December 11, 2013

Interview Season BINGO

The interview trail is long, arduous, and exhausting...even while it's also exhilarating and fun! Hopefully, all my fellow med students have gotten interviews at places they like and have gotten enough interviews to keep the anxiety about Match Day at bay for now.  As I found myself traveling around the country for interviews, I realized that all this travel often yields some excellent stories...usually about how tired we were, or that plane we had to run to catch, or about how the desperation of making all your interviews sometimes causes you to do rash things like change in public or break some (hopefully minor) traffic laws.

As some interview seasons wind to a close, maybe you can try for a blackout on the Interview Season BINGO board! If you're still in the middle of interviews, keep your eyes peeled for as many squares as possible!

Here's to safe travels and a strong finish to everyone's interview season!

Change clothes in public

Decline an interview
Offer to buy someone’s clothes off of them
Interview at your home school
3 or more interviews in one week
Participating in couples match

Wish you had picked a different specialty
Pay for a flight using accumulated reward points
Take a red-eye
Drive > 12 hours
Sleep on someone’s couch

Sleep in the airport

Skip a resident social
Miss a connection
Wear the same suit > 2 times without cleaning it

Commit a crime
Back to back interviews
3 or more interviews without returning “home”
Interview in Alaska or Hawaii
See the same person at multiple interviews

Stay for free at a hotel
Airport loses your luggage
Use plane, train, and automobile in one trip
Reschedule an interview

Download a .pdf of the BINGO sheet here.

November 11, 2013

Stand with me

Over the weekend, I attended the Medical Students for Choice national conference in Denver.  This was my third national conference, and as in years past, I was uplifted by the chance to be surrounded by future physicians who support abortion access, comprehensive medical education, and positive change in attitudes surrounding abortion.

There were some fantastic moments that stand out: meeting and thanking Dr. Phelps, whose keynote speech three years ago called me to follow this path; getting to see my friends from the Activist Leaders Institute in May; talking the whole plane ride home with the M1 and M2 representatives from my school about everything reproductive health under the sun; and hearing from the brand-new doctor who is brave enough to take on the late Dr. Tiller's clinic in Wichita, Kansas.

Something was a little different this year, though.  There was a theme that kept surfacing, one that was relevant to everyone there and one which hit home harder than I was expecting.  The theme was: you are not alone.

One of the sessions I went to was titled, "Religious Women Have Abortions." The speaker, Rev. Rebecca Turner, is a Christian reverend who started and counsels religious women on the subject of abortions.  She said something I had no idea I needed to hear.  She handed out cards that read, "We pray for medical students who want to include abortion care in their practice.  May they receive good training and find good mentors." I felt all the tension go from my shoulders as a sense of relief washed over me.  I had no idea how much of my isolation from people of faith had to do with the censure I assumed I would receive from them; here was a reverend not only saying "it's okay" but also blessing me and praying on my behalf.  I was, and am, touched.  She also gave us business cards that we can give to patients, which have two scripture verses on them.  One, from Romans 8:38-39, reads: "For I am convinced that neither death nor life..nor anything in all creation will be able to separate us from the love of God." I felt gathered in, brought back into a place of acceptance and love.

The final speaker of the conference was an MSFC alumna who has taken on the gargantuan task of providing abortions in the late Dr. Tiller's clinic.  She is only one year out of residency, and in that year she has suffered more troubles and tribulations than any doctor should have to overcome.  Anti-choice organizations found her family medicine practice in Chicago; protested outside her office; harassed her business partner and landlady until she was asked to leave the building and the practice; and have followed her every move in order to intimidate her.  She stood at the podium, looked around the room, and told us to stand strong.

The culture of medicine, she said, was responsible for our isolation.  Too long have abortion providers been pushed to the fringe of medicine, where they are perhaps the only one in their community providing this service.  Too long have other physicians cared more about other issues to the detriment of standing up for reproductive rights and abortion access.  Too long have other physicians remained silent when politicians come chiseling at the rights of their female patients to make their own medical decisions.

But then, she challenged us to continue our path.  We will be the ones to stand together.  We can be the ones who challenge hospital administrators when, no matter what our specialty choice, we ask them hard questions about whether they provide abortions on-site and if not, why not? We can be the ones who make it clear that abortion training is important to us, regardless of specialty.  We can be the ones who show the established authorities in the world of medicine that we will be silent no more, that we demand this education and this care for our patients because abortion is health care, and that we will not stand down when faced with opposition.

I have had many classmates who thank me, randomly and in a quiet voice, for standing up to ignorance on Facebook or for asking questions that make others uncomfortable.  My friends often say that they are proud of my choice to become an abortion provider as part of my practice, and they often say that they support me, especially because they're not sure they could do it themselves.

To this, I say thank you.

Your support of me is always appreciated.  It is a small beacon when I worry that I won't match, that residency programs will view me as a zealot, that someday a crazy person will shoot me for caring for my patients.

However, my plea is this: for those of you who know me, who think privately and silently "That's not right" when a professor or a classmate makes a derogatory remark, or who think "I could never do that, but I'm glad someone does;" for those of you who have private opinions that are rarely expressed--Speak.  Please.  The world of medicine needs more people who consider themselves moderates or supporters of women's rights to speak up and challenge the vocal but tiny minority who set themselves against access and equal care for women.  Those of us who are choosing to make abortion part of our practice need your support--not just so that we can have access to jobs where we are supported, not just so that our procedures can be done in accessible places like hospitals and ordinary doctors' offices and clinics, but also so that we know you have our backs.

It is lonely when you feel that no one supports what you do.  If you support us, speak.  You will brighten our day and make it that much harder for abortion opponents to tear us to pieces.  If it were clear to our opponents that abortion is a normal part of medical care, that the majority of doctors support it for our patients--their power would vanish.  Your silence empowers them; your speech uplifts us.

I need you.  Please stand with me.

November 4, 2013

The lonely luxury of interviews

There is an exorbitant luxury to the interviewing process. Each city means a flight,a hotel, eating out, and new places--all chances to try on the jet-setting lifestyle some of our business-school friends from college might know more about.

Add to that the perpetual asceticism of the med student budget and suddenly I a queen! No, an empress! Look, I have two beds, both neat and tidy with fluffy pillows. Here-a huge TV with cable programming. A bathroom that is always pristine, with little folded towel shapes and miniature toiletries to sample. Sometimes it feels like I've never stayed in a hotel before, such is the wonderment of it all.

Yet for all this "living the life," interviewing is lonely. You're traveling alone; no one will watch your bag while you go to the bathroom without thinking you're a terrorist, so take that with you. While TV is nice, they won't ask how your day went. I find myself on Facebook endlessly, hoping for a glimpse of life beyond the hotel doors.

Despite the need to prepare and research programs before the interview, when I arrive I want to do one thing: take off my pants and spread my stuff around the room, then take a nap. I could sleep for ages, the empty, bland luxury a warm cocoon around me.

Instead, there are perpetual worries:
-am I dressed appropriately?
-will I find the offices in time?
-do I sound like an idiot?
-am I laughing too much?
-am I telling too many stories?
-am I being too quiet?

At the end of the day, all I want is to curl up with a stiff drink and someone to cuddle, but at the moment I'm out of men and gin. Maybe next week.

September 29, 2013

The B word

It's Saturday night, and two of my friends and I are doin' what we do: sipping wine, knitting, watching Pride & Prejudice (Keira Knightley version. Yes, I know the BBC one is better, but who regularly has 6+ hours for P&P?).  The movie is over, we've muted the credits (despite the lovely score) and talk turns, as it always does these days, to residency applications and rotations.

Maybe it's the soft rain hitting the trees and pavement outside, and maybe it's the melancholy touch of cool in the air coming through the windows, but tonight the talk is different, deeper, more honest.

We talk about the B word, but before we even talk about the B word, we talk about the A word: apathy.

Part of fourth year seems to be this glorying in apathy.  "Who wants to do that admit? Not me, 'cause I'm a fourth year! Don't we have some JMS up in here?"  "I could tell the resident sort of wanted me to stay but I was all, 'peace out! I'm a fourth year!' " These aren't the stories we tell tonight, but they're the ones we've been telling: to our classmates, to our fourth year friends at other schools...we revel in the fact that as senior medical students, we were told that now we've "made it" and with ERAS submitted, all bets on effort are off.

One of my friends says something that strikes a nerve: "I'm not afraid of the mistakes I might make as a resident when I'm tired or I'm on call for long hours.  I'm afraid of the mistakes I've made when I just didn't care."  The essential truth is this: when you're tired, yes, of course it's easy to mix up a medication name or a dosage and make a mistake.  What's worse, though, is that sense that what you're doing doesn't matter; the resulting apathy sucks all the drive to be diligent and detail-oriented right out of your mind.

What has brought on this disregard? It's not the patients; many of the stories we tell (sans identifiers, of course) are the patients whose care has changed us, fundamentally.  The patient who was deathly ill in the MICU; the patient who lingered on; the patient we grew too attached to; the patient whose care had been delayed or inadequate elsewhere--these are the patients who stick with us, the negative examples whose care has shown us the pitfalls of medicine and, occasionally, its strengths.  These patients are what strengthen us; each one is a line tattooed on the heart and connects the disease to the person who suffers.

Instead, this overwhelming fatigue is what makes us stop caring.  For many of my friends, we took all twelve months of third year filled with academic requirements and one elective, to earn a much-coveted third month of vacation as fourth years.  Yet the first few months of fourth year are consumed with anxiety: high-stakes electives or sub-internships in our field of choice, compiling and submitting our electronic residency application, finding mentors to write letters of recommendation, studying and taking eight- and nine-hour board exams.  All of this just weighs upon us, and everyone keeps up the mantra that the class above us repeated ad nauseum: fourth year is awesome, it's the good life, it's your last chance to relax, it's when grades practically don't count, fourth year is awesome.

But it doesn't feel awesome right now.  We are tired, so tired.  When I go on dates, the guy wants to know what I do "for fun" or in my "free time." I am more and more reticent to answer, knowing my response is too often "Collapse on the couch and watch Hulu.  Does that count?"

This was my first "vacation" time in 14 months, and I spent it studying and taking board exams as well as submitting my residency application.  Next month feels like a "real" vacation, but it's an anatomy elective.  Medical school teaches you to always be working, so that doing only half as much work feels like a vacation.

At the beginning of med school, we must have had lectures on Burnout--the B word--several times over the course of the first year.  "It will happen!" and "Beware--seek help!" were what they warned us.  They neglected to mention that medical school itself engenders burnout. I can't imagine what residents must feel after a time; for me, ever the optimist, I lay my hope in the fact that I'll be doing what I've wanted to do for nearly my entire life.  I'm hoping my unbound enthusiasm for women's health will carry me through the day.

Maybe fourth year will get better.  Perhaps this is a product of anxiety about interviews (or a lack thereof); perhaps once you've been on a couple interviews you can start to live the badass, carefree life you've been promised.

After all, we're fourth years.

September 22, 2013

It's a slow, deep breaths kind of day

Step 2 CK taken. Wine drunk. Pot roast braising. Music playing.

Just a few more days, and I will have some much-deserved, much-awaited respite: true vacation. Today and tomorrow, I have only to read through the review book for the clinical skills test.  I'm not too worried about it, but I don't want to flub it, so I should probably do a minimum of work.

Who knows how the test yesterday went? The stems are long, there's always this sense of frustration at "I know exactly what's going on, but somehow I'm not sure how to answer this damned question," there are crazy pictures of rashes or lesions that cause me to make faces at the screen. The test was long. As I took my lunch break, I saw undergrads arriving to take the GRE.  I'm sure I looked terrible to them: sadly, quietly eating my carrots and sandwich, washing it down with tepid coffee from my insulated mug.  When I got home, I looked in the mirror and saw I had a tiny hemorrhage next to my left iris, probably from staring so intently at the computer screen for eight or more hours.

Afterward, I drove home, somewhat in a daze but less so than after Step 1. I felt empty, devoid of emotion.  It was done, what else can be said?  I met a bunch of girlfriends at a restaurant/bar and the combination of sangria and catching up was enough to lap away at the shores of fatigue. My friend JG and I went downtown to meet up with another friend at her bf's coffee shop after hours, where we sat and drank wine by a fire pit while we told stories about time on the wards and crazy attendings that we'd had. This was a perfect way to end the night: the sharing of tribulations make them funny, rather than tragic.

This morning, I woke up without an alarm, well into morning (at the very the late hour of 9:30!) and just luxuriated in the feel of cool air contrasting against my snuggly-warm blankets.  I plan to just take time for myself today, and do just a little bit of studying.

It's not an "I'm panicking and need to calm down" kind of deep-breathing day; it's a "take a pause and refresh before this last test" kind of day.

September 20, 2013

Bring on the inevitable

Yesterday, I was sluggishly working my way through a few questions and a chapter in my review book.  In all honesty, the effort simply wasn't there.  That evening though, a brief text message exchange with one of my best friends provoked a moderate rush of anxiety.  What if we're not ready? What if we fail? Schools will definitely see our score on this second licensing exam--and even if they don't see it right away, they'll want to see it.  Also, for the sake of being obvious, you have to pass to become a licensed physician.  No small feat to which to steel your will.

I'll admit it: I freaked out a little.  I abashedly texted another friend who's already taken the exam, asking for advice and reassurance. While I wasn't totally reassured by her response (such is the nature of worry, it is not easily quelled by mere logic), I wasn't quite ready to panic and postpone my test.

When I find myself completely at a loss, I long for the ability to take refuge in faith as others do.  It would be so nice--such a relief--to just trust that there is some external force advocating for me!  In the end, though, much as I might occasionally long for such a safety net, I cannot bring myself to believe it exists.

What I do trust in, however, is the power of meditation and the subconscious.  I have found that, when I am truly feeling lost and questioning my decisions, one of the best ways for me to sort through what I'm feeling is to turn to an unlikely source: Tarot cards.  As a teenager, I fancied myself a pagan, and while I never really fully committed to that faith (and no longer really have any faith, as I already stated), there is a central part of me that cherishes the values I established for myself during that time.  Namely, a few core humanist values: the value of all people, a respect for the earth and the environment, a desire to live in accordance with nature rather than against it, a reverence for the miracles of biology that surround us.  One practice that I picked up, though, was reading Tarot cards.  I remember carefully calculating how to purchase my deck; I always received B&N gift cards for Christmas, and I ordered my deck off of the internet.  My Rider-Waite deck has been faithful ever since, coupled with a cheap clearance book on fortune telling (also from B&N).  After several years of intermittent use, I finally have a working knowledge of each card's meaning, so that my readings now have actual use.

As a teenager, I asked foolish questions: does he like me? will I win at the debate tournament this weekend? and I can't even remember what else.  Now, my questions will probably look just as foolish in retrospect, but they feel more urgent.  Will I be successful? What will my career arc look like?  Where will I be in 10 years? Despite the self-serving nature of the questions, I still almost cried with relief when I laid out the spread for my ten-year career outlook: success, victory, reward for hard work were in every position. I don't really feel like reading the Tarot is telling the future; sometimes it seems as though whatever the cards are, you can interpret them to mean what you want them to mean.  So instead, I treat it as a psychological test, an inkblot of sorts, to see where my mind leaps to interpret the meanings of the cards.

Whether it works or not, I always feel calmer afterward; in itself, it is a form of meditation.  I feel more centered, now.  I have to take the test on Saturday and that's all there is to it.  Let the cards fall where they may.

September 15, 2013

And now, we wait

September 15th: the day that ERAS opens, and thus 20,000 medical students across the United States woke up prior to 9am ET to anxiously review their application one final time before hitting 'apply.'

It's scary, but also liberating, to finally have everything in place and to send it out into the world.  All summer, I've been thinking about my application, and my personal statement, and letters of recommendation, and programs to apply to; finally, I could take some action today.

Now I can just check the status section obsessively (to see which programs have downloaded my application) and hope for interviews to start arriving in my inbox.

Good luck to everyone!  As the NRMP website said, only 187 days til the Match!

September 10, 2013

Redemption of a Neglectful Gardener

There is a comforting persistence to a garden.  It will grow, with or without you, given minimal conditions.  If you step away for a few days, or even a week, it greets your return with a bounty that had simply been waiting for someone to harvest it.

The cherry tomato plants in my garden, despite being deprived of regular attention, are still proliferating.  Today's harvest yielded at least a pint of perfect red globes.  Hidden under the leaves of the squash plant were two small zucchini and two large ones, hefty and the length of my forearm.  The basil plants, stretched toward the sun, had put out full, fragrant leaves and the beginnings of flower buds.  Though the cilantro had gone to seed, I still harvested coriander for cooking and seeds for next year.

The magnanimous gifts of my garden, despite its neglect, were a balm for my heart.  This month has been about restoration: getting enough sleep, doing things for myself, cleaning my kitchen, studying for my board exams--all these are a form of meditation, of returning to center. Like going home to find that your mother does, in fact, still love you (even when you forget to call), my garden was there for me even though I had not put enough into our relationship this summer.  Selflessly, the garden forgave me my sins and neglect, and I find myself redeemed and starting on solid ground once again.

August 30, 2013

Eulogy for a gentle man

In memoriam for Walter Leo Harrison, III.  June 15, 1957 -- August 22, 2013.  Delivered at his funeral on August 26, 2013.

Our family is a game-playing family.  Holidays are marked not only by excessive pie intake but also by highly competitive board games.  Particular favorites for us are Scrabble and Trivial Pursuit.

When we kids were little, we would play Scrabble with Gammy, who taught us the rules and schooled us with obscure words from her crossword habit.  But when we grew up enough to have a decent vocabulary, we graduated to the blood sport that took place between Gammy, Uncle Leo, and the other adults.  I never knew Scrabble could be so strategic until I played on Uncle Leo's team a few times.  We would turn away from the table and he would confide his plan, six moves ahead of the board, just like a chess grand master.

Trivial Pursuit was another favorite, and no one could beat Uncle Leo.  His encyclopedic knowledge of American and European military history was formidable, and was only rivaled by his equally great knowledge of literature, sports, and geography.  He might have had an age advantage, since we played with the version that still used USSR as a correct answer, but overall it was his huge stores of diverse trivia that gave him a win game after game.

Despite a bloodthirsty approach to his honor on the family board game circuit, I don't think I have ever known a man who was so gentle-hearted toward everyone.  You only had to see him cradle one of his puppies or his granddaughters in his arms to see how much he cared for them.  You only had to be on the receiving end of his hospitality once to see how much he enjoyed gathering people together for celebrations.

He had a razor-sharp wit but he was always playful with it, never malicious.  He would come out of nowhere with a quick jab and temper it with a grin that made you laugh in spite of yourself.

The last time I spoke to Uncle Leo, he was in the car with his friend Rachel on their way to a shoot.  We were talking about having a family party for GrandDad's birthday this coming weekend.  I mentioned to him that I had stopped being a vegetarian and he wouldn't have to worry about cooking anything weird for me.  He countered by asking if I was eating big animals, or only the small ones?  I laughed and told him I was eating all sizes of animals.  Rachel tells me that after he hung up the phone, he couldn't stop laughing about giving me a hard time.

When I remember Uncle Leo, this is what I will remember.  He was kind and generous.  He was smart and witty and always good for a game, whether it was cards or board games or wordplay.  And he never let anyone he loved want for anything if it was in his power to give it.

He has left a giant hole in our family, and he will be dearly missed.

August 19, 2013

A Girl in Urology Clinic

"I can't believe I'm doing this in front of a lady!" said the patient, looking away as he shrugged his shorts halfway down his thighs. He was here for a vasectomy consult, and the attending grasped his testes, feeling for masses but more importantly finding the vas deferens on each side. The easier they are to feel, the easier the procedure would be when the day came.

For the first time, I felt a twinge of sympathy for my male classmates. Surely, on OB/GYN, they must have been made to feel the same way. The male gaze in the gynecology exam room is often an uncomfortable one; the discussions are private, and when the doctor and patient are both female, there is a shared kindred experience that underlies the history-taking and examination.

Likewise, I felt distinctly out of my element here. My experience with male body parts is limited to the bedroom and these few clinic visits, rather than a knowledge of my personal anatomy. There seemed to be unspoken understanding between the physician and his patient; rapport here seems to be a consistently uphill battle for me, rather than the natural thing it is with female patients.

If this had been a medicine clinic, I doubt I would feel this way; I have had male patients before, but the genitourinary exam is a whole other ballgame (ugh, pun not intended). If you consider the exam objectively, it makes sense that opposite-sex exams are generally more uncomfortable. However heteronormative it might be to say so, the specter of desire--however remote, unlikely, or unrequited--makes my examinations in the urology clinic uncomfortable.

Clearly, not all women feel this way. Several of the attendings here are female, as are most of the mid-level practitioners. Interestingly, one of them said to me, "Ugh, I would hate to look at vaginas all day!" Perhaps it is only unusual or uncomfortable if the subject itself makes you uncomfortable. I find myself at ease discussing my own body; maybe this is why I have no problem examining others or asking them personal questions about their bodies. In the end, part of what has always been interesting to me about women's health is the desire to teach other women to honor their bodies, a la The Color Purple. So many people have no idea how their bodies work; if I can shed just a little light on the matter, they become more empowered to use their body in the fulfillment of their needs.

All this is to say: I am glad to be going into OB/GYN. The male exam makes me uncomfortable, and I think many male patients seem to be a little uncomfortable with a female student in the room. I guess this is payback for my oblivious enjoyment of my OB/GYN rotation. Either way, there's only two weeks left!

July 17, 2013


I find myself feeling strongly homesick, as if I'm mourning my childhood home.  Maybe it's the blanketing heat and smothering humidity, which are par for the course back home but are more of an anomaly here. Maybe it's watching The United States of Tara, which is set in Overland Park (complete with accurate KC references, like people who live in Belton or the right area code).  Maybe it's that I haven't been home since Christmas, and I spent less than a week there.

Maybe it's that everyone that's in my year is looking to their family and hometowns for places to apply for residency, and I both want and don't want to return home. 

Maybe I'm just a little tired of being a grownup, but I certainly can't stop now.

Happy Birthday, America

I had a grilled cheeseburger for the 4th of July.  It was delicious and tasted like patriotism and nostalgia.

I'm tired of half-assing my environmental food choices, so rather than call myself a vegetarian "but I eat fish sometimes," I'll just go with what works: eat whatever I want, focusing on vegetarian choices.  I guess if I were really hardcore I'd go vegan and not look back.

But damnit, I want to have a fabulous steak dinner after graduation!

June 27, 2013

Anthem for the Feminist Army

I never thought I'd say this--but I was almost jealous of Texas a couple nights ago.  Watching Senator Wendy Davis kick ass during her filibuster, and watching her fellow senators help her run out the clock on a terrible omnibus abortion bill, I almost wished I could have been there watching it in person.  The people spoke and the day was won!

Unfortunately, Gov. Rick Perry announced the next day that he was ordering a second special session of the legislature to start on July 1st.  He said this is because Texas is "pro-life."  Did I mention that they're executing their 500th prisoner that day, too?  And did I mention she's a woman?

I was so buoyed up by watching the internet explode with support for Sen. Davis and her colleagues, and there were so many amazing moments, that when someone posted "I really want to sing 'Do you hear the people sing' from Les Mis right now!" I was inspired.  So I offer up the following as an anthem of sorts, a rallying cry for those who believe that women are people, too.

To the tune of Les Miserables' "Do you hear the people sing?":

Do you hear the people sing?
Singing the songs of mad women
It is the music of the women
who will not just breed for men

When the beating fetal heart
supersedes all the rights of mom
There is a fight about to start
when tomorrow comes!

Will you join in the crusade?
Oh will you stand and fight with me?
Behind the chamber doors
are men denying liberty
To women who should not have sex--
they should only behave!

Do you hear the people sing?
Singing the songs of mad women
It is the music of the women
who will not just breed for men

When the ultrasound's required
and the wait is far too long
It will be women who pay the price
when tomorrow comes...

June 16, 2013

And her tears were of rage

I will admit it: I cry at the drop of a hat.  I think I actually cry more when something is emotionally stimulating--I tear up at poignant or happy moments at least as often as sad moments.  The worst kind of crying, though, is rage-crying.  Watching the videos I've posted below, I found myself in tears, almost sobbing, with frustration and rage and powerlessness as the legislators of Wisconsin wrapped a noose around every woman's belly, tighter and tighter until it strangled her at the throat.

Wake up, Wisconsin.  The future is here, and it's the past, back for another try.  Bring on the day drinking, because the legislature thinks it's the world of Mad Men: women should be barefoot and pregnant, they shouldn't worry their pretty little heads about things like pregnancy or their bodies or choices, and if they get pregnant, well, the little sluts had it coming, didn't they? 

What am I talking about?  Well, in case you missed my last post, they've been up to more abortion-limiting shenanigans.  Only this time, nobody's laughing.

Late on Thursday night, the Wisconsin Assembly spent hours 'debating' SB 206, a forced ultrasound bill, that requires women undergoing an abortion to: have an ultrasound, have the details of the ultrasound explained to her in lay and medical terms (in terms of dimensions as well as visible features), and find the fetal heartbeat if applicable and have it explained.  The bill was ramrodded through the Senate with only two speeches of debate before the calling of a roll-call vote.  The bill requires that the ultrasound must be done 24h prior to the abortion (like the rest of Wisconsin's mandatory state counseling) and the woman must be provided with a list of places where she can get an ultrasound for free.  Note that the 'places that do ultrasounds for free' would largely mean Crisis Pregnancy Centers, or as one representative called them, "Crisis Pregnancy Lying Centers."  CPCs, though they receive funding from the state, are usually religiously affiliated and exist solely for the purpose of pressuring women not to pursue abortions.  Most of them provide medically inaccurate information (not just inaccurate but actually just plain false information) and often will not refer women to abortion providers.

Democrats in the Assembly proposed a series of 13 amendments to the bill, attempting to add provisions such as:
  -allowing the woman to refuse the ultrasound or to refuse to view the images
  -requiring informed consent for the ultrasound
  -requiring that the ultrasound be performed by a trained technician or clinician
  -requiring that facilities providing free ultrasounds have a physician on hand to read the ultrasound (this with several variants, including language about screening for ectopic pregnancies or other complications)
  -requiring insurance coverage for the mandatory ultrasound
  -regarding HIPAA
  -including exceptions for fetal anomalies, so that a woman would not be forced to view a devastating ultrasound more than once
  -exempting abortions performed to save the life of the woman

All of these amendments were defeated by a party-line vote.

Democratic assembly members pointed out that the bill had not actually received a vote in committee; this point of order was ignored.

The bill passed on a party-line vote, 56-39 (4 abstentions).

Activist Rebecca Kemble (@rebeccakemble) documented the unfolding disaster of a day with photos and managed to capture several of the Assemblywomen's speeches in response to the passage of the bill.  Tissues advised.

Rep. Janet Bewley chastised her male colleagues for their focus on women's reproductive health; she asked them, "Where are vasectomies and male reproductive responsibilities" in this bill?  She warned them that one day, their bodies and choices would be under scrutiny. "If it's sauce for the goose, it's sauce for the gander.  I'm waiting for the day when we can have your anatomy on trial." In the second part, she accuses them: ""You want to hold her down and force her to take another look, yet you aren't willing to take another look at this bill...You will not take an ultrasound of this bill."

Rep. LaTonya Johnson brought her fellow Assembly members to task for calling themselves 'pro-life:' "Ask yourself where you stand after the child is born and you want to protect their quality of life."

Rep. Mandy Wright's speech was the most moving.  She shared the story of how, at 8 years old, she was raped by her cousin.  She implored the legislature to think of what they were doing to women who would become pregnant after rape or incest; she implored them to think of their daughters, and how they would feel if they were placed in such a horrible circumstance.

Rep. Sondy Pope recalled her own abortion when she learned that in her second, wanted pregnancy, the fetus had a defect incompatible with life. "Some decisions you can't have! You can’t hurt people this way! Some day one of your relatives will be faced with this and then you’ll know."

Rep. Janis Ringhand reminded the Assembly that before abortion was legal, women died at the hands of back alley illegal abortionists, bent coat-hangers and all.  She reminded them that the Assembly got rid of the requirement for medically accurate sex education and its inevitable results: more teen pregnancies. "I hate to think what's ahead of my two granddaughters, who are 10 and 16...Women are in charge of their own bodies.  It's not a political issue."

Protesters lining the gallery wore duct tape over their mouths; the speaker required the duct tape to be removed.  The protesters sat with their hands over their mouths instead.  When a burst of applause followed a speech by Rep. Pasch, several rows were cleared from the room without a warning.

The most obnoxious part of the coverage I read, though, was that one representative, an emergency medicine doctor from the northwestern corner of the state, spoke in favor of the bill by describing the joy he and his wife felt on seeing their twins "tickling each other and chasing each other around the womb."  I can't believe that ANY doctor would abuse their position in order to harm patients the way this legislation does.  I can't believe anyone who's been through medical school would pretend there's enough room in a uterus for playing tag.  Luckily for me (unluckily for him), you can contact any of the representatives through their website.  I find his behavior so appalling I have happily posted my angry letter to him below, and encourage you to send him a letter telling him how you feel.
Dear Representative Severson,

You dishonor the title of Doctor of Medicine.

When you testified in favor of SB 206 and spoke about you and your wife seeing your twins "tickling each other" and "chasing each other around the womb," you were dishonest and deceitful in the name of politics, and you should be ashamed.

As a physician, unless your training was so deficient as to not include a clerkship in OB/GYN, you should know better.  Such turns of phrase belie the realities of pregnancy; what's more, choosing to speak in such a way without considering or mentioning the very real and not inconsiderable complications of pregnancy (of which I am certain you are aware) is an abuse of your title of "Doctor."

As a medical student, it is shocking and shameful to me that I will have to call you a colleague; perhaps luckily, you are in the legislature and I assume are no longer practicing medicine.

What's more, your position on these bills displays a shocking lack of professionalism; it is the fiduciary duty to our patients that requires physicians to be neutral to the choices of the woman before them; it is the duty to our patients to honor their autonomy; it is the duty to our patients that require that we do what they consider to be in their best interests despite our feelings are about their choices.

You have chosen to impose your will on the women of Wisconsin in a way that NO physician should ever do.

For shame.

For shame.

You can see the senators who voted for this bill here, and the representatives who voted for it here.  If you or your parents or any of your relations or friends live in one of the districts that voted for this bill, this is your task: Talk to them.  Tell them why this bill is bad for Wisconsin.  Especially for my friends in medical school--we know better than anyone the problems that arise in pregnancy; I know too many of my classmates who shudder when they think of what the process of childbirth looks like.  Would you force that on anyone?  Would you impose your will on your patients, or worse, the will of the legislature?  Is that ethical?

Ask yourself, and do what you can: Talk about it.  Our friends and family don't understand this the way that we do; we have a responsibility to speak up when the legislature is attempting to do our job for us (and the jerks don't even have to go to medical school or take Step exams or anything).

May 29, 2013

In which I rant for a bit (typical)

NARAL-WI put out a call on Twitter a couple days ago asking for people to come to Madison and testify at a committee hearing about several anti-choice bills. While I really am taking it easy on this psychiatry rotation, I certainly can't justify just gallivanting off to Madison to play at politics. So, I told them I'd send them some remarks for them to read on my behalf.

Well, let's just say that the former policy debater inside of me got a little excited and went a bit ranty-ranty. That being said, I think it's important for people to know what the WI legislature is up to, because they are nothing if not sneaky, and a lot of these proposed bills have serious implications not just for abortion care but for the doctor-patient relationship in general. All physicians should be concerned about this meddling in our professional affairs!

If you like legal stuff, or if you're a former debater, or if you have lots of time on your hands, read on. Otherwise, I'd read the first two paragraphs and the last couple paragraphs, and you can skip all the bill-specific stuff.


Remarks regarding current proposed legislation in Wisconsin, May 28, 2013
First, as a way of introduction, my name is [redacted], and I am a medical student at [redacted] who will graduate in May 2014. I will be applying to residency programs in the fall of this year in obstetrics and gynecology, and I have long been a passionate and active voice for evidence-based, compassionate, and comprehensive women’s health care.
As a future physician, I find that the anti-choice bills being proposed before the legislature in this legislative session to be abhorrent and utterly lacking in common sense, compassion, and good medicine.  What’s more, they are absolutely invasive in nature and are certainly not conservative in philosophy.

With regards to AB 216, banning state insurance policies from including abortion coverage as well as exempting religious organizations from providing birth control or other services, I object to both components of the bill as follows:

-Ban on abortion coverage for state employees: A ban on abortion coverage in insurance policies is wrong-headed and ignores the very human reasons that women seek abortions in the first place.  First, no woman says to herself, “I think I’ll get pregnant so I can have an abortion.” Women have abortions when they find themselves pregnant and do not wish to be, or find that their pregnancy will not result in a viable child, or find out that they have a serious illness that threatens their life, forcing them to choose between themselves and a pregnancy.  Banning abortion coverage in state employees’ insurance coverage is ignoring these REAL-LIFE reasons that women get abortions, and implies that state employees are not entitled to make these choices about their bodies and their pregnancies.

-Exemption for religious organizations: Much has been said about this issue on the national stage, and I trust the legislature is aware of the many debates that have been had.  While it is true that some religious organizations object to providing birth control to their employees, finding that they are then “complicit” in the “sin” of birth control, it would behoove the legislature to recall that studies have found that 98% of Catholics have used some form of birth control at one point or another in their life.  Also, Catholic organizations (and other fundamentally religious organizations) do not always serve or employ people who are solely of their own faith.  If a secular employer objects to birth control, yet he pays his female employees a living wage with which they purchase their birth control, does he have a right to deny her her wages so that she may not buy condoms or oral contraceptives?  Conservative values and small government says that this is absurd, and the only logical and truly conservative position on this issue is to keep employers out of the personal health decisions of their employees.  

I take even greater umbrage with AB 217.  The bill prohibits sex-selective abortion and permits the mother, father, or grandparent of an aborted fetus to sue the abortion provider for civil damages as well as to sue for an injunction prohibiting that provider from continuing to provide medical care.  Finally, the bill requires that the plaintiffs’ identities be held in confidence unless an open court is requested.  As a future physician, there are MANY problematic areas in this piece of legislation.

First: definitions.  CHILD is defined as “a human being from the time of fertilization until it is completely delivered from a pregnant woman.”  This is not a medical definition.  The medical definition of the entity in question is an EMBRYO (up to age 8 weeks) or FETUS (age 9 wks--delivery).  An INFANT is a human being who is between birth and 2 years of age.  A CHILD is older than that.  Even beyond the gross medical inaccuracies of the language, defining a child as such “from the time of fertilization until completely delivered from a pregnant woman” not only redefines the meaning of child but ALSO means that a zygote or conceptus (the MEDICAL term for a fertilized egg prior to implantation) is a ‘child,’ despite the fact that 75% of fertilization events do not result in implantation and thus, pregnancy.

Second, the bill is directed against the provision of an abortion if it is determined to be for the sole purpose of selecting for/against the sex of the fetus.  Who determines if this an abortion is sex-selective?  Does this mean that terminations for sex-linked diseases are then de facto sex-selective abortions, and thus illegal?  How does the legislature propose that doctors should determine if a woman is seeking an abortion for sex-selective reasons?  What if she has lots of reasons for termination and sex selection is only one of many?  Is her abortion still illegal? Would the legislature have all women seeking an abortion be evaluated by extensive psychiatric interviews, in order to determine the deepest reasons for her seeking an abortion?  I would STRONGLY admonish the legislature to avoid the unintended consequences of such a stance.  

Third, the scope of who is eligible as a plaintiff.  The bill permits the mother, father, or grandparents of an aborted fetus to sue the abortion provider for civil penalties.  This is illogical.  Women in the state of Wisconsin and in the United States at large are granted the right to obtain an abortion by virtue of the right to privacy established in Roe v. Wade.  Women are not required to notify their partners that they are seeking an abortion, and only minors are required to notify a parent or adult 25 years or older of their decision.  As such, the legal approach to a woman seeking an abortion is to leave this as a decision between a WOMAN AND HER DOCTOR.  It seems to me that there is thus no legal ground for allowing a suit to be made by a woman’s partner or by the fetus’ grandparents.  If anyone should be able to sue, then, the only person who should be eligible for such a suit would be the woman in question.

HOWEVER: AB 217 proposes that even the woman herself might wish to sue the abortion provider for providing an abortion on the basis of sex.  This is grossly inaccurate and absolutely demeaning to the profession of medicine.  One of the four principles of medical ethics is a respect for PATIENT AUTONOMY; as such, doctors do not make decisions for patients, instead, they offer patients options, education about the risks/benefits of those options, and when requested, guidance as to which option is most medically sound.  The only reason a woman would sue her doctor for providing a sex-selected abortion would be if somehow the physician had coerced her into obtaining an abortion.  THIS DOES NOT HAPPEN.  Doctors who provide abortions CARE DEEPLY about their patients; one could argue that by being willing to perform this service in the face of repeated attacks like this one, they care for their patients MORE than those doctors who refuse to do so.

THUS: the principle underlying AB217 is a slap in the face of every medical student in Wisconsin and a slap in the face of every physician in the state who strives to provide good, quality, compassionate care to all of his or her patients. Ethical physicians do not coerce their patients into decision, and this bill presumes from the outset that a) the plaintiff might include the patient herself and b) that the person making the sex-selective choice is the physician, which it is not.  If sex-selective abortion were to occur, IT WOULD BE THE DECISION OF THE WOMAN, and as such, for the law to hold the proper people responsible for this act, it would necessitate including the patient as a possible defendent as well.  As it is written, the law betrays an essential lack of knowledge about the doctor-patient relationship and demeans the work of every physician, not just those who provide abortions.

I am very disappointed by the legislature’s choice to pursue these pieces of legislation.  From what I have seen in the news, it seems that Wisconsin is near the worst state in the country with regards to its economic recovery and both long and short-term job growth.  It would behoove the legislature to spend more time and taxpayer dollars pursuing economic solutions to Wisconsin’s problems than in chasing invisible problems and creating them where they do not exist.  These abortion bills DO NOTHING for Wisconsin’s economic future, the most concerning and impactful problem facing our state.

As a future physician, I want nothing more than to be respected for the dozen years of post-secondary education I will have undergone by the time I am a practicing physician in my specialty of choice.  I will graduate with hundreds of thousands of dollars in debt, and yet I would never trade my chosen profession for anything, because I am dedicated to serving my patients to the best of my ability.  That dedication includes telling you that the future physicians of Wisconsin WILL NOT STAND for this kind of meddling in medical affairs: you are not physicians, you do not have the medical knowledge to make these kinds of decisions, and we would politely ask you to STAY OUT OF OUR EXAM ROOMS.