Like many women on social media, I found myself infected by the viral #MeToo campaign last month. There were different textual variants circulating, but all asked that any woman who had ever been sexually assaulted or harassed post “Me, too” as her Facebook status. Some posted just that text, some shared stories as well. On Twitter, our own formidable Dr. Esther Choo asked how many women physicians had been harassed or assaulted while at work; the consensus was, nearly all of us.

It felt like a rough week to be a woman, in a year of rough weeks, as I found myself reflecting on my own past experiences of embarrassment and guilt at the actions of another. As with the Hollywood story that sparked the mini movement, that of predator and producer Harvey Weinstein, most of my own stories involved an imbalance of power—and a resulting sense of complicity. An unwanted grope while watching Law & Order reruns with a white-haired member of my local first aid squad. (Aside to Mayim Bialik: an oversized EMT uniform on a petite woman is about as frumpy as it gets). I was counting on him to write me a letter for medical school, so I accepted an “I just couldn’t help myself” apology and we both pretended it hadn’t happened.

Then there was the colleague and on-again-off-again boyfriend at my first job out of college, who jealously read my emails, followed me to the subway even after we’d separated, and once threatened to call all the medical schools I’d applied to and tell them unnamed (and likely untrue) terrible things about me. With the last threat, I did go to my boss, and was discouraged from taking any concrete action. As another colleague told me, it was my own fault for dating at work.

All of this personal ancient history is prelude to thinking about what I would do if assaulted in a setting where I was the one with the power. Anyone working in global health is familiar with navigating relationships with an uneven distribution of power – be it material resources, medical knowledge, or social capital. Besides sustainability, there is nothing we discuss so much as acting with respect and reciprocity. In addition to all of the familiar ethical considerations, I have been asking myself, what would I do if I were harassed or assaulted by someone I was trying to help? How do I even conceptualize being “taken advantage of” by someone disadvantaged?

I have had the same hesitation at home when the offender was in a vulnerable position. I didn’t report the community partner who put a hand on my thigh and propositioned me when we were alone in a pickup truck, because I was worried about his legal status. In the ED, I’ve laughed off countless inappropriate questions and comments from patients because they were old, or drunk, or mentally ill.

I have been fortunate thus far to be treated respectfully by my local partners in global health work. But my experiences at home have shaped my fears. I have to weigh whether an offer to show me around a new city is innocent, or a pretext for something more sinister. I am explicit about having a husband and children — as if the men who have wronged us do not also have wives and children.

I honestly do not know what I will do when my lucky streak ends. In the abstract, I want to see the worst offenders face consequences, whether legal, professional, or merely reputational. But in the real world, might I keep my own counsel as I have done before? Or would I speak up, even if it would cost a fellow physician his job? Would I jeopardize an entire project by calling out a cad, if he were also a necessary stakeholder?

We are so quick to defend our vulnerable patients. Why is it so hard to defend ourselves?

I believe that we cannot change the cultural expectations of male behavior unless women start speaking up. But I also understand too well the reasons why we stay quiet.  We are quiet here, we are quiet abroad. But as we realize how many of us women physicians can say #MeToo, we should be talking about how to balance the good that we mean to do with the real harm we can do with our silence.