotiations of a gendered body in the medical ward. Patients are not the only ones with bodies. Doctors have them too, and so do the doctors in training. As these many bodies interact for the sole purpose of treating illness, there are gendered transactions between all of them. These are not stories of what went right or wrong, but stories of how cultural discomfort about the gendered nature of bodies shapes the way bodies are viewed or treated in the clinic.

‘Boys, to my right.’

The Head of the Department of Anatomy made something clear on the very first day of college – boys and girls would not sit next to each other or work with each other in her department. “You are here to study, not for distractions,” we were told.

Medical education begins with anatomy. With a scalpel one slowly takes the human body apart. Male bodies. Female bodies. Skin, fascia, muscle, ligament, tendon, cartilage, bone, organ, reproductive (and well, sex) organs. While working on a cadaver, the body is a person no more; it is an object of curiosity. A machine with no mind.

But that is also why male and female students have to also be kept apart. They have minds. And minds think. They think attraction, love, sex. Then they make bodies do ‘things.’

So that was our introduction to sex and gender:

Sex – two in number; determined biologically, based on the anatomical organs.

Gender – what is that?

Sexuality – heterosexual attraction, also called distraction.

Incidentally, we also learned physiology that year. There was an excellent chapter in the textbook (Guyton-Hall) on how nerves respond to sexual stimuli, and how they produce what we experience as ‘pleasure.’ There was a brilliant subchapter on the female orgasm. We skipped it. But the male professor who taught the class on the ‘reproductive system’ did crack a ‘non-veg joke,’ about a woman in a coffin, and her many lovers, who were surprised to see that her legs weren’t always wide apart. So desexualised was our training in anatomy, that only a handful of people got the joke – in fact, a friend asked me if the men were her gynaecologists!

‘Specimen Of A Homosexual’

We learned to take medical histories as second year students, and one morning we were ushered into the outpatient clinic for people suffering from venereal diseases. An assistant professor promised to demonstrate the history-taking skill to us and asked us to gather around an examination table, on which sat a man in his twenties. He was not comfortable with 15 people peering at him, but he was told that his discomfort was necessary for the future of medicine.

After a few questions, I was sure the assistant professor figured out what the man suffered from. His eyes twinkled as he turned around and asked us if we knew what the diagnosis was. We knew the list of venereal diseases by heart, and so one by one we called them out. The patient at this point grew extremely anxious and started to shake profusely, and asked if he had all of these illnesses. The professor looked at his anxiety and perked up. In English, he told us that he thought that the man had ‘something wrong’ to hide. Then turning around he asked the man if he had had sex with a man.

As it turned out, the patient was homosexual. He had been with women – sex workers – a few times, but more recently he was in a relationship with a man. Then he began to cry and say how sorry he was. He said he could not control how he felt, and asked if he had been punished for it with HIV.

Somehow the trembling man was visible only to a few. The professor was not one of them. Happy to have elicited a ‘complete’ sexual history, secrets included, he turned around and said, “This is the specimen of a homosexual. You are lucky to see one on your first day in this department.” I am still not sure what we were supposed to ‘see’ suddenly. We had been looking at him – thirty eyes on one man – for a while. How did a little revelation about his sexuality change the body on the examination table? How did it make it any more an object of curiosity than it already was?

Incidentally, the man did not have HIV. He had another very curable venereal disease. He needed treatment, not advice on his sexuality. But that is what he got, along with a prescription. It was free advice, so it was copious, but the message was clear: it was ‘unhealthy’ for a man to sleep with a man. It was ignorance.

FYI, we never spoke about women having sex with women. Male professors usually laughed at the idea of women trying to ‘do it without a man’. There was a small paragraph in our Forensic textbook, in the chapter on Section 377, and even the book sounded incredulous that women could orgasm without a penis. But orgasm or not, it was criminal and it was unhealthy. But that is forensic medicine – the intersection of what is legal and what is healthy – there is no room for pleasure. But there is a subtext: pleasure is a risk you run. If unlucky, your body could end up a specimen on an examination table with a biased professor on the other end.

‘She should have died.’

I was in my third year and was watching doctors perform caesarians, when a woman was rushed in from the labour ward. “Obstructive labour,” we were told. What was obstructing the labour, no one knew. The surgery was performed immediately, and out came a baby with a huge lump (the size of an adult’s closed fist) on its neck. It was a girl.

A paediatrician was called, and was asked to examine the lump. He diagnosed it to be harmless. Once removed it would stop bothering her. No repercussions. It was a time to be happy. But then an anaesthetist asked if the removal would leave a scar.

Paediatrician: Yes, but it will be nothing but a scratch on her skin by the time she grows up.”
Anaesthetist: But it is a girl. A scar will spoil her life. Who will want to marry a girl with a scar? She should have died.

The absurdity of that comment in the theatre made many people uncomfortable and the paediatrician did not like the comment about death. Still, few people contested the premise about marriage.

‘I don’t want female doctors.’

This is a short one.

The patient was male and he needed surgery in the scrotal area. He refused to be examined by female doctors. But it created some confusion in the wards. Did men care about such things too? What were they afraid of?

Obviously, he got what he wanted. But the confusions are worth mulling over. What are men afraid of? The corollary: do we take it for granted then that women are afraid of something?

‘I did not tell my husband’

A lot of women do not like to tell their husbands about their decisions to terminate a pregnancy. They have their reasons for it. And the MTP Act, setting the parameters for abortion in India, does not require that their husbands consent to the procedure. But not all doctors know that. Many of them ask the women to come back with their husbands, sending women then on a search for another doctor or sometimes forcing them to undergo unsafe abortions.

However, sometimes doctors get it absolutely right. I was intern under Dr. X in the family planning unit, when I met a woman who wanted to terminate her pregnancy, and did not want her husband to know about it. They hadn’t had children for long years, during which on his insistence she underwent infertility treatment. She was told the treatment had failed and so she adopted two children. Suddenly, she became pregnant with twins. She was now afraid that her husband would send the adopted children back to the orphanage in order to raise the biological children.

So here is what Dr. X did. She asked her no questions, and gave her exactly what she wanted. The woman asked also that her tubes be tied. She did that as well. I learned from her that the clinic is sometimes a subversive space and that women can use medicine to gain some control over their lives. Here is what Dr. X taught us: doctors can help in that kind of subversion if they more cued into social realities.

 ‘Women Drink.’

Another patient shocked the doctors when she walked in with alcoholic liver cirrhosis. It was not an uncommon diagnosis in the male wards. But did women drink that much? Correction. Did Indian women drink that much? This was not a woman whose addiction could be blamed on ‘westernization.’ She came from a village.

Initially, everyone looked for a reason – was she abused? Did her husband force her? Did she suffer from a mental disorder?“ No, I like to drink,” she said.

She started to drink with her husband, a little everyday after work. But then she started drinking more frequently and as time went on she developed an addiction. She had been in and out of hospitals, and she was used to being judged for it. But she was quite nonchalant about it. She knew she had a problem, but she did not think being female was part of it. Neither did her daughter, who was her caregiver. The woman’s relationship with her son was strained; he was embarrassed that his ‘mother’ (let me say female parent) was addicted to alcohol. “Women drink,” she said during one of our conversations before she was discharged. “That’s not the problem. I just did not know when to stop.”

I wish more doctors saw it her way.

Pic Source: cartoonstock.com