For those of you who haven't been on vacation for two months and are eager to read some more about medical training, the following is an old post about one of the most unforgettable experiences I had during medical school:
when i thought about going to medical school, i never thought i would spend a morning watching people have abortions, but now that i think about it, i really should have been outraged if i didn't.
one of our professors quit her job at a more prestigious medical school because abortions were no longer part of the clinical curriculum there. at my school, they don't make you watch, but the professor made an impassioned argument for observing at least one abortion regardless of what our beliefs are. being pro-choice myself, i initially didn't have any problems with going to the abortion clinic for a few hours, but as the date got closer, i started becoming more and more squeamish. other med students, even ones who were staunchly pro-choice, said that they became nauseated and couldn't stay for more than 30 minutes or so.
it would be hard to find the abortion clinic if you wanted to hurt the people who are there. it's in a normal-looking clinic, and the woman waits in the same waiting room as other clinics. when her name is called, she is brought to a nondescript room in the middle of a nondescript hallway. there are two rooms. someone else has already talked to her about her choices during a previous visit, and surgical abortion is what she's chosen. when she arrives, she changes into a hospital gown and talks to the nurses.
when the physicians walk in, everything is set. most of the women are put under conscious sedation, which means that they were drowsy but still aware of what was going on. they put a speculum in the vagina just like a pap smear and inject the local anesthetic around the cervix. then they slowly insert small rods into the cervix one at a time, increasing the size of the rod to make the cervix dilate. when the cervix is wide enough, they will use suction to evacuate the uterus. if the pregnancy is very early, they can use what looks like a big plastic syringe. by drawing back on the plunger, there's enough of a vacuum to almost empty the uterus. if the woman is further along, they can use a machine to suction. then, they'll take a metal loop and scrape the inside of the uterus to make sure nothing is left (you can feel the gritty texture of the uterus using this tool), and it's done.
the contents of the uterus are brought to another room and put in some water. the doctors sift through the contents with some tweezers, separating out the clots of blood to make sure that all the fetus parts were removed. i saw only first trimester terminations, so nothing i saw was bigger than my pinky. however, you could see a small skull with an eye and a very thin skeleton. they would usually measure the length of the fetus's foot to determine how far along the pregnancy really was. they identify all the major fetus parts to make sure nothing is left in the uterus to cause an infection.
i almost left after three procedures because i felt sick. it wasn't the procedures themselves that bothered me but the sifting through the uterine contents afterwards. the smell, the small, human-like object torn into pieces and then reassembled to make sure we didn't leave an arm or a head in the uterus ...
what were my impressions after seeing twelve surgical abortions in three hours? the physicians i worked with were all very kind, wonderful people, but i was a bit surprised at how business-like they acted. they introduced themselves, were sensitive to the patient's pain, and made sure to be as quick as possible. however, there was no chit chat before the procedure, no connection made between physician and patient, which is very different from most aspects of ob/gyn. i made this comment to a nurse, and she told me that doing abortions day after day, year after year takes a toll on providers. maybe that's how they're able to keep themselves together.
i was also surprised at how fast things went. it was very efficient with almost a factory-feel to it. the physicians were in the room for about 5 minutes. afterwards, the woman would go to recovery for 15 minutes or so and then leave.
in most areas of the world, women only get local anesthesia during this procedure, so only some of the pain is diminished. one woman did not want the drugs that would make her sleepy, and i could tell she was in a lot of pain. she screamed for the whole five minutes while the nurse who usually injects the drugs could only hold her hand.
i only write about this because i doubt any of you will ever see what i saw that day. it didn't change my mind about whether women should be able to have an abortion. i almost left the clinic after a few, but i thought it was important to stay. however difficult it was for me to see these women go through a difficult and traumatic event, it was more difficult for patient. i certainly better appreciated how performing abortions can take its toll on someone--patient and provider. even if you believe in what you do, it must be difficult, and i'm grateful that some people find an inner strength to provide this option to women.
It's been over a year since I spent the morning in the abortion clinic, but I have thought about that time often. For a while I considered going into family medicine or ob/gyn because abortion services can typically be part of that training. However, I wasn't sure if I could be an abortion provider no matter how strong my belief in a woman's right to abortion access. During my interviews, an internal medicine program director told me that one of her trainees learned how to perform abortions during residency, so I guess that door is still open to me.
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