magical moments

While biking home from clinic a few days ago (yes, the bike commute is the best!) I was thinking about how I wanted to go into this field because I like being able to offer support, guidance, and skills at women's most vulnerable moments - but that these moments don't always take the form of delivering a beautiful baby or removing a breast mass or uterus and curing someone's cancer, they are not always helping someone get pregnant after years of trying.  Often they are much less magical and women feel much more ambivalent about how helpful I'm being, and more frustrated or scared about their situations -

they're a woman who comes in from clinic after being told she has an intrauterine fetal demise (IUFD) for induction, a woman who thought she was coming in for a regular prenatal visit who is told she is in preterm labor and going to deliver her baby months sooner than she had planned, a woman in her 40s with symptomatic fibroids (pain, bleeding) who has never had sex, but doesn't want to have a hysterectomy because she doesn't want to give up on the idea that someday she could be pregnant, another woman in her 50s with vaginal bleeding for years who has never had a pelvic exam or a pap smear who you have to counsel about her high risk of cancer, a woman who fled her abusive family to come to a new country only to live with abusive "friends" here with few other options because she is still undocumented, another woman trying to figure out what she is going to do with her young child in labor because she has no one to watch him, or the woman with a urinary infection during pregnancy who refuses to leave the hospital, even after her antibiotics, because she is so afraid of the pain she isn't sure she can go through with labor, a woman spending her pregnancy in prison who hasn't slept for days because she cannot figure out a comfortable position for her growing abdomen on her one allowed mattress and built-in pillow.

** 

but I guess those ARE the moments why I went into this field: to explain what's happening with her body, to explain that it's not her fault, to explain what we are going to do to try to make it better or easier, to write prescriptions for extra mattresses, to talk to the other people in their lives with the authority of someone with knowledge and skills, to counsel about her options, to hold her hand and tell her that 

I'm just so sorry this is happening to her.

~~~~

"the wound is the place where the light enters you"

-Rumi

the turnaway study

*according to this new study, this woman is very wrong.

One of the hypotheticals that is always touched on in reproductive rights discussions is what would happen if we simply did not allow women to have abortions?  Well, the Turnaway study from San Francisco-based research group Advancing New Standards in Reproductive Health (ANSIRH), investigated that question and just presented their first results.  

There's a great overview on the Slate XX blog to check out.

In brief, the group followed over 1000 women across the country who went to have abortions.  Most were able to obtain abortions (97% had no regret), but almost 200 women were not able to have abortions, usually because they were farther along in their pregnancies than the places they went to have abortions would perform the procedure.  The researchers interviewed these women extensively and compared them with the group who was able to obtain abortions.  

A few (of the many) things worth mentioning:

1. women not able to have abortions were more likely to be financially struggling a year later.

Compared to the group who did have abortions, a year later (the study is ongoing) those who were "turned away" were more likely to be on government assistance, living beneath the poverty line, and less likely to be working full time.  

2. women not able to have abortions were more stressed.

They also reported more stress and were equally as likely to be depressed as the other group of women (as in, no happier).  

3. women not able to have abortions had more medical problems.

Including pregnancy complications and postpartum complications (abortion is almost always safer than pregnancy, as is birth control).  

4. women not able to have abortions were more likely to be victims of domestic abuse.

The researchers attribute this not to the "turn-aways" being more likely to enter into abusive relationships, but being less able to get out of them while pregnant/with a new baby.  But this didn't mean that men were more likely to stick around - they found that "men were no more likely to live with a turnaway who'd borne their children than they were to live with a woman who had an abortion".

This study is excellent data to add to the discussion of women's reproductive rights - showing that the consequences of our reproductive choices are far-reaching and longer lasting than just 9 months.

~~~~

"As women's access to abortion care...becomes increasingly restricted, it is extremely important to document the effect of unintended pregnancy on women and their families.  The Turnaway Study is an effort to capture women's stories, understand the role of abortion in women's lives, and contribute to the ongoing public policy debate on the mental health and life course consequences of abortion and unwanted childbearing for women."

- taken from the Turnaway study website, under Why this study is Important

(*I copied this image from the Slate XX blog review of the turnaway study, because it was just so good)

Reproductive Ven Diagram

This past weekend I went to a friend's wedding in a beautiful park.  The friend had thought she was infertile so had been not using birth control (!!)  But, when she found out she was pregnant, she and her long time boyfriend were both absolutely thrilled.   They decided to get married and start a family all in one year - all things they had hoped to do in the near future anyways.

The way she put it was "I feel like in the ven diagram of when I should have children, the circles are overlapping the most right now - so I want to do it".  She only gave a few examples of circles, but I sort of ran with it.

Here's my image of how this would look - I could have kept adding circles...

How do your circles fit together?

On another note, during the ceremony, they read this poem by Kuan Tao-Sheng (1262-1319):

MARRIED LOVE

You and I
Have so much love,
That it
Burns like a fire,
In which we bake a lump of clay
Molded into a figure of you
And a figure of me.
Then we take both of them,
And break them into pieces,
And mix the pieces with water,
And mold again a figure of you,
And a figure of me.
I am in your clay.
You are in my clay.

In life we share a single quilt.

Mitt Romney's Personal Liberties

The Daily Show with Jon Stewart
Get More: Daily Show 'sFull Episodes

choices

oh hey there.  yup, I know I've been away from my blog a while.  (It's been a pretty busy summer!)  But while studying at the beach, hiking around Yosemite, and spending 15 hour days at the hospital on my cardiology rotation (more on those soon) - I've been thinking about the goals of my blog.  It has and will always be a space where I record down the most interesting thoughts that have come up in the conversations all around me.  However, clearly (hopefully!) there are just way too many fascinating questions and thoughts to record them all down - I'd be sitting at my computer typing all day, instead of having interesting discussions!  So I'm going to try to commit to a goal of putting up at least one blogpost a week, and if that feels good, I may expand to 2.  Then I can at least keep track of some of the interesting thoughts that have come up in the past week.  I'd like to do this in a way that lets you know when to expect a new post and also keeps me honest - so I'm planning on a "by Monday evening" weekly posting.  Except for this week ofcourse, because Monday was really second Sunday :)

Maybe because I'm creating my residency application list (due in less than a month!) but I've been thinking a lot about CHOICES lately, as in - how do we make them? Are we even good at making them?  What makes a good choice?  What are the hardest choices we have to make?  What should be the easiest?  So while I construct a post or two about my crazy fascinating month of Cardiology, hopefully these thoughts will get you thinking too:

*An Amazing Book About Choice (called Choice: True Stories) recommended by a dear friend.  It's a collection of essays by women about their choices surrounding reproduction.  Everything from adoption to what it meant to finally be a mother to abortion to miscarriage to raising a daughter.  The authors are lots of famous writers too, so it's beautifully written, and most of all, a great reminder of the impact of these choices, and that how they are made can change the experience entirely.

*I also read a fascinating article (called "The Two-Minus One Pregnancy") about twin reduction (if you're intrigued and/or confused, you should read the article) in the NYT sent to me by another friend.  This friend is going to do a presentation on this to our journal club and I'm really intrigued.  It's definitely a topic that makes me really uncomfortable, as it challenges where the edge of my morals lies.

*I also watched a TedTalk by Sheena Iyengar, who is a researcher at Columbia whose interest is in Choices, how we make them, if we are good at them, etc.  One my favorite examples is when she talks about some of her experiments - including one where she interviews people from post-communist Eastern European countries and offers them an option of seven different sodas.  They all say, this is only really two options: soda or no soda.  Despite the fact that in the US, some of us get angry if we are given a Coke instead of a Pepsi or vice versa.  I'm excited to read more about her.

That's all for now!   But I'm back and more is coming (check back on Monday evening or Tuesday mornings)!

e

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

"It is our choices that show who we really are...far more than our abilities"

- Dumbledore

(in JK Rowlings Harry Potter and the Chamber of Secrets)

Markings of Birth

I'm in rural Vermont without internet for a few weeks, but I dipped back into town long enough for a little skiing, a little time with friends, and to post this video, courtesy of my friend Arielle about the beautiful changes of a woman's body** that happen after pregnancy.  And how even though abdomen's may not be flat anymore (though they can be), they have scars that tell such a story.  

(**don't worry, it's only photos of abdomens - no other body parts!!)

If you're interested in reading about it, check out the website here!

first test of motherhood

around 4am last night, on the 26th hour of my 28 hour call day, I was standing at the side of the bed of a 29 year old woman who was trying to push out her first baby and screaming "help me, help me, help me. I can't do it. I can't do it" and I was thinking (amidst telling her she was safe, her baby was safe, that she was doing a great job, to KEEP. FREAKING. PUSHING.) that birth is really the first test of a mother. I have yet to see one first vaginal birth where the mother didn't actually tear through her vaginal opening. Not like, it happened to tear. Like, she pushed so hard to get that baby out that she is actually TEARING HER OWN SKIN. It seems like a pretty good test of what's to come: are you willing to tear yourself from the inside out in order to give life, air, comfort to this brand new baby that you aren't even sure what it will be like, but you already know you love it enough to rip yourself open.

The best part is that after the big, (often) tearing push, the baby goes on the mom's chest, the partner leans over and pushes her sweaty hair back from her face, they gaze at their new, crying baby who is covered in white vernix together and glow. They all glow.

Terrifying and amazing.

oh, yeah. so I started my ob-gyn rotation and freaking love it.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

"a healthy woman is much like a wolf: robust, chock full, strong life force, life-giving, territorially aware, inventive, loyal, roving".

-Clarissa Pinkola Estes, author of Women Who Run with the Wolves

Elastic Doctor Women

an anesthesiologist recently wrote an op-ed about women in medicine where she discusses how the personal decisions made (mostly by women, she says) about having children should be taken into account when we're deciding who to admit to medical school and residency programs.

And I quote:

"I have great respect for stay-at-home parents, and I think it’s fine if journalists or chefs or lawyers choose to work part time or quit their jobs altogether. But it’s different for doctors. Someone needs to take care of the patients."

"Students who aspire to go to medical school should think about the consequences if they decide to work part time or leave clinical medicine. It’s fair to ask them — women especially — to consider the conflicting demands that medicine and parenthood make before they accept (and deny to others) sought-after positions in medical school and residency. They must understand that medical education is a privilege, not an entitlement, and it confers a real moral obligation to serve."

I'm not quite sure what to say first.

Luckily, other people responded faster and I got to read some eloquent Letters to the Editor.

One, from a neurosurgeon who said that this had long needed to be said, that maybe you could be a part time pediatrician and be okay, but any part time surgeon would be inferior because her skills would be worse.

Another, from a family med doctor who said that she thought it was interesting that an anesthesiologist - who walks away at the end of the day without any patients, whose patients are asleep for 90% of the time she sees them - would be able to comment on what constitutes "full-time". Spending 30-35 hrs/wk face-to-face with patients grappling with all sorts of diagnostic dilemmas certainly is different than 40hrs/week of unconscious patients who never call you at 2am.

One of my favorites was from a doctor who wondered why the author wanted to ask prospective med students about working part time and not if they wanted to subspecialize, or if they wanted to do academic medicine or work for a pharmaceutical company... or all the other ways doctors practice that is not filling our major needs for doctors.

***

At this point in my career, those decisions about family and lifestyle seem to be closer and more real than ever before and I do feel a strong pull towards the honor and responsibility of practicing medicine, of being someone's doctor. So I'm doing a lot of adjusting of my vision of being a mom, of being a wife, of being a neighbor, a sister, a cousin, an aunt, a dog owner...

but don't we want our doctors to be all those things too?

we don't want to create these doctors who live in the vacuum of a hospital, where they don't interact with anyone without asking them how they'd rate their pain on a scale of 1 to 10, do we? we want doctors to understand the importance of parents, of siblings, of partners, of children. how can we expect doctors to understand how we value these people without expecting them to value them also?

I'm still not sure how I will be all these things at once, and it certainly hasn't been easy to be a med student and all these things, but I'm going to keep trying.

(in case you don't know, that's Elastigirl, a pixxar character from the Incredibles,

designed to be able to to everything at once - the perfect mom)

last minute question

My last patient yesterday was a 15 month well child check. Matthew (we'll call him) was a healthy boy with soft brown curls who came in with his mom and maternal grandfather (who told me to call him Grampy with a huge proud smile on his face) and proceeded to run all over the exam room. We slowed him down just long enough for me to examine him and go through my exam with the resident with whom I was working. At the end of the (approximately 45 minute) visit, we're wrapping up our discussion about how Matthew seems very healthy, that he'll have to have some immunizations today, and we'll see him again in 3 months for the 18 month well child check, when his mom says, "I have a quick question for you, actually". "so I just found out I'm pregnant and I have MRSA. What will that do to my baby?"

whoa.

so after addressing her actual question (we'd probably treat you for MRSA, it's possible your baby would be exposed and would also have to be treated, but this isn't something too concerning), the resident says, "so. how are you feeling about being pregnant? have you figured out OB care?" she pauses and looks at the ceiling and says, "actually, not yet. I'm gonna keep the baby because I couldn't possibly not keep the baby. but I just broke up with the father and haven't thought about prenatal care. maybe you could do it?"

the resident says, "of course. I do OB and since I'm already your primary care doctor, and I'm already your son's primary care doctor, I think that would make it easy." and then he pulls up her chart in the EMR and begins to ask her some screening questions before setting up another appointment for her to come in herself.

oh family med - how all-encompassing you are.