Delaney Collins
ENG310
Dr. Tuttle
December 10, 2019
Power Dynamics in Patient Provider Relationships:
Across Four Texts
The practice of medicine requires the transference of some anatomical authority from the patient to the provider. Governed by cultural context, the roles of patient and provider have been, and in some ways still are, concomitant with accepted gender roles and expressions. Specifically, women and femininity have become associated with the submissive role of patient, and conversely, men and masculinity have become associated with the dominating role of the physician. Modern poetry and literature has sought to address this relegation of women and femininity within medical contexts through narratives formed by feminist ideals. Amongst many examples, Betina Judd’s poem, “Betsey Invents the Speculum”; Courtney Davis’ poem, “What the Nurse Likes”; Ruth Ozeki’s novel, My Year of Meats; and Lori Arviso Alvord’s autobiography, The Scalpel and the Silver Bear, feature narratives that resist societally accepted gendering of medical roles. While each author of these four texts manifests literary protestation from different narrative perspectives, Judd, Davis, Ozeki, and Alvord feature the reclamation of patients’ bodily self-determination to disempower the authority of medical providers, and vice versa. Through confounding the traditional, gendered, roles of patient and provider, the authors illuminate how healing more effectively takes place in patient-provider relationships that transgress gender.
Betina Judd’s poem “Betsey Invents the Speculum”, offers a narrative from the perspective of one of the enslaved black women who was exploited by Doctor J. Marion Sims for medical research during the mid 1800’s. During these experiments and operations, Sims would proceed without anesthetics, analgesics, or sedatives— believing the dehumanizing myth that people of color were unable to feel pain. The discoveries Sims made through the, especially cruel, enslavement of these women has lead to his accreditation as the “father” of obstetrics and gynecology. Likely, this credit is due, in part, to his paramount invention of the speculum— a medical tool that was, and is still, integral to gynecological medicine. In, “Betsey Invents the Speculum”, Judd illuminates the narrative perspective of the otherwise unnamed woman whom Sims experimented upon. Beginning with the title of the poem, Judd engages in using the poem’s narrative to ascribe humanity to the victim of Sim’s medical abuse by naming her Betsey. Judd’s naming of Betsey allows the reader to understand her narrative outside of her identity as an enslaved black woman— preventing further marginalization of her narrative. This is further upheld through the use of first person narration, which supplies a narrative readily internalized by the reader. Judd’s entitlement of the poem also foreshadows it’s narrative resistance: Betsey’s reclamation of the invention of the speculum. Judd’s poem narrates this repossession with the lines, “Sims invents the Speculum/ I invent the wincing/ the if you must of it/ the looking away/ the here of discovery.” (l. 7-10). Judd’s narrative uses a lens of survivalism to reallocate the conception of the speculum from Sims and his abuse, to the anatomical fortitude, “the if you must of it”, demanded of Betsey (l.10). By using this language of survival, Judd’s narrative resists viewing Betsey’s body through a lens of victimization— which would automatically disempower her bodily determination by rendering her helpless. Instead, Judd’s narrative determines Betsey’s role as “the here of discovery”, which legitimizes the importance of Betsey’s resilience and credits the role of her body in the invention of the speculum (l. 10). Ultimately, Judd’s narrative disempowers the abhorrent practices of Sims through accrediting the invention of the Speculum to Betsey’s anatomical faculty. “Betsey Invents the Speculum” is an example of reclaiming the inventions made by medical professionals by crediting the contribution of the patient’s anatomical authority.
Contrasting Betina Judd’s patient narrative in “Betsey invents the Speculum”, Courtney Davis’s poem “What the Nurse Likes” focuses on the perspective of a nurse fulfilling the role of the medical provider. In her poem, Davis utilizes the first person narration as a provider to illuminate the power of patient autonomy in a patient-provider relationship. Davis’ narrative addresses the power that providers can wield over their patient’s anatomical functions, and where they cease, writing “I like the way we stop the blood” and “turn the heart on and off with electricity//I don’t like when it’s over/and I realize// I know nothing.” (l.34, 36-39). These lines confine the continuum of medical professionals authority— their knowledge— pithing the patient’s lives. This limitation disempowers the absolute knowledge ascribed to medical professionals, and thus their authority over patient’s. bodies. Davis further reduces the provider’s authority over their patient’s body to the knowledge of their illness, writing “I like talking about patients/ as if they aren’t real, calling them/“the fracture” or “the hysterectomy”/ /It makes illness seem trivial” (l. 25-28). Reducing the patients down to their ailment represents how limited the knowledge medical professionals have about their patient— even once the has transferred some of their anatomical authority to the provider. Furthermore, Davis reallocates all autonomy to the patient writing, “I like saying/You shouldn’t smoke!/You must have this test!//I like that patients don’t always do what I say.” (l.9-33). Through these lines Davis represents and supports a patient resisting submission, and maintaining their bodily self-determination— further confounding the perceived absolute authority of the medical provider. Davis’s narrative in her poem, “What the Nurse Likes” , reallocates the power in patient-provider relationships to the patients—rationalized by the governance of the extent of care a medical provider is able to give by the anatomical authority of the patient.
Ruth L. Ozeki’s novel My Year of Meats, depicts how patients maintain reclamation of the anatomical authority when providers attempt to wield absolute authority over their patient’s bodies. Through third person perspective, Ozeki narrates the experience Akiko has when going to doctor for help with her fertility. After the doctor determines that Akiko’s amenorrhea is caused by disorder eating behaviors, he tells her “‘I must have no patience with stubborn wives like you. There are so many young women who are desperate to have a baby, who… are honestly incapable of doing so…You lack fortitude… This is my diagnosis, which I will give to your husband.’” (81). The doctor is attempting to weld his absolute authority over her bodily self-determination by disempowering the legitimacy of her suffering and by referring her anatomical authority to her husband. Immediately after the meeting, “Akiko felt meat start to rise within her, although she had eaten nothing all day. She flushed the toilet, leaned over and heaved…” (81). Through Akiko’s immediate return to purging behavior, Ozeki represents how even when medical providers have not recognized the limits of their own authority, patients will continue to wield their anatomical authority despite their medical demands. Additionally, as Akiko’s normal purging behavior occurs after binge eating behavior, Ozeki represents the harm done by providers through attempting to maintain authority over a patient’s body despite the patient’s protest (80). Through the relationship between Akiko and her medical provider, Ozeki demonstrates how patients reclaim their own anatomical authority outside of provider care to disempower medical authority. Additionally, Ozeki depicts how medical authority can be an obstacle to providing care and improving the patient’s health.
Supporting the rational behind the Ozeki’s narrative in My year of Meats, Doctor Lori Arviso Alvord’s autobiography, The Scalpel and the Silver Bear, represents how transferring provider authority to the patient can result in better health outcomes. Alvord narrates how she dealt with a cultural conflict in the case of a young child, Melanie, who presented with symptoms of an appendicitis (137). Melanie came in to the hospital with her mother and grandmother, Bernice (138). Upon being diagnosed, Melanie’s guardians were informed the the treatment for appendicitis was an appendectomy— or surgical removal of the afflicted organ (138-139). However, Bernice was opposed to the surgery due to the traumatic history she had endured that, resultantly, informed her perception of European medicine. As a Navajo woman, Evelyn’s grandmother had suffered through cultural supremacy and indoctrination of boarding schools (140-1420. There, her rights had been limited and replaced with forced “bilagâana”, or Anglo, practices (140-142). In the hospital, Alvord listens to Bernice and begins to understand her traumas (141). Afterwards, when faced with the decision to legally override the consent of Melanie’s guardians, or to honor Bernice’s choice, she “…told Bernice that the decision was hers to make.”, based on the belief that it “…would be empowering; that they alone, not the doctors or anyone else, control the fate of their bodied.” (144-145). Ultimately, this choice lead to Bernice autonomously signing the consent papers and Melanie receiving the surgery. Through the story of Melanie and Bernice, Alvord narrates how culture and trauma inform our medical decisions. By recognizing the potential validity of Bernice’s fear, over her own medical authority, Alvord’s choice lead to a less traumatic medical experience. Through disempowering her own medical authority— and allowing Bernice to utilize her authority to make a choice for her granddaughter— Alvord preserved Bernice’s trust in the medical providers and prevented future avoidance of the hospital system. Thus, Alvord’s narrative depicts how disempowering medical authority so patients can reclaim their autonomy ultimately results in better short and long-term health outcomes.
Through Betina Judd’s poem, “Betsey Invents the Speculum”; Courtney Davis’ poem, “What the Nurse Likes”; Ruth Ozeki’s novel, My Year of Meats; and Lori Arviso Alvord’s autobiography, The Scalpel and the Silver Bear, four differing narratives regarding patient-provider relationships are offered. Individually, each text utilizes the reclamation of patient authority and disempowerment of provider authority to make greater implications about our perception of medical relationships. Overall, all of the texts provide critiques one how the patient provider relationship has existed, how it does exist, and how it should exist. Also, each narrative problematizes the transference of authority between patient and provider through history. However, all of the texts favor the empowerment of the patient’s authority. Thus, the influence of these texts in resisting the prescribed roles of medical relationships suggests a future interest in narratives where patients reflect on the active disempowerment of medical providers, as well as their own authority.
