This is part of the Medical Humanities series on Op-Med, which showcases creative work by our members.
A Promising Young Man
Editor’s Note: The following article contains depictions of sexual assault and physical abuse.
The worst happens in the small hours of my nights as I unsuccessfully try to sleep. In these moments, I frenetically turn each injustice over in my mind, until my mind is a whirl of angry colors and my heart is pounding too quickly. It is midnight.
With each memory, I feel the rising tide of several emotions. Shame. Fear. Sadness. Rage.
Morning rounds. I am sipping coffee and battling countertransference, my regular adversary, as the team discusses my patient, the present object of my countertransference.
“So nice to work with, such a nice guy,” someone says about him.
Eight years in federal prison.
“He was really embarrassed about it. It’s not something he likes to talk about, but he opened up to me about it yesterday.”
Aggravated rape of a minor.
“He says he had a threesome with her and didn’t realize how old she was. He was probably high out of his mind.”
Murmurs of assent. “Probably had no idea what he was doing.” “Poor guy.”
Convicted. Sex offender registry. My attending’s warning to me: “Try not to be alone with him.”
“Why was she there in that bar, anyway?”
“This is why I tell my sons, ‘You meet a girl in a bar, make her prove her age. You gotta make them take out that ID and prove their age before you take them home, or you could end up in the same nightmare.’”
I swallow my bitterness and my cold coffee as the team scrutinizes the underage rape victim that we do not know with a far more critical eye than it ever turns to the man who has been convicted of her rape in a court of law.
It is two in the morning now.
A new unpleasant memory washes over me. Morning rounds. Different unit, same theme.
“Liz says she’s annoyed by the guys following her around. Apparently, Joe tried to touch her.”
“Oh please. If she doesn’t like them, why does she keep coming out of her room and going to the common area?”
“Right? And swinging that long hair around, she knows what she’s doing.”
“I think she just likes the attention.”
It does not escape my notice that the offending male patients never receive the same scathing censure that the team reserves for Liz.
Frustrated that the memories are stealing my sleep, I angrily pummel my pillow.
Three in the morning, another. A friend, Kelly, recounts an assault by a former partner.
“He punched me in my head twice. Knocked me down to the ground. I got up to try to fight him off, and he put me right back down. I had a concussion and contusions.” She lightly touches her head.
“Because there was a physical assault, by law, he had to be arrested. But it took the police two weeks. One of the detectives said to me, ‘Do you realize that he could lose his livelihood over this?’ He shamed me. I felt victimized again. I felt violated. I couldn’t believe I was talked to like that by an institution I was supposed to trust.”
I study her indignant countenance while sucking on an alcoholic strawberry from my drink. The memory of a taste, vodka and strawberries, sweet and biting, forever associated with the pain of her helplessness.
Another painful memory that I cannot suppress. A letter. After months of staying quiet, I begin to disclose details of my abuse at his hands, of his sexual misconduct, of my pain, of his cruelty. There is a catharsis in finally sharing my ugly secret and I revel in it. Here I am, everyone. Scarred, imperfect, damaged. Do your worst. You cannot possibly do more to me than he has done.
My abuser, I suspect, preferred me when I was quiet.
And The Institution is less than thrilled by my new voice. Although I have violated no institutional policy or law by relating my experience, The Institution sends me a warning:
“I did just want to caution you, though, that there can be a line that is crossed that may put you in a difficult situation. If you are communicating about his prior activities and it impedes his ability to continue in his education or to [be employed], that could be problematic. I would never tell [you]…not to confide in friends and family, but I would advise you to take care on what is shared publicly or might be reported to a future employer.”
I was wrong, this is worse.
Why is it that when a woman is violated, our institutions’ first response is to discredit or to silence her? In the hospital. In a police precinct. At our workplaces.
Why is it…
The underage rape victim’s responsibility to prove her age?
The female patient’s responsibility to avoid sexual harassment in the psychiatry unit?
Kelly’s responsibility to safeguard her abuser’s career?
My responsibility to protect my abuser’s employability?
Why do our institutions value his reputation more than our lives?
What hope do I have? The world will always find something wrong with me and with women like me, and will always make excuses for him. Will always give multiple chances to him, while discarding the women like me.
What is there for me after this? I am utterly broken and alone.
I will start my psychiatry residency soon. Perhaps I will meet a severely antisocial inpatient and fall madly in love with him. Break him out of the unit. Resort to an acrobatic life of crime with him. Kidnap Batman. Find myself in a relationship much like my last. Leave him. Destroy a factory. Adopt two hyenas.
I make myself laugh a little with my absurd musings, and then I dissolve into tears once more.
If she ever retaliated after years of abuse and fed that Mistah J to her hyenas, I have no doubt that the world would have condemned her and mourned the loss of another promising young man.
I’ve gone insane.
It is six in the morning. The sun is rising and I have lost yet another night of sleep to the memories that relentlessly assault my mind, no matter how much I try to forget. I pull my blanket over my head and sheer exhaustion finally accomplishes what I could not. As I fade into blissful oblivion, I wonder how long it will be before madness finally swallows me whole.
An Interview with the Author
How does this piece relate to your previously published piece, “The Man Who Mistook His Wife for a Doormat"?
A couple of things stood out to me during the intimate discussions with colleagues that have been taking place over the last few months in response to my earlier piece. The first is that, while kindly wishing me well, some people seemed to be under the impression that I found peace and that writing about the experience was bravery on my part. The truth is that I do not feel brave, and while I would say I’m doing much better today than I was in the months after leaving that situation, there are days when I struggle, and the emotional burden feels insurmountable. I tried to capture that in this piece — the absolute worst thing for me is the lack of sleep (and before this experience, I was an outstanding sleeper).
I get the sense that many people believe that physical abuse is the worst thing you can experience in an abusive relationship. For me, however, the regular assaults on my self-esteem, in fact, on all that I am, are the things that keep me up at night to this day and that hurt far more than getting hit ever did. And those are the things that just will not go away. I write, not only to heal, but also to be more authentic. I don't see myself as brave. I still feel very broken. I’m healing, but it’s a process. I wanted the nonlinearity of that process to come through. Also, when sleep-deprived, my brain takes me on unusual and entertaining adventures, and it occasionally inserts me into the DC Universe. Harley Quinn is my favorite anti-hero.
How long have you been writing about your experience with abuse?
Earlier this year, I wrote a narrative medicine piece for Doximity on domestic abuse. It was my first foray into sharing my more lyrical writing publicly, and I was very nervous about being so vulnerable in that forum. The reception to that piece was overwhelmingly gratifying and heartbreaking — several clinicians either publicly commented with their own experiences of intimate partner violence or sent me longer private messages sharing personal traumas, and I was grateful that they were, in turn, so willing to be vulnerable with me. I decided to continue writing from different angles of this experience, and my hope is that anyone who has experienced the same and is reading this can find something to relate to and know that they are definitely not alone.
I have been writing a fair amount over this past year. I'm very grateful for the opportunity to share my work and to engage in difficult discourse over it. To me, medicine, and psychiatry in particular, is more than treating the symptoms and managing the condition — to me, psychiatry is fundamentally about the human experience and connection and narrative medicine plays a large role in building those connections and healing. I'm additionally very grateful to start my career at an institution whose ethos is very humanities-centered, and I'm so excited to see where it takes me.
What do you hope clinicians can glean from this piece?
The second, and more important, reason for this piece is a general trend I notice in our society about how we talk to and about survivors of gender-based violence, and these infuriating musings are another source of my regular insomnia. It should come as no surprise to anyone that this type of talk pervades politics and law enforcement. It surprised me, however, that this type of thinking is also pervasive in medicine. During my preclinical education, I listened to countless lectures on supporting survivors of gender-based violence and keeping these patients safe. When I started clinical rotations, however, I was very surprised and disappointed to see that these preclinical lessons often did not translate to the clinical environment. The incident with the male patient who had a record of sexual violence is a very real experience that I had on one rotation that still troubles me. I did not write this piece to try to hurt that team; as a matter of fact, this was a truly wonderful team to work with and the patient care was outstanding. However, I find it striking that they were so willing to excuse his sexual violence and even to cast judgment on his minor victim just because the patient was “such a nice guy" (in fact, I'd like to note that intoxication would absolutely not have been an excuse for his actions had the patient been driving and killed someone unintentionally, and yet it was offered as an excuse when he committed sexual violence).
I think that this incident, and the others that I reference throughout the piece, are indicative of a much larger societal problem, and it is something that we should absolutely discuss in medicine. This is not a function of a few heartless people. It is my opinion that this is a societal issue, and it is so deeply entrenched in our culture that even the best people in medicine cannot help but fall into this line of thinking. These types of conversations send a couple of very clear messages: first, that it is a victim's responsibility to avoid physical or sexual violence, and second, that an abuser's reputation, employability, and career potential carry more weight than a victim's safety. It astounds me that our societal institutions' outrage is often directed at survivors for talking about their experiences, rather than at abusers for engaging in abusive behavior in the first place. We absolutely cannot say as a profession that we are supporting survivors if we are willing to bend over backward to excuse the violence of their abusers, whether we are making these excuses during rounds or explicitly "cautioning" victims who report abuse not to talk about their experiences, lest their abusers' employability is affected (another very real experience that greatly disappointed me, and that I know is not unique to me).
Chloe Lee is a resident physician in psychiatry. Her interests include psychotherapy, narrative medicine, trauma disorders, and women's mental health.
If you or someone close to you has experienced sexual violence, please call the National Sexual Assault Hotline at 800.656.HOPE or visit the resources available at RAINN.org. If you or someone close to you has experienced domestic violence, please call the National Domestic Violence Hotline at 1-800-799-SAFE or text START to 88788.
Illustration by April Brust