Otherness in the ICU

By Dr Tahiya Amin


Tahiya Amin is the trainee representative for Women in Intensive Care and is currently working in NSW

 

Being a woman of colour from an obvious minority background is hard work. In a climate where Muslim women are endlessly politicised, it always has been. But enter the milieu of medical training and it certainly does not get any easier.


Even if the comments are few and far between, a lifelong accumulation of strange looks and vaguely insulting comments will inevitably get to you. Sprinkle in a "Your English is so good", with a "When is the doctor coming to see me?" and that will do the trick. Being the only person in a group to be asked to show ID when entering the hospital will do wonders for your sense of self worth. There are always the vibrant workplace conversations about the pros and cons of the Afghanistan war, or the nuances around Muslim migration to look forward to.


The good news is, that you do develop an increasingly thicker skin. To give myself credit, I know this to be true for myself. For all the things I will ever complain to a sympathetic ear about, there are many more that I sweep under the carpet and make a dedicated effort to ignore. But despite the thicker skin, there comes a certain fragility, an inevitable point where teeny tiny microaggressions begin to accumulate and wear down your defenses. The usual nerves and doubts of being a junior trainee can be compounded by a real sense of otherness.


I imagine it is the same for our patients. If I, as a trainee, feel the lack of representation and diversity amongst female intensivists, surely my patients would note the same. While reviewing a COVID positive patient on the ward recently, I was startled when the woman grabbed my hand and squeezed it tightly. While I hadn’t even realised the patient was of Muslim faith, she was incredibly excited, remarking through broken English that she had never been cared for a Muslim female physician before. As I left the room, I asked if there was anything else I could do to help. She asked if I could call her family and update them. I asked if the ward team had done so, and she remarked that their reviews were often short as her English was poor, so she had not asked them. Familiarity confers safety and a sense of belonging.


The feeling of otherness can be isolating. It is easy enough for supervisors and mentors to tell you to keep your head up and rise above any antagonism. While well intended, this unfortunately ignores the reality that the way people view you inevitably affects how you view yourself. This also ignores the fact that many women of colour have almost always encountered a lifetime of microaggressions, and likely do not need the same in the workplace. When an ED colleague belligerently told me I was being “too big for my boots” and “obviously didn’t know what I was talking about” while I relayed a plan from my consultant, I was upset. I was upset anyone would talk to a colleague in that manner, and then felt upset I was feeling upset. Shouldn’t I be able to rise above all of this and not get emotional? Wasn’t I stronger than that? It was an enormous relief when a friend reminded me that this male, Caucasian registrar had likely never been spoken to (read: yelled at) in this way before. It was unlikely anyone had ever challenged him in the ways that I was challenged so regularly. I was entitled to be upset, and the last thing I needed to do was give myself further grief for feeling how I did.


And really, the very best thing I’ve found throughout training has been a strong support network of women. Some of these women are in training in other specialties entirely, or are passing through ICU from other departments. Some of these women are also visibly Muslim, wearing hijabs in the workplace. Across the board, they represent a sympathetic and understanding ear, endlessly supportive and willing to listen. These support networks can foster a real sense of shared resilience and pride, recognising that the achievements of others comes despite a multitude of challenges. Beyond the serious stuff, laughing and venting about all the stupid things people may say or do is real chicken soup for the soul. When a colleague asked if I wore my headscarf in the shower (note: a very weird question), my friends and I laughed about it for ten minutes.


One of the things I am very keen to see change in ICU is how few women there are in the specialty. While I meet many female trainees, it is still an incredibly masculine space. Particularly, there seems a paucity of women of colour, and more so, women of colour who look like me. I remember as a kid entering an unfamiliar space, and immediately scanning the room. Another minority figure, and a sense of ease would pass over me. It feels like a similar story in the ICU world. To meet female intensivists is always exciting, but to meet female intensivists of colour, even more so. This may particularly present as an issue in smaller units, where female trainees may find difficulty in finding female mentorship and senior support.


In fact, one of the reasons I was excited to join WIN as a trainee representative was as part of an effort to network and meet female trainees and intensivists from a variety of backgrounds. While I’m still finding my place in the network, it has been wonderful to meet like-minded women with their own unique stories and experiences. I hope that diverse voices and perspectives are always welcome and useful, and hope to contribute towards an ICU community that is more representative of the community it serves.




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