Blood on her shoes: hospital safety equipment and embedded sexism

There were no size 5 gumboots on the surgical unit.

I was doing a six-month obstetrics & gynaecology residency. I looked all through the women’s theatre changeroom. I found nothing but single-use elasticated paper shoe covers, and a few pairs of clogs and sneakers. I sneaked into the men’s theatre changeroom. There were lots of pairs of white gumboots, but nothing smaller than a size seven. (This is men’s sizing; my size 5 feet are the average size for a woman). I tried the sevens on, but I couldn’t walk in them safely. Not an option for an OB/GYN resident rushing from place to place.

I asked theatre staff about smaller gumboots.
“All the female residents before you just wore the shoe covers over their street shoes”, came the bemused reply. “Why do you have a problem with that?”

Have you ever been at a C section? Right up close, I mean — assisting? There’s a reason obstetric staff don a huge shin-length plastic apron before putting the sterile gown on. And it’s not just because some surgeries can involve blood splashes. When a women’s uterus is cut open, amniotic fluid gushes – sometimes fountains – out. Typically, it gushes toward the assistant, possibly because the obstetrician isn’t so keen to take a shower in it, and positions the operative field accordingly. Being quick with a suction tube can help, as can leaping away from the table at a strategically-timed moment. But if it’s under pressure in there, and especially if it’s a “crash” section (luckily, we did few of these), the assistant can expect to have bloodied body fluids dripping off the bottom of their gown at least some of the time.

Gumboots come up to just below the knee, and are waterproof and readily cleaned and sanitised. Gumboots leave the assistant safely undeluged in bloody fluids. Paper covers over street shoes… well, you can imagine the rest. There is no way to get them clean them after that. It is unhygienic and unsafe, not too mention the expense of shoe replacement.

This is Infection Control 101, right? Right? Gumboots are basic safety equipment for hospital employees who are required to assist at C sections and similarly non-tidy procedures.

Well, I asked, “What do the male residents do? Do they wear paper shoe covers?”

I was told, “They just grab some of the hospital gumboots from the pool in the men’s theatre change room.”

“Could I have some gumboots in my size, please? A five.”

There came silence. “I don’t think they make them in that size. Nobody ever asked for them before.” I was brushed off.

In this hospital, functional protective equipment was only provided for doctors who happened to be men. The embedded sexism was so powerful that it had not occurred to the staff that women were doing the exact same jobs as men. It was just assumed that women would wear dinky paper covers over their street shoes, dealing with the contamination and cleanup on their own time and on their own dime, while men clumped around in practical, safe, sanitary boots, provided free of charge and cleaned by the hospital. I guess clumping around in boots was no job for a woman. Hospital administration preferred to deny the existence of female OB residents, ignore them, pretend such oddities didn’t exist.

It was the same story with scrubs. The women’s change rooms were stocked with two-piece scrub outfits, the top being a basic tee-shaped shirt which pulled off over the head. If the shirt was bloodied, there was no way to safely and cleanly remove it – it would only pull off over the head. The men’s changerooms were stocked with one-piece overalls with a zipper up the front. If contaminated, the wearer could unzip the overalls and drop them to the ground, without contaminating their head and hair in the removal.

I went into the men’s change rooms and grabbed a stash of overall scrubs to wear. I had to wear an overlarge size to accommodate my breasts and hips, meaning I had to roll the legs up (again, a potential safety hazard) – but it was better than the “women’s” scrubs.

What happened with the boots in the end? I had to escalate the gumboot question through three or four levels of the hospital hierarchy before someone begrudgingly agreed to locate and buy a pair of freakishly small gumboots especially for me. It took several weeks of bureaucratic hogwash, and I was forced in the interim to work in an unsafe environment with improper safety equipment.

Those gumboots are probably still there, though perhaps my name, writ large along the backs in black marker, has rubbed off by now. I hope there’s a woman resident finding them useful to this day, someone who didn’t have to fight the system just to avoid getting blood on her shoes.

Categories: gender & feminism, medicine

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10 replies

  1. I’d never thought of the contamination issue with the T-shirt style scrubs tops: there must be occasions when the nurses are covered with bodily fluids as well. So what are they supposed to do to avoid contamination?
    The male nurses did/do, I presume, just use the zippered styles as the surgeons do.
    The gumboots are surely an issue for nurses as well.

  2. Thanks for this interesting post. Another one of those 101 ways we’re made unwelcome.

  3. Tigtog: in some settings, definitely. On this specific OB theatre unit, the nursing roles weren’t generally in the line of fire – the scrub nurse stood off to the side of the field, and circulating and anaesthetic nurses were well out of the way of the deluge. So clogs were adequate for less major contact (e.g. with floor contamination).
    I’m actually hard pressed to recall any male nurses on that unit – midwifery was an almost completely female profession at the time, which it still mostly is today. I met plenty of male nurses in ED and psychiatric nursing specialties, however, and a few in orthopaedic nursing. Nursing specialties seem to be, if anything, even more gender segregated than medical specialties in the environments I’ve worked in. Hospital pharmacists were almost 100% male, physiotherapists a mix, and occupational therapists almost 100% female. I wonder how that tallies up with the average pay in the different jobs?

  4. That’s unbelievable.
    I’m reminded of how the first generation of airbags were designed for the average height man, and just happened to decapitate shorter people, i.e., women.
    It is stunning how often “male” is still the default setting for “human being,” and women are seen as freaks who require special accomodations.

  5. Kate: and not just “male”, but “average to slightly larger than average sized adult male”. The airbag story is scary, and not even confined to women – children, of course, are at major risk from airbags, as are adult little people. Standard seatbelts are not optimally safe for smaller than average-height-male people, for fat people, for children. I know the seatbelts in my (small) car are incorrectly placed on me in the driver’s seat, and I’m a hair under five foot four.
    So this sort of safety equipment is actually constructed for a minority of the population.

  6. This is one the things that I like about traveling in SE Asia – things are designed for people who are about my height in contrast to here where nothing is.
    Airline and coach seats are my pet hate – the neck support in the head rest pushes the top of my head forward and the lower back support pushes my upper back forward, while the seat belt seems poised to cut my head off. It is not comfortable to say the least.
    Great post. I always find it amazing how such a simple request to be treated as a equal human seems to be so frequently met with bemusement and allegations of being ‘difficult’. “Why won’t you just put up with inequality? The other women do.”

  7. Thanks for this post Lauredhel. It’s the sort of thing the rest of us would never know. And Cristy, that was a very perspicacious last paragraph.

  8. I wrote this in comments on my private LJ – thought I’d copy it here.
    It is amazing how powerful the silencing mechanisms can be, especially with the combination of hierarchical power and other privileges.
    I know (and regret) that I didn’t speak up when a surgeon I was training under was making me work unsafely within the operative field. I said twice that I felt unsafe, and was shouted at and ordered to keep doing what I was told. I only got out of that situation after he stabbed me with a bloody scalpel. Being an intern, and a female intern in a surgical unit in the early 90s, was not a position conducive to whistleblowing and objections. It’s hard to start to imagine what it is like for women with much lower levels of societal privilege than me.
    We also tried to speak up about the unsafe hours on the obstetric unit (two residents providing 24-hour, 7-day cover for a 100-births-a-month obstetric unit, plus antenatal clinics, gynae clinics, and inpatient elective and emergency gynaecology). When one of us was sick, the other was put on continuous 24-hour cover. The registrars (next step up in the hierarchy) would pitch in with resident work when we collapsed, though they were overloaded also. We wrote letters to the hospital, which were dismissed. I was told that I just couldn’t handle it because I was a woman (no mention that the other resident was a man). A year or two later the job was upgraded to a three-resident job, which would have barely covered the demand.

  9. The rostering of junior doctors generally is a disgrace. Every now and then an article about the overworking of interns, residents and registrars hits the mainstream media, and there’s a bit of tut-tutting, but it never seems to stick. One resident I was working with was a diabetic, who was deliberately running himself into hyperinsulaemia(?) to give himself more energy to get through his rosters.
    I think it’s largely the complaints of women doctors about the insane rostering that is starting to make a difference. Just enough women are actually complaining about inhuman expectations that endanger patients as well as doctors that some impetus into addressing the problem is being generated. Prior to women entering medicine in large numbers the men (and the occasional female exceptionalist) have put up with as some sort of hazing ritual.
    Just one example of the ways feminism can benefit men too, in forcing the acknowledgement that some superman expectations are bloody stupid and dangerous.

  10. Jeebus on Crostini, haven’t these guys ever gone to a discount store and hit the kids section for rain boots?
    We have at least two pairs of outgrown size 5 rainboots that are in the charity pile. (I wear size 41, men’s 7.5). Too bad I can’t send them to Australia for you!

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