Dr. Jen is on the righteous fury road again:
Sims is really bad news as her longer post articulates:
Sims did not obtain consent from Betsey, Anarcha and Lucy although he claims he told them he would treat them for free for six months, they’d be cured and that he would not “endanger their lives” (Sims was probably deluded enough to think he would master a fistula repair in six months and then make a fortune hence the hospital). Some who support Sims say this was informed consent of the day but of course it’s easy to promise outcomes for a surgery you’ve never performed on women who have no recourse for false claims and no ability to say no.
Some historians have also argued the enslaved women would have been suffering so much that they would have leapt at the chance for repair. Betsey, Lucy and Anarcha and eight other women have been rendered voiceless by history so we shall never know their thoughts. It is true as surgeons we see desperate patients with horrible conditions who say “I don’t care” when we detail complications but these patients are speaking about modern surgery with anesthesia and have the ability to make an autonomous decisions, they are not enslaved women who will be held down for a surgery that had never been tried before by this particular surgeon.
We have the words of one of Sims’ contemporaries, Dr. Cotting, on informed consent and fistula surgeries as recounted in 1844 when he saw a young woman who “resolutely refused to submit to any operation, in spite of earnest and repeated persuasion, and at length declined all further interference.”Despite the horrors of a fistula many women of Sims day who had the ability to decline surgery did so. To say that the enslaved women would have been willing participants is simply not supportable and is offensive.
Well he’s clearly a negative example at best.
The discussions of speculums and the pain needlessly inflicted on woman to this day reminded me of this passage from the wonderful Guilt-Edged Ivory, book three of the absolutely essential Ivory trilogy by Doris Egan:
Physician Technocrat/2 Sel-Hara greeted me after a short wait. He was not much taller than I was, young, wth the dyed-white hair of a pure high-caste Selian, though I noted he’d adapted to local custom sufficiently to wear a jewel in one ear. It was a large, blood-red stone and he wore it like a peacock. Not many men can carry off such drama, but clearly Physician Sel-Hara was not one to suffer self-doubts. Probably the Knowledge that he was performing his two years of altruistic duty, and could soon go home secure in the fact that paradise was his, gave him a certain edge over his patients.
“Theodora of Pyrene,” he said, rather neutrally, though I thought I saw a flash of passing contempt in his eyes when they moved over my Ivory clothing. It may have been my imagination. “Far from home, are you not?”
I made a noncommittal sound.
“I’ve looked through the history you submitted,” he said. “Over here.”
I wanted to hold onto my wallet pouch—it contained certain items that as a sorcerer’s partner I don’t like to be away from”but he took it from me for no good reason I could certain and gestured me toward the examining table.
Scanners of all kinds they had in abundance, but like all doctors, Physician Sel-Hera felt that nothing could replace an eyeball inspection. Unfortunately, in addition to screening the indigent, this clinic specialised in well-paying Ivoran citizens lured in by the reputation of barbarian medicine, and the speculums were built to scale. To the scale of the average Ivoran woman, that is, not a barbarian a bit on the small size even on her home planet. After a quarter hour of effort, Physician Sel-Hera dropped the third one into a sterilisation bucket and said again, “We will try a smaller size.”
For those of you who know what this means, I know I have your sympathy and I thank you for it. For those of you innocent of these procedures, let me sum up the experience by saying it was painful.
“There should be discomfort, but no pain,” protested Sel-Hara when I suggested that perhaps he should skip the smallest size right now. Or better yet, after I’d taken a week off to heal. “After the exam, I can make an appointment for you to see the Clinic Psychologist, if you wish.”
Implying that I was unbalanced for even thinking such a thought. You see why I love dealing with Selians.
The more assertive among you are probably wondering why I didn’t tell him off then and there. But you have to bear in mind that a young woman with her legs up in a cold draft, trying to control involuntary tears of pain, is not in a good psychological position to take the offensive. Besides, he had information I wanted.
“I need to know…” I got out, working to keep the tremor from my voice, “if…there’s any reason…gods!…I can’t have…a healthy child.”
“You will wait for the final report,” stated Discomfort-But-No-Pain Sel-Hara.
“But I mean…do you know of any reason…why an Ivoran and an outsider…” I gasped and lost control of my grammar.
Sel-Hara was apparently annoyed by the fact that I was not working harder to collude with him in the unreality that he was not causing me pain. He interrupted, in the flat accents of an implanted language, “This is not the time for talking. This is the time for listening.” Then he added, as an afterthought, “How can I tell in any case? You say your husband will not come in to be examined.”
I really didn’t feel up to discussing the complications of my marriage at that moment. I thought, if only I were a follower of na’telleth philosophy, and could rise above this kind of thing, concentrate on something else. My mind was a blank. Out of nowhere, I remembered my first class on Athena, a new-made scholar fresh off he ship, and started to chant mentally from Socrates on doctors and lawyers: “Is it not disgraceful, and a great sign of want of good breeding, that a man must go abroad for his law and physic because he has none of his own at home, and put himself in the hand of other men whom he makes lord and judge over him?” A message from the past straight to me, not that I had sense enough to take its advice. It did give me heart to go on, as Sel-Hara showed every sign of covering old and tender ground again.
I must have been muttering.
“You are distracting me, ” said Sel-Hara, in tons of annoyance.
“‘Of all things,'” I finished—not aloud—”‘the most disgraceful.'”
He glanced thoughtfully at his instruments. “I will use the smallest,” he announced, as if it were his own idea.
So I shut up and endured, figuring that questions about pregnancy were probably pointless anyways. After an exam like this I wouldn’t want anyone to touch my body for the rest of my life.
One reason to read literature (and other stuff) by people who are different from you is to learn things outside your normal ken. I remember reading this, probably in grad school. I had read stuff before about women and their experience of medical care but this was a lesson indeed. (I’ll post later about a key contrast between Egan and Kundera).
It’s hilariously, but sharply, written. I love every bit of it. (Read the trilogy! It’s fully of great stuff!)
Jo Walton really gets something wrong about the Ivory books:
It’s hard to explain what makes Doris Egan’s Ivory trilogy such fun. There are serious books and there are frivolous books, and these are definitely in the latter category, but they are none the worse for that. They’re delightful rather than deep, and the world needs more delightful books. There’s not much beneath the surface, but the surface sparkles. It’s funny how we categorise books like this in terms of guilty pleasures, foam baths and chocolatesfemale guilty pleasures, please note. Nobody says reading W.E.B. Griffin is like knocking back a couple of six-packs in the locker room.
The dialogue in these books is a thing of joy, and Egan even makes the romance plot work. The first book, Gate of Ivory, is the best, and it stands alone sufficiently that it doesn’t really need sequelsbut it has sequels, Two Bit Heroes and Guilt-Edged Ivory, and they’re lovely. I refuse to feel guilty for finding them utterly enjoyable. Sometimes that’s all the justification you need. These are books with a very high “I want to read it” quotient, they’re hard to put down, they have great characters, and they’re a ton of fun.
These are science fantasy, in the same kind of genre as Doyle and Macdonald’s Mageworlds books. And there are investigations in all the books, which makes them kind of mysteries. There’s also a romance, but they’re a long way from being genre romance. There are adventures and hairsbreadth escapes and sorcery and spaceships. It’s still hard to pin down what makes me like them so much.
So first, the Ivory trilogy is most certainly not spece opera esp. not the Mageworld kind. Ivory is planetary scale and fairly narrowly focused. Stuff happens that affects the government but in a sidelong way. A better comparison would be with A Civil Campaign (and maybe Memory, though Memory is an odd beast). The Ivory books have something of a comedy of manners in the A Civil Campaign style. There are serious events, but not apocalyptic or world shattering per se. There’s serious character development but not aching or wrenching. There are moments of severe hilarity which almost slide over into slapstick or silliness but are firmly held in place (and thus elevated) by the general commitment of the book.
Ivory is closer to Memory in being not just a comedy of manners. A Civil Campaign is brilliant but Memory pokes deeper into Miles. Theodora doesn’t have quite the psychological turmoil that Miles does (but Miles is a big ole drama queen!). Theodora is the stranded visitor who works toward having a place and learning a new culture and learning about herself in that culture and in light of that culture. And that makes them very not frivolous to me. I think that is deep. It’s as deep as Miles’ struggles as a “mutie” in a hostile society. I think it’s more profound that grandiose space opera (I mean, Mageworlds is pretty frivolous in my book; fun, but frivolous).
Now I suppose Walton is trying to redeem “frivolous” as a descriptor and I’m down with that. I think it’s just the wrong term here. The Ivory books remind me more of Le Guin’s science fiction as cultural anthropology with a stronger focus on a person, a first person voice, and more humor, reflection, and irony. Consider this passage:
She’s have had her brideprice rights, her divorce rights, her children with their duty to obey and defend her—she could have carved out a bearable, compromised life for herself. It’s what I would have done. I mean, there are always books.
And plays. And sunsets. The way the capital looks from an aircar early in the morning when you’re approaching from the west. I’d have taken the chips I had and banked them, and not risked them all on a question mark.
But I’m a prudent little soul, born to buy insurance. My own wild chances were always forced on me; Eliana was made of more splendid stuff.
It almost seduces you into accepting her assessment, even though it’s obviously false. Indeed, much of the second book is devoted to showing her riskier side. Heck, her coming back to Ivory at all is a big risk taken for love. Theodora is not a tragic figure like Eliana, but in large part because she chooses well and succeeds.
This odd narrative unreliability inserted at the climax is striking to me. It helps ground her character and situation. That she immediately goes on to attempt upending a Ivoran tradition of how couples handle infertility gives the lie to her self assessment. But her self conception is of being a prudent little soul. Of the mild and fitting in. It’s just wildly at odds with the way she is.