Tag Archives: MS4C

Blogger once thought extinct, spotted!

I had a fun experience recently. We have medical students rotate through our family medicine clinic. We’ve had some great students recently, and I got along great with one in particular. She was waiting to find out if and where she matched in ob/gyn at the time. She since found out she matched in New England, and I think she’s happy, but bracing for the cold! I’m so happy for her.

On the last day she was at our site, she and I were saying our goodbyes. I get to work with a lot of medical students, but she and I had gotten a bit closer than most. I wished her luck in the upcoming match, which was a bit bittersweet for me, considering my crappy match experience. She said, “Now that the rotation is over, I have a confession to make.” I was really curious – I couldn’t imagine what it could be. “I used to read your blog all the time, when I was planning on going to medical school.”

I laughed and blushed, and was really surprised. I have only been “spotted” twice before, and both of those times were years ago, when I was still blogging regularly, once at a Medical Students for Choice conference, and once at a Lamaze Conference. I was planning on writing about her spotting me on here a bit earlier, but I had a little excitement in my life in between. Hope you understand.

I really like to work with medical students. I hope we get to interact with medical students at the new residency. I am pretty sure we will. I hope to incorporate teaching into my practice even after I am done with my residency. It reinforces material, and I end up learning just as much if not more.

Oh, and Happy Doctor’s Day, everybody!

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Breaking the silence

I am happily coming down off the high of presenting at the Medical Students for Choice annual conference – I was part of a fantastic panel on Protecting Choice in Birth. I felt honored to be sharing the table with some brilliant people – two wonderful ob/gyns, two reproductive justice lawyers, and little old me. We talked about the legal and ethical underpinnings of patients’ rights and choice in birth: site of birth (e.g. out of hospital birth), VBAC, even use of a doula or refusal of certain interventions.

It was a wonderful experience. The director of MS4C told us the response was so overwhelming that the conference was buzzing about our panel, and we are definitely invited to return. I learned a lot from my co-panelists, and loved the enthusiastic response from the audience. One sweet medical student literally had his jaw agape when Farah Diaz-Tello, from the National Association for Pregnant Women, described a woman who had her baby taken away and put in foster care for simply wanting to postpone signing a blanket consent for any intervention or procedure during her labor and delivery. She had a healthy, spontaneous vaginal delivery with no complications during her SECOND psych consult (after the first psychiatrist deemed she was clearly mentally competent and allowed to refuse consenting to an unnecessary hypothetical cesarean), and apparently her six year old is still not in her care due to the red tape surrounding her case. Jaw dropping, indeed.

I talked about my journey, including being a patient, mother, midwifery student, doula and research fellow before becoming a doctor. I discussed the hostile-to-patient-autonomy atmosphere in South Florida, my fellowship research on labor interventions, and how to present risk to patients.

I almost burst into tears when my co-panelist, the lovely and dynamic Dr. Hanson, showed pictures of twins and breech births she has delivered all over the world. I did end up tearing up during lunch, not just because birth is moving and emotional, but because I am slowly accepting that I will most likely never be doing these difficult deliveries, and my wonderful copanelists innocently asked me about my residency plans. I may not be doing deliveries at all.

I got a decent amount of invitations to obstetrics residency programs. I am slowly canceling them, one by one. I simply cannot justify moving my two boys to a city where I don’t know anybody, then disappearing to work my ass off 80 hours a week at all times of day or night. I also don’t want to put them in public schools in the Deep South. When I got divorced during my third year of medical school I knew that would mean facing residency as a single mom. The divorce was worth it, but now that I have experienced the reality of how hard internship is, even with significant family support in my home town, I had to reconsider my options.

I will most likely be pursuing a family practice residency at a local residency program, probably at the hospital where I am doing my internship. Yes, obstetrics can fall under the family practice umbrella, but I would be the first family practitioner to get hospital privileges in the greater Miami area in recent or remote history. In other words, the chances of that happening falls between not likely and impossible. Yes, not even if I do an obstetrics fellowship, which would involve leaving town for a year. It’s just not the standard of care here, even if it’s normal in other parts of the country. And my custody arrangement stipulates that I practice here after training. So, even if I move for residency, I would have to uproot again and come back.

I can still do women’s health. I can still do prenatals. I can do lactation medicine, including the pediatrics portion. I can even be the medical director of a local freestanding birth center, just not their backup surgeon. Which, honestly, was never a huge draw for me. I want to be at the normal pregnancies, not a back up for the ones that go wrong. I can do family planning. I can still do academics, including medical ethics, which is an interest of mine.

So, most of the time I am ok with this. Most of the time. I have a lot to be happy about. I have great kids, good family support, a supportive director of my residency program, relatively good health, friends, a cute little house, a fuzzy loyal dog, and a blossoming (very tentative!) new relationship with a nice guy. And I’m a doctor, for Chrissakes. With a job in a shitty economy.

So, anyway, another permutation on the journey. Let’s see how it plays out.

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Reply turned post, from abortion to homebirth style

Hello! Hey, I’m a doctor!

Please go read this excellent article at RH Reality Check: Why Birthing Rights Matter to the Pro-Choice Movement.

Here is a great quote from the author Laura Guy, who is a doula (yay!) and a certified lactation consultant (IBCLC) (double yay!):

But let’s be clear about something. Reproductive justice means that everyone has complete control over if, when, where, how, and with whom they bring a child into the world. It means that people have accurate, unbiased access to information regarding all facets of their reproductive lives, from contraception to pregnancy options, from practices surrounding birth to parental rights. It means that our choices are not constrained by politics, financial barriers, or social pressure. In other words, how can the right to give birth at home – safely and legally – not be on a reproductive justice advocate’s radar?

As I commented on the article, I was thrilled when, during the keynote address at my first Medical Students for Choice meeting, the speaker mentioned out of hospital birth. Reproductive rights are full spectrum. They start before sexual activity begins – bodily autonomy begins with birth, stretches through childhood with protection from oversexualization, extends through accurate sexual education, includes contraception and freedom to choose when and how to become sexually active, and definitely doesn’t end once one decides to carry a pregnancy to term. The ability (or lack thereof) of women to choose the site and mode of their delivery, among other important issues of autonomy during pregnancy, are key ways that women’s rights are challenged daily in this country. Pregnant women are not human incubators.

So, seems like a bunch of mutual appreciation society activity here. Where is the angst that usually prompts the reply-turned-post? Well, on the RH Reality Check link of Facebook, one commenter says: “This is great and it’s also important for women to have the right to medical interventions (like elective C-sections) they feel are right for them.”

Here is my reply:

‎@Kathleen – within reason. Feeling something is right is one thing, but unnecessary medical intervention is not a “right” per se.

It’s a very nuanced issue that may not fit well in the comments section on Facebook. For example, evidence and expert position statements warn against early induction. Feeling like an induction is right is not enough of a reason to get one. Take it from someone who has been in the paper gown, sick of being pregnant, and in the white coat – many women feel like an induction before the end of pregnancy.

Also, someone who is a really poor candidate for vaginal delivery (placenta previa, for example), may feel like they want a vaginal delivery, but it is not medically advisable. Same goes for women who are poor candidates for homebirth. I think homebirth is an excellent option for good candidates. Not all. There is a role for practitioners to play here, too.

As a physician and most likely a future ob/gyn, I will be one of many practitioners who need to constantly work that balance between respecting a patient’s autonomy, providing good informed consent, and practicing good medicine with a good conscience. Medicine is more than ordering off a menu.

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Trust Women! (For more than a month even)

Trust Women I am so excited! I just bought a Trust Women silver pin for my white coat! I opted to donate to the organizations listed, including one I belong to and one of my personal favorites, Medical Students For Choice. I can’t wait to wear it!

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Blog for Choice

I missed Blog for Choice day this year. Rachel has a great round up at Women’s Health News. The research team I am doing my fellowship had a grant application due today. I rocked the references. We had some long days, and it finally was finished yesterday afternoon.

On to the choice stuff. I am of course extremely annoyed about this Tim Tebow Focus on the Family Super Bowl commercial nonsense. NPR reports that CBS has made an announcement in defense of accepting the ad, which, based on an anecdote about Tebow’s mother refusing a medically recommended abortion when she had amoebic dysentary and ending up with a Heisman trophy winner, encourages people to ignore medical advice during pregnancy when they take teratogenic medications. Or is just about a mom lovin’ her son, depending on who is telling you about the ad.

CBS has refused to take Super Bowl ads they have deemed too controversial in the past from the likes of MoveOn.org, PETA, and the United Church of Christ, who were simply stating that they were inclusive to everyone. Now that the Tebow Focus on the Family ad is causing an uproar, CBS has announced oh, by the way, did we mention we have changed that policy? Coincidentally, right before FOTF approached them, I suppose.

I took the Redhead’s advice (hat tip to SharkFu) and made a donation to Planned Parenthood. I also threw some money at Medical Students for Choice, a group of which I am a proud member. Please join me as part of the backlash to this nonsense.

I trust women. I trust Tim Tebow’s mother to make her own choice about her pregnancy, and I trust all women to have that choice, too. Even if they come to a different decision than she would. I also hate that this anti-choice advocacy totally ignores all of the women (and mothers! and their children!) who die every year due to illegal abortion. Here is my blog for choice day post from last year if you mistakenly believe that anti-choice laws don’t kill mothers and their children, or other myths about abortion.

If you can’t afford to give money, consider installing the GoodSearch toolbar on your browser, and your searches will earn money for Medical Students for Choice.

I am having a Beatles Rock Band party during the Super Bowl. My hubby will have the game on in the living room, but I will be in the back room doing the Beatles thing. And making and serving food. I hope to miss the Tebow commercial. And any commercial with farting horses.

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My day yesterday

Now that I am done with my 12 hour day at school today, I can actually sit back and write about yesterday.

This is a political post. So, if you’re just here for the birth stuff, you are forewarned.

But, considering all the stuff I have posted about race recently, if you are still sticking around, you must be OK with my ranty side.

Yesterday was a fantastic yet very confrontational day. I can feel a little adrenaline release just thinking about it.

First of all, we had a very successful Medical Students for Choice meeting. I billed it as a “Common Ground” event. We had a wonderful speaker, Rev. Dorothy Chaney, a Baptist preacher and a member of the Religious Coalition for Reproductive Choice. I met her at a meeting of the Planned Parenthood Interfaith Council. I was so moved about her story about when her aunt almost died from an illegal abortion. She prayed, and told God that if she survived, she would dedicate her life to making sure this didn’t happen to other women.

Well, now she is a preacher who provides counsel at a local abortion clinic, and supports sex education and outreach through her church in a predominantly black and impoverished community in Miami, one that has a high teen pregnancy rate. She also was part of the Institute on Religion and Democracy at Howard University.

Rev. Chaney did a wonderful job. We only gave one day’s notice for the event. We had standing room only. Many people showed up who were not members of Medical Students for Choice, including a few medical students with bibles. Don’t get me wrong, there are members of Medical Students for Choice, at our chapter and that I have met at the national conventions, that take their religious faith very seriously. But, these particular students with bibles were not there to be members.

A few highlights from what I thought was a very successful event. At one point, after she was done speaking, one of the attendees asked her something about “killing babies” and she corrected him and said “Honey, they’re not babies yet. They’re fetuses.” (Which, technically, they’re not, since we were discussing first trimester abortion, which is still the embryonic stage, but anyway….) The medical student said “No, they’re not, they’re BABIES!”

I wanted to freeze frame them and say, “Hold on, which one is the preacher and which one is the medical student?”

At the end of the event, a first year student held up her bible and said “I have something to say..” and Rev. Chaney said “I have the same bible as you!” brightly. The first year student continued “I want you all to to read the bible for yourself and decide what it says.” And I smiled broadly and said “Thanks so SO much. That was exactly the point of our event to find common ground. Thanks for attending and participating so respectfully!”

So, if that wasn’t enough, there was a health care rally at Senator Bill Nelson’s office. I went, and so did the other research fellow. It was…interesting. There were more pro health care reform people than antis, but not by too much.

OK, I’m pretty biased, but the signs and arguments on the anti side were pathetic. Many referred to killing seniors. I can’t believe anyone would hold a sign with the thoroughly debunked death panels lie on it. I find it really offensive, to tell you the truth. A woman with one asked me if I ever heard of the Heritage Foundation. I said “My father worked at the Heritage Foundation. And he had a living will.” End of life counseling is not euthanasia.

There were also a lot of references to the Constitution (these people who love their federally subsidized flood insurance think that the Constitution outlaws federal spending on anything not spelled out in the original document?) and socialism (and many admitted they loved their Medicare. Except for the guy with the socialism sign who said he had no insurance and took his children to the department of health. Seriously).

Some highlights:

The other fellow is doing research on end of life. She had a bunch of surveys with her, and was asking people to fill them out. It is a research study for the medical school. She is collecting opinions and knowledge about hospice and living wills. It is an IRB approved survey, not biased or politically slanted. One older gentleman with a sign saying “Kill the bill, not our seniors” refused to fill one out.

So, you’ll demonstrate with a sign about end of life counseling and options, but you won’t fill out an opinion survey about it? I guess he has his own way of getting his opinion heard.

Oh, and I got called a “racist bigot”. This is seriously how the conversation went:

Him: “I don’t want to pay more taxes. I like my insurance.”
Me: “Well, that’s where we don’t see eye to eye. I care about the general public good, and you care about yourself.”
Him: “That makes you a racist bigot! You think you are more important than everyone else!”

Yeah, and liberals are playing the so called racism card? I recently got called a Holocaust denier by a friend of my brother’s because I said it was OK (and precedented) for the president to address schoolchildren. What is wrong with these people? If lies about killing the elderly and full term babies (oh, yes, they were yelling about infanticide, too) don’t work, then start calling people the worst random insults that spring to mind, even if they are completely unrelated to the conversation.

And, I’ll end this with some photos of misspelled signs! This one said “KILL THE HEALTH CARE BILL, NOT GRANMA” but his arms got tired before I could take a picture of it in its full glory.

sign 1

And, here’s the woman in the garbage bag with the sign about who works for us. It was raining about an hour before I took this picture. I guess she was afraid the rain might come back, and maybe her clothes were dry clean only. She drove off in a gorgeous new convertible Mercedes. You’d think she’d have a nice raincoat. Or maybe a dictionary. I am sure she earned that Mercedes by merit, intelligence and hard work. Wouldn’t want any giveaways.

sign2

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I write letters, activist style

A double hat tip to Shakesville, one tip for the title and another for the story.

CNN has a headline referring to Scott Roeder, the confessed assassin of Dr. Tiller, as an “anti-abortion activist.”

Here is my letter:

I was shocked to see Dr. Tiller’s assassin referred to as an “abortion activist” by your website (http://www.cnn.com/2009/CRIME/07/28/kansas.doctor.killed/index.html ) in a headline.

I am an abortion activist as a member of Medical Students for Choice. This man was many things: an assassin, a murderer, a terrorist, or simply “accused murderer” would have been accurate. He was not an activist.

Many people have complained that the popular media has normalized violent targeting of reproductive health care workers, and have theorized that this euphemization may embolden such “activists”. Please keep this in mind when covering this issue.

Signed,

A future provider of a legal, safe, necessary, common medical procedure who is sick of being maligned while violent nuts on the fringe’s feelings are coddled by the “most trusted name in journalism”.

Here is CNN’s Feedback form if you are so inclined.

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