Plaque, Punishment, and Personal Responsibility

Today, we cleaned an absolutely horrifying arteriosclerotic plaque out of CC Queen's common iliac artery.

The dissection didn't even examine at the iliac. We were dissecting the kidneys (well, technically the posterior abdominal wall) and looking at abdominal autonomics.

Then we went apeshit when we realized CC had a great big BONE branching out of her abdominal aorta!

Then, when we realized the "bone" was hollow and crunched neatly with firm pressure, we totally went berserk.

This motherfucking plaque was a good 2-3mm thick over the entire diameter of the common iliac. We yanked junk out from the aortic bifurcation through at least two inches of artery. And it was beyond grotesque. Oozy, creamy goo and sharp, calcified chunks that held their shape when we set them down on CC's thigh. I wanted to puke.

This is what arteries do when they are upset. Whether it be because of aneurysm, cholesterol, or genetics, their robust pink sprightliness withers into a crackly, unyielding crust. Blood struggles to get through. Eventually, the plaque itself may get upset. A piece may break off, block the vessel. If this happens in the heart, it is called a heart attack. In the brain, a stroke. I knew all this. But in digging several grams of shit out of CC's iliac, I came to appreciate how dramatic it is.

Later, over nachos, I thought about the different ways in which we might be responsible for our own illness. "This," my professor intoned in my brain from the first day, "was a LOT of potato chips." He was referring to the thick layer of adipose on CC's hips, but could the same be said for her wretchedly stenotic iliac? Did it matter? Is a small cell lung carcinoma less tragic if it grows in a pack-a-day smoker? Should the smoker be blamed for "failing" to overcome a full-body addiction to a substance which was subtly, relentlessly promoted to him, a substance that may have allowed him a moment's relief from some other stress he could not otherwise control?

I don't know. We are told we need to refrain from "judging" a person's choices. I think part of the reason, which I never realized before, is the danger that comes from blaming patients for their own ailments. And I don't know how to reconcile the fact that so many illnesses are preventable with my belief that our choices are dictated by so much more than our free will with my wish that my father would exercise more.

I told you plaques were dramatic.

Wherein impostor syndrome hits hard

I am so crabby lately. I really am not by nature a crabby person--in fact, I think many people who know me would describe me as one of the more annoyingly bouncy people they know.

But lately, ugh. Every buffoon in my class (not that everyone in my class is a buffoon) makes me feel like standing up and yelling, "How did you people even fucking get here?" But I don't, because I'm still dwelling on my failed neurobio exam, and the fact that despite spending the majority of my evening on abdominal vasculature, I still feel totally underprepared for my dissection tomorrow. So maybe I don't even fucking belong there, either.

The sitch is not as seriously heavy as that sounds. I know, consciously, that I just need some time (who doesn't need time to memorize 50 fucking vessels?) with this new material, and that juust failing an exam worth a tiny percentage of my grade is not that big of a deal. And I'm still annoyingly bouncy most of the time, I just...am becoming increasingly disillusioned and a little overwhelmed with this whole doctor business.

I think part of the issue is that I actually have to touch people now. I've been a student my whole life. I can read, I can write, I can solve word problems like nobody's business. I have never in my life had a problem with talking to people about hardly anything. Sex, drugs, eating disorders, sexual assault, I've verbally tackled a lot of things most of my classmates (hell, lots of docs) haven't touched. But now we're learning how to physically examine someone, and it feels so much more real.

I'm supposed to palpate organs, touch faces, find the fucking femoral pulse, which I can only inconsistently find on my own damn self. My fingers feel big and stupid as I pray to whomever is listening that I can find what I'm looking for, that I don't let the air out of the sphygmomanometer too fast, that I don't poke the otoscope too far into somebody's ear and bust their eardrum. People are gonna trust me with their moms, daughters, sisters, partners, and babies? What? I can't even figure out how far back I'm supposed to stick the fucking tongue depressor.

My guess is that this is extremely normal. But nobody talks about it. We smile confidently and say "Sure!" when asked if we want to try out the ophthalmoscope. But really, we just pretend like we see the red reflex.

It's 1am. Rant over. Class starts promptly at 9.

On Tim Tebow on CBS

I've been reading seemingly endless commentaries on CBS' decision to run Focus on the Family's antichoice Superbowl ad featuring the Tebows, and my position on it has been evolving since I heard about it.

My original impression was one of largely apathy--I'd much rather see FoF and their anti brethren running commercials than standing outside clinics screaming at women. I mean, come on, it's a 30-second spot during a football game. Sure to prevent a whole slew of drunken halftime abortions, right? Whatever.

But then I began reading a little more about the content of the ad, and how CBS had made decisions in the past to avoid running "controversial" ads, and I began to form a stronger opinion. My main opinion is that CBS is enormously hypocritical for choosing to run such an ad, which has already been voiced by other bloggers. However, I do have a couple issues with this ad that I have not been seeing emphasized as much.

First, who is this ad designed to reach? Of course, a large number of women watch the Superbowl, and a large number (if not quite as large) follow college football and recognize Tim Tebow. But the placement of this ad and the use of a hot young college football athlete doesn't sit right with me. It reeks of FoF sitting atop its man-as-the-head-of-the-household structure to ask male viewers, "It's 10:00. Do you know what your women are doing?"

I also have a problem with the "your baby could be the next Einstein" nonsense. This is the same shit on a different plate. With no subtlety whatsoever, FoF puts one of college football's (and perhaps soon-t0-be pro football's) superstars up on a pedestal to warn us about the "potential costs" of abortion. We always get harangued by antis about about all the risks of abortion--post-abortion syndrome, breast cancer, and a bunch of other mythical nonsense. FoF allows men to get in on that action too, since men's stake in abortion is apparently a future NFL quarterback.

Finally, I take issue the content of the ad itself, which is supposed to feature Pam Tebow defying her doctor's orders and carrying her pregnancy to term against all odds to have this wonderful superstar baby. Before that, though, I seriously question the angle some bloggers are taking, that Pam Tebow's life may not really have been in danger. Come on, people, we're heading down the road to an environment in which life-of-the-mother abortion restrictions might become more and more commonplace, and you're questioning whether this woman's life/health was really in danger? Knock that shit off right now.

I think focus, so to speak, of criticism of the ad as it is being presented should be the primary focus. As the story goes (so far as I've heard), while she was pregnant with Tim, Pam Tebow was doing mission work in the Philippines when she contracted amoebic dysentery. Docs recommended abortion due to the risk to Pam's own life. Pam, in a heartwarming display of moral conviction, chose life, and was therefore rewarded by God with a Heisman trophy winner.

Focus on the Family's mission is to "help families thrive". Am I to understand they believe families would thrive equally well without mothers? So Pam Tebow survived. Great, I'm happy for her. I'm glad her "choice" worked out. But it seems to me that the message of this ad for women is, "It's okay to ignore what your doctors say. Look how you will be blessed if you do the right thing."

The problem is, childbirth isn't always a blessing. Fuck you, James Dobson, it isn't. Women die in childbirth in the US at a disgusting rate, and for FoF to encourage women to disregard their own best interests in the name of morality and NFL glory is, ahem, disingenuous at best. Not only is it egregious to imply women's health and lives are less important than their self-righteous bullshit view of morality, but in terms of argumentative consistency, something's gotta give. I do believe these are the same people who trumpet the needs of children for both a father and a mother. And they can't have it both ways.

On the prospect of having failed my first medical school exam (not counting PDS, which is gay)

Med school is hard. Shit.

In 500 words or less...

My previous blog entry came a little early, as I did not learn about Blog for Choice day until just after I published it. I'm a little disappointed, because I have exams coming up next week, and I don't have a lot of time to devote to this really great idea. So unfortunately, I'm doing just a quick commentary on this year's question: What does Trust Women mean to you?

Trusting Women means trusting myself. I am a 23-year-old cis female medical student. And I will be an abortion provider.

And there's a little part of me that's just terrified. Some medical students get freaked out over exams, or because they're scared of failing, they're scared of not making it into their top choice residency program, they're scared of whatever.

When I get freaked out about medical school, I get scared of doing all this goddamn work just to get harassed, threatened, hurt, and/or killed by people who don't trust women. When I get freaked out about medical school, I get scared that I won't be able to stand up to the murderous hatred spewed forth by people who don't trust women.

In those moments, I take a step back. I think about the people all over the world who have fought for women before me, who have sacrificed so much so that I may pick up the torch--who have literally died for me to be here. I force myself to remember the fight for reproductive justice (or any kind of justice) should not be comfortable. I slap myself on the wrist for thinking I deserve a cushy, carefree doctor's lifestyle when so many women need the services I will be capable of providing.

Ultimately, I remember that trusting women means trusting women to determine the course of their own lives, regardless of what the people who don't trust women might be screaming at them.

And that includes trusting myself.

All Talk

I recently read a piece I really liked critiquing current mainstream feminism for, well, failing. One of the particular criticisms which hit home for me was that feminists have "failed to frame the debate and influence how we talk about issues that affect women’s lives."

I studied rhetoric during my undergrad. I spent blissful hours analyzing the deliberate (and inadvertent) ways in which we lay the groundwork for persuasion, inspiration, unification, and various other rhetorical -ations. I know Angry Mouse wasn't criticizing me personally, but nonetheless, I don't like being told I've failed to construct a solid rhetorical framework on which my perspective and I can stand.

So I had been mulling this over in the back of my mind for a few days when yesterday, I got the very sad news that an expectant family member, M, had miscarried. The other family member from whom I received the news, G, told me they had discovered the fetus had a severe malformation and would not survive, so they chose to terminate the pregnancy.

"Hold on," I protested. "You just told me she had a miscarriage."

"She did."

I paused, knowing full well G (to whom I am very close) is antichoice, and there was a good possibility M is antichoice, as well. I chose my words carefully, not wanting to provoke debate in that moment, but at the same time, unwilling to let the misrepresentation slide.

"Look," I said, trying to inject as much compassion into my voice as possible. "I can't imagine how hard this must be for M and her husband right now, and they should tell the family whatever they feel comfortable sharing. But based on what you just told me, M didn't miscarry. Medically, that is called a therapeutic abortion."

Silence.

"I'm not trying to upset you or argue with you right now," I continued, "but I think it's important to recognize--"

"No, I see. I...I thought if the pregnancy was not viable, then you called it a miscarriage no matter what."

We talked for awhile about medical and popular terminology, and I think we both ended the conversation feeling okay. But I came away with a major rhetorical revelation.

We need to stop shying away from "abortion." I recognize the antichoice crowd loves to level the "pro-abortion" accusation at us, and one of the easiest ways to distance ourselves from that accusation is to shy away from abortion, to talk about how awful and painful it is, how no one wants to have an abortion, and we should do all we can to reduce the number of abortions.

I think all of those things are often true. For many women, having an abortion is an extraordinarily difficult decision and process. I support many of the steps that can be taken to reduce the number of abortions--greater social, economic, and medical support for pregnant women, increased access to contraception, more comprehensive sexual health education.

But the decision to have an abortion isn't difficult because abortion is inherently, intrinsically awful, unsavory, and undesirable. My support for increased access to contraception isn't because it will reduce the number of abortions. This attitude sneakily forces us, as pro-choice as we are, to paint abortion as something we should work to eliminate solely because abortion is bad.

I love abortion. I love abortion because it can allow women to take control of some small (or perhaps not-so-small) part of our lives, often when we cannot control many or any other aspects. I love abortion because it can save women's lives. I love abortion because it can save families. I love abortion because it is one of the things that allow me to help people. I love it abortion because it can create mothers, families, doctors, teachers, and futures.

So, drawing inspiration from Angry Mouse's rhetorical criticism and M's rhetorical choices, I am reframing the way I talk about abortion. I do not mean to say that I plan to discount the pain many women do experience when choosing abortion, or to withdraw my support for increased sexual health education. But I too have been guilty of defending abortion as an unsavory necessity, as something we unfortunately have to permit because of x, y, and z.

No more. Abortion sure as hell is one of those "issues that affect women’s lives." And I am rebuilding the framework which has allowed antichoice negativity to slither inside.

Another week, another organ

Despite the fact that I am currently working my ass off to stay just a couple of days behind, it's been a pretty uneventful week. Except for the part where I yanked the heart and lungs out of a dead body and played around with them, sticking my fingers through vessels and probing around for ducts.

Okay, so first of all, the aorta. IT IS HUGE. Want to know how big your aorta is? Make a fist. Stick up your index finger. Now stick up your middle finger right next to it. Those two fingers are about the size of the aorta, one of your truly, truly great vessels. The pulmonary trunk, brachiocephalic veins, and common carotid are all impressive, but nothing takes the cake like the aorta. Giant.

And the lungs! Snap, crackle, pop, the alveoli burst like a million tiny bubbles as you roll the lungs between your fingers. A pocket of air might burble out through the severed bronchus, spraying you in the face if you're not careful.

Everything is so predictable, yet I sometimes have trouble finding things if they're not on CC. CC is not an exemplary cadaver, by the way. The poor woman was falling apart at the end. Scoliosis, hernias (plural), pacemaker, major abdominal surgery. And yet in spite of it all, everything is there. Sympathetic trunk, communicating rami, intercostal nerves bundled neatly with robust little pink arteries and dark purple veins. Just like the book, just like the diagrams.

Med school. Sigh. I am simultaneously falling deeper in love and starting to hate my life.