Back and forth we went, quickly turning over the two exam rooms and getting through the long list of patients. The doctor walked swiftly with a gun strapped to her waist while my watermelon socks in snake print clogs nipped at her heels. The weapon looked out of place against the pale blue of her scrubs, yet it was essential for her protection. She slid open each door, snapped a purple glove on her right hand, lifted the sheet covering the patients bare, shaking legs on metal stirrups, and did a quick pelvic exam. An exam not medically necessary but required by the state in order for the patient to get the pill that would end her pregnancy.
This patient had not yet been deterred by the five hour drive across state lines, waiting in an unfamiliar city for 24 hours between appointments, the $500 bill she paid out of pocket, nor the protesters’ signs of photo-shopped fetal parts.
Would this last step finally change her mind, make her feel some shame about whatever behavior had brought her here in the first place? Would this forced indignity, this invasive pelvic exam, shove a shiver up her body so strong she would cough up the pill and another unwanted baby could be born into this state, which cares more about birthing a child than the quality of life that develops afterwards?
The state legislature that passes these abortion restricting laws does not think about the pain and discomfort a patient will experience. The exam felt more than unnecessary and invasive; it felt cruel and humiliating. It ignored the principles of trauma-based care and bodily autonomy; it threw the lessons of evidence-based medicine I had been taught out the window.
It wasn’t until my last year of medical school that I finally stepped through the doors of one of the last three abortion clinics in Louisiana. My preparation for this moment began when I moved to the South from a liberal California bubble. The landscape of mountains was replaced by bayous, and pride flags replaced by confederate ones. I began parking next to state-sponsored, license plates urging drivers to “Choose Life” and driving by protesters praying outside Planned Parenthood. Scenes I had heard of but never experienced .
I began working hard to learn about the parts of reproductive health my medical training left out. I read, researched, joined reproductive justice organizations, planned educational events, volunteered, and attended conferences. I sought out opportunities to travel and see abortion providers’ work in action. From Mexico City, to California, to New York, I saw what abortion care looks like in “choice-friendly” environments.
I heard doctors use shared-decision making while discussing pregnancy options with patients.I felt how luxuriously time seemed to slow down. Patients could catch the breath their anxiety had taken away. I saw how patients felt seen and listened to, as though for the first time.
I learned no decision was ever made lightly. The stories each patient walked in with were different. Yet they shared a depth of emotion from which sprung an endless fountain. Tears shedding fear, heartbreak, disappointment, relief, and countless stories that were present even if they were never spoken. I learned to anticipate them when a patient lay backwards on the operating table. I would dab at their sorrows as the doctor held her hand gently and the anesthesiologist carried her off to sleep.
What I did not see before working in a Louisiana clinic were patients forced to watch or listen to their ultrasound. Operating rooms were not abandoned by anesthesiologists or nurses who refused to participate in surgical abortions. Doctors were not forced into small pink clinics encircled by security cameras and protesters. They did not wear bullet-proof vests or gun holsters as part of their daily dress code.They were not mandated to read aloud false information threatening patients with cancer or mental illness as a result of abortion.
State laws didn’t force hands or probes or words into patients.
When siloed from hospitals to private clinics, abortion care becomes separated, as though different, from other medical care. It strips patients and providers of institutional support and resources. It furthers the stigma patients experience as they travel further and longer to access care. It discourages medical providers from offering these services, and isolates those who already do. Policies and regulations limiting where and whom offers abortion services, also impact how this care is implemented. The tighter the restrictions get, the harder it is for providers to offer the quality healthcare experience they and their patients deserve.
This struck me when I came back to the South. I saw how hard clinics were struggling to survive. There were not enough doctors willing to do the work, or staff to lend helping hands. Time moved too quickly for the number of patients waiting. Slowing down to hear women tell their stories meant denying other women’s access to services. There was not enough money for medications, not enough medications for comfortable sedation, nor enough chairs for unhurried recoveries. There were not enough tissues to let tears spring forth. There was not enough heartspace to hold room for another trauma of rape, incest or violence.
As restrictions increase and resources dwindle, providers’ wrists are tied tighter and their reach gets shorter. Their communities are left empty-handed, grasping for help that keeps pulling further away.
Like fourth year medical students across the country, I am counting the days until Match Day on March 20th. The day I find out where I will spend the next four years training in an Obstetrics and Gynecology residency.
I do not want to leave Louisiana. I do not want to leave the swamplands that have wrapped me in their warm, humid heat. I do not want to leave the communities that brought me into their families and homes, nurturing me through these four trying years. I do not want to leave the patients who have graciously taught me with their stories and bodies; from them I have learned more about the art of healing than any medicine textbook or lecture ever could demonstrate. I would like to return the favors, and continue serving a population in dire need of better healthcare. This state has some of the worst maternal health outcomes in the country. It has only four doctors providing abortions and only three clinics in which to do them. The lives of Louisiana women are on the line.
But if I want to learn how to tackle these problems effectively, I cannot stay here. My ability to provide quality healthcare necessitates learning how to address the full spectrum of patients’ reproductive health needs, including abortion. It also requires having opportunities to practice these skills without the threat of secrecy, bullets, legislation or criminal prosecution. Unfortunately I won’t find this education in Louisiana.
People tell me I can always come back, and I hope to. But what kind of care will I be able to offer my patients if there are no clinics left?
What will I do if my legal obligations and my hippocratic oath give me opposite answers?
How could I look a patient in the eyes and say “I’m sorry, there is nothing I can do for you”?
This is not the answer I want to be forced to give.
For now I wait for The Match and hope it takes me somewhere where I can ask “What more can I do to help?” and learn the skills to meet their answers.
Originally published on the Medium: https://medium.com/@alanaclaire_40443/learning-to-be-an-abortion-provider-in-the-south-8fb612eabe69