med school is like this cat

two sides of the miracle of birth

Tuesday August 11

the nurse mid-wife i was shadowing today offered to allow me to assist in two births.
i watched her coach the patients for the most part, but then after the baby began crowning, she showed me how to apply anterior and posterior pressure to the tiny, fragile, jelly-like cranium of the baby to minimize trauma to the mother's vaginal canal.
after the first one, i was having a lot of trouble trying to blink back the tears of joy, astonishment, my body quivering in its attempt to physiologically scream Hallelujah. it was a difficult birth and the mother was torn up quite extensively and would need hours of stitching up afterwards. but to feel the head finally pass through, and then the rest of the body follow quicker than a blink of an eye, and then all of a sudden you have this steaming mass of human in your hands...
the first one came out with the cord around his neck, and immediately the room was swarming with Peds docs with baby gas masks and various suction devises to get air into this little blue body, which by the minute was turning pink and robust. there was tension in the air like a thunderstorm, but it thankfully passed.
the second birth was almost too easy - not nearly as much blood or pain. the tiny girl came out purple and crying. i wasn't so apt to begin crying this time around but was still wide-eyed with the gravity of what exactly i was doing. i still can't wrap my head around it now.



Wednesday August 12

scrubbed in to a repeat C-section today. got the low down on sterile technique in the OR. and also got an eyeful of the horrors of cutting through a woman's midsection to extract her baby. this lady had tons of adhesions from her last procedure, so there was a big use of the cautery tool. i was put on suction and retractor duty. it felt horrible to be pulling her flesh in ways it was never meant to be pulled, and i suppose it is a testament to the resiliency of the human body that you can pretty much rip through the fascia like it was the first day of anatomy and the patient will still be okay in the end. the smell of burning human i could take, the massive quantities of spurting blood i was fine with, the cutting and scissoring was okay -- but when the attending took her hand and shoved it up in into the abdominal cavity, the sound of ripping fascia was just too much. we treated our cadavers this way, for crying out loud. didn't help that this woman was half-consciously struggling with discomfort despite the anesthesia.
the baby was delivered and almost immediately began heartily crying. there was still joy and relief in the OR. however, something just wasn't the same. plus, they ultimately had to put the mom under general anesthesia so they could begin the long, long....long process of putting her back together again.

summer of love

will update with photos later (as if people are even reading!) but just wanted to make a quick note for myself

this summer has been absolutely amazing
not necessarily fun, per se, but i feel like an entirely different person

taking the trip to india was really really difficult. physically and mentally. we saw so much poverty. so many people in need. and then you realize how fraught india is with corruption and bureaucracy, and you lose all hope for humanity. it was hard to stomach. but in the end we gave medicine to nearly 2000 people in just 5 days. there was joy in every tiny thing: running water. a ceiling fan. children singing. a man riding an elephant down the freeway :)

now, i'm in a women's health externship at sf general/ucsf and, like india, it's been exhilarating and terrifying at the same time. it makes me see first hand how stifled women's voices are not just in terms of healthcare but in society in general. it is hard to stomach. but there is joy in every tiny thing: holding a hand in the operating room. finding a heartbeat on an ultrasound. sharing laughter in the face of desperation.

i'm a million times more motivated to go back to pomona and try to make it through the rest of the infamously hellish 2nd year of medical school. everything i've seen in the past couple months could make anyone completely jaded and bitter. i'm trying so hard not to let it do that. trying to go through every day not with hate towards the evil in people, but with love for what we can hopefully be.

I want to

...eat my way through San Francisco magazine.

I also decided my first substantial paycheck as a doctor will be spent at French Laundry.

One day....one day...

i am not my hair...OR ARE I

i have an asian 'fro. or as i call it, an ayzro.
half of my scalp grows hair that is fine and straight, half coarse and corkscrew-curly. it drives me mad. i perpetually have a frazzled look, as bits of curly ends pop off the crown of my skull. putting my hair up causes a Mrs. Brady bend that lasts until i shampoo it, but when i try to curl my hair for a night out, after three hours its dead straight. i could never get that full, sleek, sexy look that some of my friends had, and i would think, if i only had that hair, my life would be better. There would be one less thing ugly about me.

in college i discovered Magic Straight, a Korean concoction of chemicals that allowed my hair to be as flat uncooked angel hair. i'm not gonna lie - it was super convenient. i could shower and let my hair air-dry and it would lie perfectly straight. it felt great to whip my hair around during dance practice and have the strands fan out into a perfect circle. it felt great to tie my hair up and feel the stiffness of the base of my ponytail as it artificially resisted the curving pull of gravity. i felt like it made my enormously round head look smaller. i even felt glamourous. i felt more confident about running my fingers through my hair, about flipping it over my shoulder nonchalantly. but of course, all this came at a steep price - one that i, in my vanity, was only too glad to pay nearly yearly at a local Korean salon.

this past year in school, i had no time to look for a Korean hair place, and trusted no white-person-salon to get my hair as i liked it. and thus, over the months my head re-grew its native flora of wirey fly-aways. i felt frumpy and was constantly pissed off at my hair's refusal to make me look good. i felt like my head looked huge and puffy and rounder than it is. i left socal for summer vacation fully intending on visiting my Korean salon so i could become sexy again.

during my trip to india, i realized something.
there are worse things in life than shitty hair. there are better things i could be putting those hundreds of dollars towards.

people who have met me recently might be surprised to know that i was pretty much the epitome of awkward and extremely introverted up until a few years ago. i was the person who never said a word out of sheer unadulterated fear of embarrassment. i was the person willing to sacrifice almost anything to feel pretty so that i could feel accepted. i pored over beauty magazines. i researched plastic surgery in depth. i hid in the corners at parties and meetings and public functions. (well, until i discovered alcohol, that is.) i was so convinced that i was born terrifyingly ugly, and that the only way people would want to connect with me was if i was pretty. i had (and have, still?) such low self-esteem and sense of worth that for the longest time i could only cobble together an identity out of what what i thought others thought of me. and therein was my true problem.

it is a struggle that most of us endure - self-acceptance. realizing that the world is what it is, but also simultaneously that it is what you make of it. you don't conform to some arbitrary standard that people you don't even know have imposed on the world around you. you create your own world through your attitude. and i guess, sometimes it takes a trip to one of the poorest places in the world to make you snap the f*ck out of it.

coming to accept my hair has become to me a journey with far greater meaning than simply accepting the fact that i can only look like me, not like a model from an herbal essences commercial. it has become more of figuring out where i fit in in this world, how i can make a difference - what makes life worth living, and how i can make myself worthy of this life. by investing so much in torturing my hair into something it was not, i was putting value in something that isn't lasting - an image that i thought other people would value - as opposed to valuing my own self, what i am capable of, what i am able to give to the world.

i am my hair. i am a walking conglomerate of contradictions - curly and straight, wirey and fine, strong of will and weak of desire, big-boned and small of face. i am a sniveling, simpering wall flower, and a loud, joyous social butterfly. i am as cold as San Francisco in the summertime. i am as gentle as a roaring tide. when the wind blows, my hair parts in the middle of my head in a way that makes me look like a balding monk.

but you know what. that's okay.

v-day

last night was the performance of the "new" vagina monologues. eve ensler published a collection of works dealing with domestic violence. i helped to set up the show for my service learning project. i performed my piece. and then spent the show outside, watching the food and money tables, trying to listen through the crack in the door.
i got really drunk. i had a lot of wine while i was outside. i didn't intend on doing it, but throughout the show setup i felt silently criticized by others, and was also really frustrated that i hadn't planned it better with the director, who was simply amazing, but spacey. i felt like i didn't do my job, that i could have done it better.
that stress showed in my piece. my voice started to waiver and crack. so i drank. i drank half a bottle's worth of red and white, on an empty stomach. and when one girl started to read her piece, i cried. and was still crying when the show ended and so everyone saw.
i am so glad i was an integral part of V-week, and learned all these things about domestic violence. i am glad that i visited the local battered women's shelter here. i am glad that there are people on this campus who are passionate enough about these issues to have them integrated into our school life. i am glad that our curriculum was changed to reflect that - we now have a standardized patient encounter where we will have to counsel a girl on abortion. i am glad that the "moral majority" is the minority here, or that they are too busy to enforce their beliefs on the rest of us.
i am not glad, however, for the prevalence of politics pervading student life. how one or two people make the power grabs. how second years groom first years as replacements and then come election time do not give anyone else a chance to run for positions, give ideas, make their voices heard. politics are so stupid. the petty stories i have heard...its like, seriously? we are not in jr high. we are in fucking medical school. and i'll bet this shit goes on in hospitals and clinics also. you will never escape other people's shitty behavior. all you can do is control your own. at the show last night, i didn't - my voice turned to steel, my face, a scowl. i was and am really ashamed of that. so i drank. and i cried.
as i was driving to school this morning, thinking about the show, i also realized, for the first time -- in 26 years, this was the first time i had realized this -- that my home was filled with domestic violence. domestic violence is not defined by physical blows. but by control, by fear, by emotional damage. and then all my flaws made sense -- my self-destructive tendencies, my obsessive search for safe places, within dorm rooms with the door shut tight, within people i could trust who would never abandon me. because at no real time had i truly a home --
and it was not my fault.

and i suddenly no longer felt so ashamed to cry.

choice.

In my career as a physician, I do plan on becoming trained in how to perform abortions.

Do i condone abortions? no. but i will be damned if i do not do everything in my power to support what i believe is true freedom: the power of free will. the ability to choose.

i believe what i believe, but i also respect what other people believe and am fine with letting them alone to believe it. it is when they try to impose their version of the world and their morality on 300 million other people that i have a problem with it.

according to their version of the world, under no circumstances must a child be harmed, including time in utero, because to them what is in the womb is considered human. even in instances of rape, when the mother's life is in danger, of situations where the child will most likely be cruelly abandoned, or if the baby will be born so severely deformed that it will only live outside the womb for an hour or two -- this baby must be born no matter what the cost, because God sanctions all life.

the fetus is sacred. therefore, no matter at what stage, it is to be valued more than the mother carrying it.

very little attention is paid to the cost that women must pay. conception is a dual act between a man and a woman, and yet it is an undeniable biological fact that the woman must suffer the brunt of the consequences, intentional or not. all this not even taking into account the great physical duress of pregnancy and childbirth itself -- ligaments stretched out, muscles weakening, incontinence, hormones -- and all that in a normal pregnancy. in most of the U.S., if the pregnancy was a consequence of rape, the woman is expected to suck up the horrendous trauma she went through and have the baby anyway. if the woman was a twelve year old who barely has any idea of what sex really is besides what she sees on tv, she must have the baby anyway. if the woman is with a man who abuses her and her other children and will most likely abuse this baby also, if she lives in extreme poverty on the streets, if the fetus has a congenital defect so severe as to cripple it for the few years it will survive costing millions of dollars in care, she must deliver the baby all the same.

and in fact, many women do.

and in fact, many women who CAN CHOOSE this, DO choose this.

no woman in the history of civilization has ever sought to get pregnant just to get an abortion. no physician can honestly say they enjoy the procedure either, especially as gestational age increases. abortion is not fun, it is not joyful, it is never a matter taken lightly. even some pro-choice women opt not to have abortion.

but they have had that choice.

thanks to the hard work and far-sightedness of some of our fellow classmates, in our medical program we have been exposed to films and talks from doctors who have been at the front lines caring for women who were unfortunate enough to not have that choice. doctors who have seen the gruesome outcomes since the 1930s, 40s, 50s, when this discourse was nonexistent in our society. they have seen those women, left with no choice, who have resorted to taking matters into their own hands. hands that desperately unwind that rusty wire hanger, hands that insert caustic substances into their vaginas that burn through the peritoneum into their abdominal cavity, hands that push themselves down staircases. they have seen these women butchered, suffer, and die, needlessly.

the consensus from all these doctors who have been practicing for decades is the same.

to deny women the right to a medical procedure done correctly by a trained professional is an act of violence in itself.

banning abortion is the most misogynistic act of society there is.

you can ban abortion and write this into law, but it will still happen. it will still happen in the dark alleyways, in solitary suburban bathrooms, it will still happen in the shady, disease ridden parts of town. it will be performed by unskilled hands, by those whose grasp of human anatomy and sterile procedure is at grade-school level, at best. women will puncture holes in through their reproductive organs, they will bleed to death, they will languish in the hot fever of infection for days upon days. they will see the potential that could have been their life come to an end. watch a documentary with interviews of women who have attempted to end a pregnancy themselves, whose friends have died in the attempt. try to remain unmoved at their stories.

you may consider a woman ending her pregnancy to be "murdering her children." but it is not our choice to make. it is hers. the blood, the burden, the shame, the guilt, the horrific pain, the emotional torment, the shadows and ghosts haunting her until the end of her life -- that choice is hers. and hers alone.

how dare we sentence her to possible death because we, in our warm and comfortable homes, having seen none of this with our own eyes and having held no trembling and terrified hands in our own hands, enforce our pure white doctrine upon a woman who did not ask to receive it.

to see women promote policy that is so completely anti-woman breaks my heart.

as a physician, it is my duty above all else to protect my patient. if for whatever reason i cannot, i will find someone who can. i MUST be my patient's advocate, no matter what they believe, no matter if they are a moral or immoral person, an irresponsible or responsible person, a shining example to society or the most wretched sliver of a human being. i am not here to judge my patients. i cannot be, and still be a good doctor.

and so i choose to become that physician of last resort. regardless of what i personally believe, i choose to learn the skills that may one day save a young woman's life.
and many of my colleagues choose otherwise.
and we are all blessed, because we are able to make that choice.