December 7, 2010

T-shirt slogans and vocations

"Being pro-choice is not being pro-abortion.  Being pro-choice is trusting the individual to make the right decision for herself and her family."  ~Hillary Clinton.  This is what my new, purple t-shirt says.  

The national conference for Med Students for Choice was this weekend in Chicago.

I sat at a round table after breakfast and listened, along with over four hundred other people, to Dr. Rachel Phelps give the keynote speech of the conference.  She spoke on the current barriers to women's access to contraception, reproductive health care, and abortion services.  Her words would have been depressing, if I had focused on the current undermining that is occurring across the entire United States.  As I listened to her speech, I could feel my heart beating forcefully in my chest.  I could feel a rising sensation in my gut, a feeling that spread and took hold around my heart and squeezed painfully so that the air I drew in to breathe made my chest ache with tension.  My heart literally ached at what Dr. Phelps described.  

She spoke of the laws and restrictions that make it ever more difficult to obtain an abortion.
She spoke of physician-only laws, of 24-hour waiting period-laws, of parental involvement laws.
She spoke of the violence that has been done to physicians who provide abortions.

She spoke of the women that she sees in her work: white, black, Asian, rich, poor, educated, ignorant, young, old, middle-aged, married, single, mothers, first-pregnancies.  She spoke of the women who had been yearning for a child but found out that their fetus had such a severe chromosomal abnormality that it was incompatible with life.  She spoke of women who already had several children and loved them dearly, but simply could not afford either the money or especially the time and energy to have another child so close the others.

She spoke of how often she saw women whose contraceptive method had failed.
She spoke of how often she saw women whose doctors had misunderstood their birth control methods or needs, of how often their doctors had taken them off birth control or refused them an appropriate method because they did not have the right information about different methods.
She spoke of how few hours medical schools spend on an aspect of health which touches nearly all of our female patients, of how little time is spent on the methods of birth control, of how few residencies related to women's health even talked about contraception or abortion.
She spoke of how often her patients thanked her for making a decision bearable that was so hard for them.
She spoke of how 1.5 million abortions happened last year alone in the United States.
She spoke of how 1 in 3 women will have an abortion.
She spoke of the 1800 doctors who currently provide abortions and how they are aging and retiring with no one to take their place.

I felt my heart constrict, I felt a band of resonant pain around my chest as I listened.  As Dr. Phelps talked, I realized that this, this was something that mattered to me, deeply.  I realized that, no matter how much I try to say that I am open-minded about what I want my specialty to be, this called to me.  If I truly wanted to help those who cannot help themselves, this was my calling.

Life is too precious for it to be undertaken lightly, and no woman should be forced to bear a child she does not want.

I want to be an obstetrician/gynecologist.  I want to help my patients with anything related to their reproductive health.  I want to help them bear the children they want, and I want to be able to help them when they face a pregnancy they cannot continue.  I want to be there for my patients for the joyous births, but I also want to be there for them when they face the deepest sorrow, or fear, or uncertainty.

I want to honor women's ability to make their own decisions.  

I want to be an abortion provider.

December 2, 2010

In Memoriam

We are privileged to have spent an entire semester examining the bodies of our donors. We have sliced them open, separated skin from muscle and muscle from bone; we have laid bare the inner structures of brain and lung and heart and gut. In many ways, we know our body donors much more intimately than we may ever know another patient: we have seen the ravages of age and disease not only from the outside but from the inside, from the discolorations that betray a bruise or internal bleeding and from the calcification of arteries. As we moved from the arm to the head to the chest and abdomen and now move on to the hips and legs, we have learned the secrets that a lifetime compiles in the flesh. Here, one donor had an appendix in a highly atypical position, on his left side. There, a donor died of cirrhosis of the liver and as a result, his entire preserved body turned a pale chartreuse. Our donors, unlike patients, cannot hide things from us: we can see the extent of a disease's path, the traces of malignancy or self-destructive behavior which have writ large upon the organs their telltale signs.

We know so much, and yet so little.

Who was this person who lies here on the table in front of us? Was he kind? well-liked? despised by one and all? Did she have many children? and did they give her grandchildren? Was his life happy, or shot through with sorrow? Did her family mourn her passing, or was it a blessing in its mercy? What convinced them to donate their bodies so that we might learn?

It is these questions which we push aside or ignore, because these are the questions we cannot answer. In some ways, it is helpful not to know. The distance that we are given by the sheer anonymity of donation allows us to ignore the fact that here before us lies the body of a human being. To ignore the humanity of our donors, though, is to deny our purpose here--to learn to help the living through the sacrifices of the dead.

Many of us have grown attached to our cadavers. In a strange way, they are our labmates, no different from the students standing across the table from us. As a mark of affection, we named our donor Betty Jo. Her name engendered a heated discussion. We debated several names, trying to find one that fit our impressions of our donor the best. In the absence of a true history, we created one for her. Betty Jo, we decided, was clearly someone's grandma. She was the warm and fuzzy grandma archetype, with a checked apron and a plate of cookies straight out of the 1950s. Even though we had no way of knowing if “Betty Jo” was anything like our imaginary patient, by giving her a name, we included her more in our dissection. After her christening, we tended to refer to her by her name, or even talk to her a bit. When the dissection was difficult, we were upset with her; when we found an interesting structure, we gave her praise.

As we draw near the finish of our anatomy course--and as we come ever closer to day when we must bid our body donors goodbye--today is a chance to take a moment and reflect on their gift to us. Without their donation, anatomy would be purely abstract, rooted in the fictions of Netter's atlas. Instead, our knowledge is concrete, tied to specific donors and the structures we saw and identified there. In tracing the nerves and vessels within the body itself, we have created our own maps of anatomy that will guide us in our future careers as physicians.

For this, we must be grateful. It is only fitting that we honor our body donors here today, that we take a moment to thank them with our hearts for the knowledge we have gained at their sides. As future physicians, our privilege to know the intimate secrets of other people has already begun; let us remember our body donors as we go out into clinics and use that which we have gained to learn the private information of other patients' lives.

Delivered at the MCW Body Donor Memorial service, 12-1-10.