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Facing a career in abortion provision in a sexist world

20 Nov

A fellow first year medical student was in my bedroom one evening last week. I was sprawled on my bed, she was sitting in my well-loved-by-humans-and-cats orange velour armchair, bought by my grandmother in 1962 at Sears when firey orange was a reasonable color to use to upholster furniture or paint hallways. I love that chair – it sat under my lofted bed in the attic room I shared with my sister during my childhood, and it came with me to college where it was moved from dorm to dorm through four years, residing with me or with friends in almost every New England state over the summers. It’s not pretty, or new, or fashionable, but I love it. It’s comfortable, it’s familiar, it’s me.

That night we were chatting about the upcoming challenges in our lives: balancing medical school with family and friends, the difficulties of finding time to do the other things we love in life, anticipated academic difficulties. We also found ourselves talking about family and the future, and the conversation moved in the direction of babies. Several of our classmates and friends had recently given birth. We talked of their challenges and the similarities and differences of our lives. As often follows, we talked of our own thoughts on having children.

My disinterest in having my own children is often perceived as pathology, something many women experience. But I find that in particular, everyone has an opinion when they find out these two things about me: that I’m interested in specializing in obstetrics and gynecology, and that I don’t plan to have children of my own. In this instance, my fellow first year latched onto my interest in abortion, taking it as a twisted motivation to prevent others from having children. She questioned my ability to be an impartial compassionate health provider to those who make different reproductive decisions than mine, and mused that patients would be able pick up on my silent judgment of them and their choices.

In addition to the personal hurt this conversation brought, it made me think about having an academic interest in medicine as a woman, the persistent sexism we face in medicine, from institutions, classmates and even friends. Medicine is incredibly hierarchical and conservative, with a past (and often a present) rife with abuses, injustice, and paternalism. Speaking up about these problems is a challenge, and I’ve been finding that it is difficult and exhausting to share my academic medical interests. You can bet that if my answer to the question “what specialty are you thinking about?” was ophthalmology, or pediatrics, or internal medicine, I wouldn’t be required to explain why I’m interested, why it’s important, and why it’s worth a lifetime of academic and professional investment.

I’m sure if abortion provision and family planning didn’t interest me, make me think, or inspire me, there would be something else: cardiology, surgery, infectious disease. And I strive to have an open mind to any subject – I’m sure I’ll make space in my learning and my practice for different things. But if my interests that brought me to medicine were different, I would be a different me. I would seek out different opportunities and partners and educational experiences. But this is me – I have an orange velour arm chair, and I have a legitimate, rigorous academic interest in becoming an abortion provider.

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Picking a medical school that trains abortion providers

23 Jan

I visited colleges with my best friend when I was 16, hoping to jolt myself awake from my junior year case of senioritis. I predictably discovered that I didn’t know what I was looking for. We decided upon two (decidedly superficial) tests: First, did the admissions office give free frisbees? Were they the ones with monogrammed liberal arts school seals on them? Were they weighty, with a good lip, or were they cheap three-quarter sized neon knock-offs? And secondly, did the cafeteria offer chocolate milk, and if so, was it whole milk? Skim? Good chocolate syrup or a generic chalky powder?

I eventually chose one of those schools; realizing the vast number of factors actually more important than their chocolate milk or their free frisbees. And I developed into a person who cares about more and different things…but now I’m applying to medical school, with still two tests of my future happiness there. They are both of the social-justice variety, based in my professional interests, and tests of what kind of school I am interviewing at:

Test #1: Are there curriculum hours committed to abortion-training, and will the school help me find rotations that allow me to learn this skill set?

Test #2: Are there curriculum hours, a student group, and administration-commitment to training tomorrow’s doctors to care for folks in the LGBT community?

My most recent interview and visit left me not only certain I wouldn’t attend, but utterly discouraged. When asked about LGBT-inclusive healthcare training at his school, my student interviewer looked baffled. He mentioned the first name of “a girl who is involved in the student group, probably”. He also casually mentioned how uncomfortable he would be to ask “if my patient slept with boys or girls”. In response to the inquiry about abortion care, he felt empowered to share that he is a libertarian, so approves of a woman’s right to choose, but he wouldn’t feel comfortable performing an abortion or even referring someone to a different provider. He was also quite sure that “the school probably wouldn’t take action” against me if I pushed to do a rotation specifically focused on abortion care.

I’ve been able to stay excited in the often draining days leading up medical school by planning what kind of doctor I will be. Every doctor has a specialty (right now, I think gynecology and obstetrics for me), but every doctor also has a defined philosophy. Who will I be as a provider? How will I demand excellence from myself? These questions bring me back to the framework of reproductive justice: I will be a better doctor if I can understand every patient, their unique situation, and the forces in their lives that lead them to one decision and not another. Reproductive justice means an intersectional understanding of the struggles and triumphs my patients will experience in their journeys toward reproductive self-determination, and understanding my place as a medical professional.

Access to competent, quality, and respectful health care for lesbian, gay, bisexual, transgender individuals is reproductive justice. Access to competent, quality, and respectful abortion providers is reproductive justice. And despite being utterly thrilled and excited to interview at several medical schools, my experiences asking about these important issues have been disheartening at best, terrifying at worst. As respected as the medical profession is, and as difficult as it is to be admitted to school, doctors can only be as good as their training. My ideal medical school would train and nurture students to become tomorrow’s trusted, inclusive, and knowledgeable health-care providers, willing and able to help anyone who comes to them regardless of their choices, their gender identity, or their sexual orientation. It wouldn’t be bad if they had good frisbees and chocolate milk, too.