Vital Times 2020 - 81

SPECIAL FEATURES

Voices in the OR:
A Self-Reflection and Examination
of Unconscious Bias
Edward Riley, MD

O

ur obstetric
anesthesia team sat
down to debrief after
a particularly harrowing
case. We had just replaced
our patient's blood volume
twice over after she went
into labor with a placenta
previa accompanied by
a placenta accreta. The
operating room had been the usual controlled chaotic
scene of multiple teams intensely focused on their
responsibilities. It was noisy. Too noisy. I had to
remind everyone to restrict themselves to essential
conversations. With that command, the room quieted.
Sitting in the conference room during our debrief,
the obstetric anesthesia fellow asked how she could
get people to listen to her during resuscitations. She
had asked for quiet in the operating room three times
unsuccessfully before my request had obtained the
desired result.
I had a ready answer to my fellow's question. Sheila
Cohen, a legendary obstetric anesthesiologist, had
been my mentor when I was a young doctor. She
learned how to use her voice early in her career so
that she could command the necessary authority
to get the world to listen to her. I had heard her tell
female residents to not end their sentences with a
lilt in their voice, as if they were asking a question,
a pattern linguists refer to as " upspeak. " Sheila's
guidance resonated with me and reminded me of my
late wife's determination while training at Princeton

Theological Seminary to abolish all hints of the surfer
girl speech patterns she had developed growing up in
Laguna Beach. My current wife learned to speak with
authority in law school so that she could go on to be a
litigator. It was clear to me that my fellow had to stop
sounding like she was asking a favor and speak with
the authority a male doctor would.
The female resident anesthesiologist on our team
said the people in the room listened to her, but her
commands were met with glares from the female
nurses and male physicians. She wanted to know
how she could use a compelling voice without getting
the stink eye. A more senior female resident sagely
said not to worry about the feelings of those who are
offended when a female takes authority. I felt we had
satisfactorily addressed the issue.
That night, as we drove home from the movie
Bombshell, I told my wife about the debrief, expecting
her to endorse the lessons I had imparted to my
trainees. After all, I had learned by listening to her
and the other strong, dynamic women in my life.
Instead, in an exhausted voice, she said, " Why should
women have to sound like men to get people to listen
to them? Why isn't it that everyone in the room gets
quiet when she asked for quiet because she is a
doctor asking for quiet? "
Somewhat chastened, I went to the place I always
go for answers: the medical literature. The theme
was clear. I discovered something that all women
physicians already know; women physicians do not

Annual Publication 2020

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Vital Times 2020

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