Welcome to this week's edition of Dear Dr. Horton. Send the anonymous questions that keep you up at night to a real former Dean of Medical Student Affairs, Dr. Jillian Horton, and get the perspective you need with no fear of judgment. Submit your questions anonymously through this form, and if your question is appropriate for the column, expect an answer within a few weeks!
Dear Dr. Horton,
Over the past month, much of what is occurring in our political and social climate has been serving as a constant reminder of inappropriate behaviours/sexual harassment I've experienced as both a patient and a medical learner.
Do you have any advice in navigating these feelings?
This is one of the hardest things about medicine. Physically, it unfolds at the hospital but psychologically, it unfolds in your living room. You deal with people experiencing trauma and loss; meanwhile, you are a person with your own trauma and loss. Every time you are in a setting that reminds you of that trauma and loss, you experience more trauma and more loss, and can feel totally helpless in a case like yours until two things happen.
The first thing is you have to find a way to viscerally, unequivocally understand that none of the things you are referring to are your fault.
One particular experience with a student helped me understand this.
This wonderful young woman had been assaulted on one of her clerkship rotations. Fortunately, her physical injuries were relatively mild. But her sense of trust and safety at work had been totally disrupted. She came to see me for advice about moving forward.
She started by telling me what had happened. She told me about the room, where she had been sitting, how she had tried to control the situation, and how the patient had positioned himself relative to her and the door. As she talked, I felt a sense of impending doom.
Why? Because I could see where this was going. She hadn’t done a single thing wrong and had in fact done exactly what I would have done earlier in my life. But I could hear the subtle signs of danger in her narrative because I had learned them over years… over tens of thousands of interactions with people, most of which were good, a few of which were creepy, and a few of which were truly terrible and led to the same kind of experiences as hers... and yours.
I had almost twice the number of years in my life as this student to accumulate a visceral understanding of those warning signals. And as I listened to her story, the only reason I knew what was coming was that I’d had an entire adult lifetime to learn what was coming.
That day, in that moment, I had a very profound realization: she couldn’t have known. There wasn’t anything she could possibly have done to really know. It was terrible, horrendous luck that she was assaulted by that patient, and better orientation might not have been enough. Because she could not have known.
As I listened to her that day, I felt a huge rush of compassion not just for her but for all of us. I had fresh, immediate, profound insight into the fact that some things are and will always be true. One of those things is that good people who expect others to observe the normal rules of human decency will never be capable of fully anticipating the behaviour of human beings who don’t observe those rules. Never, ever capable.
You couldn’t have known, Demoralized. You really could not have known. But one of the many, many injustices when these things happen to you is that instead of the person who does these things being ashamed, you are the one who leaves feeling helpless, ashamed, and embarrassed. Navigating the feelings associated with these experiences really means that you have to work towards believing and then knowing in your heart that you couldn’t have known, either. And because you couldn’t have known, it is not your fault.
Earlier this year, following the wrenching testimony of Dr. Christine Blasey Ford and the confirmation of the Supreme Court justice she had accused of sexually assaulting her, I watched Mitch McConnell say with a little wave of his hand, “These things always blow over.”
I thought to myself: what “things” does he mean? Because the things that so many women have been talking about these last few months don’t blow over, not at all. They often leave long, cryptic shadows that can wreck all the furniture in your psychological living room for the rest of your life if they aren't brought into the light. This requires time, and a significant amount of work… work you will feel like you don’t have time for because your life in medicine already feels unmanageable.
But that is the second thing that will help you navigate these feelings: bringing them into the light.
How can you begin?
You just did.
Note: The student has given her consent for this story to be told.
Dr. Jillian Horton is a graduate of McMaster Medical School and completed her residency and fellowship in general internal medicine at the University of Toronto in 2004. She was the Associate Dean of Undergraduate Student Affairs at the University of Manitoba from 2014–2018 and now directs programs in wellness and medical humanities at the Max Rady College of Medicine. She has won awards for mentorship, professionalism, and teaching at the undergraduate level. She is also a mother, musician, and writer. As an Associate Dean, she cared so much about undergraduate students because she never forgot what it felt like to be one of them.