Welcome to Third Year

It would be hard to miss her. She walked into the atrium, towering tall in a bright orange jumpsuit. She was led down the hallway, her handcuffed arms held straight out in front of her, palms parted as though to grasp a bouquet of flowers.

When we saw them later that afternoon, they were uncuffed, poking through flimsy sleeves of the hospital gown she was given. Without her body wrapped in its orange uniform, or the security guard sitting at the foot of her bed, you wouldn’t know she came from the prison. She now matched her neighbors, donning that sad sky blue material, that pitiful excuse for a color. The one decorating most healthcare facilities, the one that is supposed to warm up sterile rooms and hearts alike while failing at both. Continue reading “Welcome to Third Year”

Pennyroyal: a less than royal mint

I wrote this a while and submitted it to Physicians for Reproductive Health blog where it was published. Click here for a link to it, or read below.


Last summer, I received funding from the national network of Medical Students for Choice to do an externship in Mexico City. This externship consists of spending two weeks observing in an abortion clinic. But before this…a little detour to Oaxaca.

The week before starting at the clinic, my boyfriend and I planned a short but sweet three-day vacation in Oaxaca, just an hour flight away from Mexico City. The first day passed blissfully. We spent it strolling and tasting our way through the city’s cobblestone streets. The next day, we embarked on what was promised to be a beautiful adventure, hiking through the Mancomunados villages of the nearby Sierra Norte mountains. We started in a pueblo called Cuajimoloyas and headed out for the six-hour trek with our guide, an ageless local named Jose. Over and under trees we trekked, stumbling through fields of wild flowers, happening upon a newborn baby goat, discovering agaves with shoots 50 feet tall. I had asked Jose to share any knowledge he had of the plants, particularly the medicinal plants, which only seemed appropriate as a medical student.

He first showed us poleo, explaining how it is typically used for the stomach and digestion. As we had spent the previous day eating the entirety of Oaxaca’s food supply, these leaves looked quite tasty to my intestines. I popped a few in my mouth and on we went. When we passed another bush I snagged a few more, asking Jose if one can eat too much poleo.“No, no pasa nada,” he responded. And with the trust that comes from pure idiotic ignorance, I chomped on a few more.

We pressed on, heading to Latuvi, a small town perched high within a sea of mountains and known for its abundance of peaches and apples. Hours later I was hot and tired but motivated by the pulque tour and sweat lodge waiting for us at the end. However, when we made it to Latuvi that’s where it all ended. Or began. The poleo that Jose promised wouldn’t cause any harm decided otherwise.
Continue reading “Pennyroyal: a less than royal mint”

Finding your Dx

Recently, I wrote this email:

Hi Dr. W,

I was a patient of yours in 2006 when I started at Scripps college.

I’ve thought about you many times as the years have passed, how lucky I was to receive such wonderful care. I am proud to say I have never relapsed since, and am strong, healthy and happy. In fact, I am now a medical student at Tulane, hoping to pay it forward. 

Thank you for your work,

Alana 

I’ve heard a lot about the self-pathologizing that happens in medical school. How everyone will start to think they have the various diseases we learn about. With my own family history of hyperchondriasis, I too, have been waiting to find my rare diagnosis. Waiting to learn about the condition that pieces together all the symptoms I didn’t even know I had. Luckily, by now we’ve gone those most of the bodies systems, and my bones, blood, and organs have come out “unremarkable”.

Then we started on the brain.

Continue reading “Finding your Dx”

Unsolicited Advice

I have always been a wanderer. My mother always kept an eye on me as I would drift from the crowd to find a quiet place to play. On family bike trips I would speed past my family until the road came to an end, or sprint ahead on a hiking trail losing myself in the monotonous beauty of oak trees until I was called back by the shouting of my name as they searched for me. As social as I was, I always needed time to be alone, time to be bored. Time long enough for boredom to turn into daydreams, for daydreams to turn into fantasies, and for fantasies to turn into inspiration.

I do not wander to get lost, although it sometimes happens. Two feet guide my steps, the right slightly larger than the left. Two hands balance my stride, one soft holding no expectations, while the other clutches to a small hope for discovery.


At the library a few weeks ago, I asked to share a table with a girl pouring over pages of organic chemistry. Because I cannot help myself (I am my mother’s daughter after all), I asked what she was studying. She told me she was studying for the MCAT exam. I could have guessed from the tired and desperate look in her eyes. A look I haven’t seen on myself for a while, but remember all too well. I sat down and pulled out my books on pathology and Step 1 Exam prep.

I promise it gets much more interesting, I said with a smile. Continue reading “Unsolicited Advice”

Abortion: when politics meets practice

The first day of my externship I arrived to a sweet little 3 story clinic tucked between mom and pop shops in a residential neighborhood in Mexico City’s Avante neighborhood. I showed up ready and eager. I had done my research: spoken to previous students who had attended the clinic, read up on procedural standards, researched the history of reproductive rights in Latin America, and familiarized myself with the current policies that highlight Mexico City as a sanctuary within the country at large*. This new information added an extra pep to my steps alongside the pro-choice activism I’ve been engaged with through medical, political, and social spheres. These two weeks were to be an officiation, a baptism of sorts; a way to fully immerse myself in the work I’ve been so passionate about.

The experience was structured for me to follow patients throughout their visits. First, was the medical consultation where clinical histories were taken, ultrasounds performed to confirm gestational ages, and discussion were had about birth control options moving forward. Second, was the counseling session with the psychologist. Recognizing that most patients arrived resolute, the purpose was not to help women make a decision. Rather, it served as a space to reflect on a woman’s ability to decide, to have control over her life and body, to help strengthen her ability to confront fears and conflicts, both internal and external. At the end of the session patients received their medications. As preventative measures, a dose of antibiotics and ibuprofen; as preparatory, a dose of misoprostol**. Lastly, they moved to the operating room for a 15 minute procedure that started with paracervical anesthesia***, then cervical dilation, and lastly manual vacuum aspiration.

Like a mute shadow, I followed along, observing. Each stop through the process showed a new depth of compassion offered by members of the clinical team to the women that passed through their care. I was touched, inspired really.

Until I saw my first abortion. Halfway through the procedure I had to dismiss myself and sit in the hallway outside. I heard the nurse speak softly to the patient, “Breathe in, hold for 3, breathe out,” and I followed along. 

When it was over, the doctor came out and met me with just as much kindness as he did his patients. Just breathe, sit down whenever you need to. Let us know if it ever becomes too much, he told me. This happens everyone’s first time, he said with a smile. But that was just the problem. See, I wasn’t supposed to be this grossed out. This is the work I had come here to do, this is what I had prepared myself for. I wanted so badly to be a model student, to not be everyone else.

Like most falls from hubris, the fact was I was just disappointed in myself. Disappointed that I couldn’t handle it, and even more disappointed that I had assumed otherwise. The truth is that there are some experiences no amount of work can prepare you for. Some journeys have no shortcuts and the only one road to take is the one that passes through. So it was and I continued down the path. 

I wish I could say that each day it became easier. But that is not what happened. I did not learn to disconnect myself, nor to stop imagining the sensations of what I saw. I did not learn how to still my focus on the procedure or concentrate on the anatomy involved.

And as the days turned to weeks, I learned this was okay. These are skills that can come with time and practice. Instead, the experience taught me more important lessons.

I learned that abortions are not pretty, they are not fun, and they are not a desired procedure. But they have always been necessary, and as long as human continue to mate, they will remain necessarily. That women will always need access to abortion services is not up for debate. Rather, the question is always how, where, and in what conditions they occur. Quality care goes beyond safety. It requires honesty, trust, and difficult conversations, as much as it does tender handholding and empathy.

I learned not to minimize abortions; that the experiences they bring are as varied as the women who have them. As a physical procedure, they can bring the pain of invasion as much as they can an ecstasy of liberation, a reclaiming of one’s body. As a process, abortions span an ocean of emotions where despair and relief, fear and gratitude, loneliness and solidarity are tangled up like seaweed.

As future abortion providers, our job involves more than a procedure. It requires meeting women where they are at, walking with them and providing a safe space to support them through their process, whatever form theirs might take.

 

 

 

* In Mexico, similar to the U.S., states are able to regulate the national abortion law, which only mandates approval for abortions in cases of rape or incest. Although other exceptions exists such as when the life or health of the mother is at risk, for socioeconomic security, or for the health of the fetus, these vary on a state by state basis. Then 2007 rolled around and Mexico City brought with it the decriminalization of all first trimester abortions. As of now it sits in the middle of a country as a quasi sanctuary city for women seeking safe abortions. Women come from other states of Mexico and other countries, as far away as Brazil and as close as El Paso, Texas.

** Depending on the gestational age, misoprostol was taken either sublingually (when less than 12 weeks) and buccally (when over 12 weeks), to contract uterine muscles, helping preventing perforation, and to dilate the cervix.

*** For pregnancies over 15 weeks general anesthesia is used.

 

 

Big Easy’s First Lesson

New Orleans. This place finds creative ways of welcoming you. To the careful observer, she weaves her lessons into unsuspected moments of the day. She holds history in her cracked sidewalks, her houses reclaimed by nature, her schizophrenic thunderstorms, her regular before-dawn drunkards, and the ghosts who wander her streets, making sure their stories are not forgotten.

She hunched over her bike, sweat being to trickle down her face as she wrestled with the lock. A large backpack was precariously balancing over her right shoulder slowly slipping down, a not so subtle reminder of the class she was increasingly late for. Panic increased her uncoordinated jabbing motions to get the lock in place.

Something caused her to look up. An old man walking towards her was watching. As he passed his slow twangy southern accent sang out, “take your time baby, take your time.”

“I know but I’m late!” she laughed back anxiously. There was no response as he kept walking. She looked down at her bike, put her backpack down, and stood up.

“That is exactly the reminder I needed to hear right now,” she said as she took a deep breath.

Weightlessly, effortlessly, she bent down, locked her bike, and grabbed her bag. She turned to say “thank you” to the old man but he had disappeared.

So she head to class, remember to move slowly and take her time.