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.

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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.  

May 16, 2013

Iced tea on a humid day

The weather has swung from a brief and chilly spring to borderline summer.  The air, heavy-laden with moisture, cleaves to my skin.  My mind drifts to other early summer days, when the weather was just like today, when the blanketing air was a good excuse to lie alone in the sun and set myself adrift in mourning.

A glass of iced tea, drops of condensation running down the side, takes me back to the end of high school.  I drank gallons of it, lying on a blanket in my grandma's front yard, reading Interpreter of Maladies and disappearing into stories of Indian immigrants.  Their memories and homesickness felt right to me, a longing to fit in in the midst of loss.

Sometimes I worry that I will forget.  A few days ago, I momentarily forgot the precise date we lost him--was it the 16th or the 17th? the 16th--and in a brief panic I took my mind there, reliving everything to reassure myself.  

I feel a need to mark this date every year, and yet at the same time, I worry that by commemorating the day, I dwell on it.  There is a certain selfishness in wallowing.  

Maybe instead, I should look at it as what it is: a chance to look back, to remember my father, to wish (as always) he was here to see me grow into an adult.  The sadness is less of a raw wound and more of an old bruise, faded and pale green, tender to firm touch but otherwise well-healed.  It's like the taste of iced tea in the back of my throat, cool and crisp and a little bitter.

May 8, 2013

Death Stalks the Pregnant Woman: sestina

I have seen the end of life in its beginning
labor does not always end in birth
The snake that swallows its own tail
turns inside out, and death
stalks beside the pregnant woman,
stroking her hair with crooked hand.

The perfection of a motionless hand,
cold, without a chance for a beginning
Torn from its home, a woman
who crossed the street and earned a birth
under duress.  She also approached death;
we waited to see the coin fall on head or tail.

A tiny form, tucked head to tail
contorted on imaging, yet with hand
untouched and small in death.
Denied a beginning,
instead a cesarean still-birth,
Torn from her home, a woman.

Life has forever been the work of woman
alone, much as a cat that cleans her tail,
or sometimes a midwife to attend the birth.
With others there to lend a hand
more infants survive a perilous beginning
but still some mothers bleed and hasten toward death.

So many ways that death
courts the expectant woman:
vomiting empties her in the beginning
pre-eclampsia threatens at the tail
or hemorrhage spills blood through the hand
of the midwife who attends her birth.

The promise of an infant makes birth
a worthy endeavor, even when death
stretches out a reaching hand.
So many sacrifices asked of woman
and given gladly in anticipation, despite the tail 
of life visible in its beginning.

Giving birth is not benign for every woman:
Death is always close, like the snake swallowing its tail,
stretching a hand toward those two lives, beginning.

May 5, 2013

Winter skin is tender

Yesterday and today I spent all day in the sun, basking like a lizard in the warmth.  My skin is unused to such affection and I was rewarded with a blush of sunburn.  Yesterday, it took the shape of my v-necked t-shirt as a small red patch on my chest; today it was my arms that, newly exposed, took the brunt of the rays and are now rosy-pink.

In my haste to enjoy all the sunshine I possibly can, I forgot that winter here is long and makes skin forget the power of the sun.  I pay the price, gladly.

May 4, 2013

Birdsong on a damp dawn

The warm mug of tea cradled in my hands and the cool moisture in the spring air fight to be the most enjoyable part of the morning. The chattering birdsong echoing between the houses is a contender, too.  The neighborhood is still asleep, with only a few souls awake and beginning the day.  Sleeping in is glorious, but there's serenity in the early morning.