Not Consented

and why I almost didn’t write this book

She stepped back and accidentally bumped into the person behind her in the airport security line.

“Saw-ree, saw-ree,” she said, turning with a heavy Chinese accent.

The women behind her threw her hands up, pursed her lips, and stepped back dramatically. She didn’t use her voice, but her annoyance was deafening.

The TSA officer had asked the immigrant woman to look into the camera. While searching for it on the small screen, she stepped back into the person behind her. It happens.

I was standing right behind them, watching everything unfold. The woman reminded me of a younger version of my own mother. She looked like she was in her 50s. Traveling alone, I could tell she was nervous.

Was she here to visit her child studying in the U.S.? To attend a graduation?

I’ve watched my own mother do the same: sitting in rooms where she didn’t understand the language, rehearsing sentences in case someone asked her a question.

Was her heart pounding every time she encountered someone official, like TSA or customs, the way my mother told me hers did?

In a split second, I knew exactly what I was going to do next.

“阿姨，这边。” (Auntie, over here.) I said to her in Mandarin with my news-anchor voice and camera-ready smile.

If the annoyed person behind her was performing, I could be stage-ready too. I gestured toward the camera using my whole hand, not pointed fingers, to signal respect. Then I guided her forward, lowering my torso slightly.

“哎呀，谢谢，谢谢！” she thanked me profusely.

Out of traditional courtesy, I waved both hands to deflect her gratitude…only this time, my movements were JUST A LITTLE exaggerated. Then I deepened my bow slightly and smiled even wider.

…all while completely ignoring the woman now sandwiched between us. In my peripheral vision, I could see she had become the one looking uncomfortable.

Good.

Because if your comfort is built on someone else’s discomfort, it deserves to be disrupted.

And disrupt it, we did.

With extra-loud kindness to each other — our own defiant counter-act.

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Sign Here, or Face the Labels

(This section draws on pieces I’ve written over time, threading what became Consented. If you want to go deeper, you’re welcome to follow them.)

If you must know the truth, I know a thing or two about causing discomfort.

As doctors, what we prescribe can make people feel worse before better. The things we do to people, in the name of healing, hurt, burn, and traumatize.

We do all of this while entering people’s personal spaces unapologetically.

And when patients push back, we flail our hands, purse our lips, and act like we are the ones whose efficiency, authority, and expertise are being disrupted.

Why would the patient make self-sabotaging decisions against our advice? Don’t they know we are the actual experts?

Are they confusing their Google search with our medical degree, again?

Why are they acting so dramatic after “just a pinch,” “some pressure,” or when “this won’t hurt?”

How dare they be noncompliant? Unreliable? Difficult? Drug-seeking?

Didn’t we tell them to “just go lose weight,” to take the medicine “as directed?”

Don’t they remember having already signed that piece of paper titled informed consent?

Aren’t they, what we casually call in medicine, Consented?

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I Almost Stayed Quiet

I almost didn’t write Consented.

Sitting in my pale-blue writing chair three years ago, I looked out at the San Antonio summer and hesitated.

After our first writing project failed to land a publisher, my literary agent, Kathryn, told me it was time to pivot.

I had prepared an answer: a memoir of being a young family doctor in rural America. Delivering babies. Holding hands at the end of lives. I even had a title ready: Call the Country Doctor.

Kathryn nodded as I read from my notes. We both played our parts. But our bored expressions gave us away.

My writing assistant—my then-two-year-old Labradoodle, Moshi Moshi—yawned and collapsed onto her side. Outside my window, a neighbor walked by with a dog whose hair was so overgrown it looked like a giant dirty mop, dragging its feet slowly in the Texas heat.

“I’m going to call the mobile pet salon on him,” I muttered. “This is a grooming emergency.”

Kathryn laughed as I followed the scene across my screen, fully derailed mid-conversation. I laughed too. Moshi Moshi lifted her head, like something interesting was finally happening.

“Well…I do have another idea for a book,” I said.

“Let’s hear it.” Kathryn leaned in.

“Medicine is infested with this parasite called ‘medical rape culture,’ where it trivializes and normalizes violations of patients’ bodily autonomy,” I said, sitting up straighter. “And it’s taking all of us with it.”

Kathryn’s eyes lit up. “Okay, Zed. Now we are talking.”

And we haven’t stopped since.

So, I almost didn’t write Consented. Because I was raised in, trained by, and am still part of the system I am writing about.

I have caused the harm I name in this book.

And I wasn’t sure I was allowed to say anything about it.

Over the next three years, every time I worried I was being “too loud” about exposing the culture of medicine, Kathryn told me to say it louder. Every time I thought I was being “too disruptive,” my editor told me to disrupt more.

Together, the team behind Consented helped me see this book for what it is:

An act of repair.

And a call to reinvention.

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And here is my statement:

On behalf of anyone who is a woman, a person of color, in pain, disabled, fat, gender nonconforming, neurodivergent, older, chronically ill, not English-speaking,

or any combination of the above,

In a unified and amplified voice with anyone who has ever felt powerless in their own healthcare,

Consider your refusal to consent

co-signed.

We are #NotConsented.

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A Refusal, Co-signed

For those who preorder Consented, thank you. It helps this work reach further than I can on my own.

And for those who have chosen to support this work as paid subscribers, I made something for you.

You can peel and place it inside your copy of Consented. I’m calling it a bookplate, but it’s more than that.

This is our defiant counter-signature.

A way to say: this is not informed consent. And we are not consented.

Because if medicine required your signature, this is mine back to you.

I’ll be sending a separate email to gather your address in the next few days, so I can send you one that’s personalized, signed, and held with care.

Now let’s go say it louder.

And be more disruptive.

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PS: We did end up calling the dog grooming ambulance. The pup finally got a much-needed haircut. After that, I watched him bounce by my window each day, lighter and almost regal. It’s nice to feel at home in your own body again.