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Politics and clinic update.

I think anyone intelligent who watched the debate last night would agree that McCain stomped Obama into the ground. The guy was genuinely laughing at him for being so dumb on a couple of occasions. I get less and less enthusiastic about the election each time I have to compare the two sides.

In clinic news, www.40daysforlife.com began last Wednesday. Around 20-30 middle-aged folks gathered outside the building on the sidewalk singing hymns, waving signs at passing cars, dramatically praying, and passing out lies about abortion. They came at 9:30, an hour and a half after the clinic opened (I suppose they couldn't be bothered to get up that early, even though their own vigil schedule specifically says the protests begin at 8am). They left before noon, because it was getting too hot and they were getting hungry. Lunch is obviously more important than "saving babies."

A couple of them still managed to get arrested. The police are generally on our side, since we aren't doing anything other than what we do every Wednesday. Some of them are too stupid to understand that they aren't allowed on the property where the clinic is.

One patient told me that they started to bring out young kids to parade around for the patients to not give a damn about (seriously, if any kids are going to influence their decision, it'd be their own kids). This patient also mentioned that her parents used to make her come to protests like this when she was a girl. Several patients semi-joked that their parents would be out there if they knew.

So far, I haven't seen evidence that patients are being swayed away from abortion by the protesters. By the time they come to us, they have already made up their minds. One girl was unsure of her decision when we asked her get into position on the OR table. So, we got her up, got her dressed, told her to think about it some more before going through with it, and sent her on her way. I expect to see her next week. She strikes me as the sort that knows it is the right decision, but is very sad about it. They generally end up coming back for their abortion a week or two later. If the antis can't influence someone who has all those negative emotions about their decision, they are completely impotent.

We're expecting a big crowd on Monday. They are all supposed to meet for lunch down the street and listen to some minister give them a pre-game pep-talk before coming over. Looking at the schedule for laminaria patients, we'll likely be done or close to it by the time they even show up. It will also be around 95 degrees outside, or hotter. They won't last long, or they'll stick it out and feel righteously miserable. If they are lucky, they may catch one of the smokers on a break. That has yielded amusing exchanges so far. I particularly like how our CM flumoxed an anti by informing them about our counseling, pre-natal, adoption, and childcare referrals. I think the anti's head exploded when she was told we send unsure patients home instead of manipulating them into having an abortion.

There is a pretty even mix of men and women. I don't find it surprising. Women are just as susceptible to dogma and ignorance as men are. They don't have the imagination to think about what women with unwanted pregnancies are going through, or what might be influencing their decision. Another thing, most of the women are past or right in the age when menopause sets in. I noticed it with my mom, who became less enthusiastic about being pro-choice after she was post-menopausal. She seemed to forget that she had an abortion fund saved up (with contributions from her own mother) when she was in her early 20's so that she'd be able to obtain an illegal abortion or travel to another state (or country) to get a legal one. She isn't in touch with the sense of near-panic she felt at that time, and she so she doesn't empathize with women who feel the same things today. It's a lot easier to ignore the necessity of legal abortion when it isn't an issue that will effect you. That's my explanation.

I'm not sure how this will continue at our clinic. The Planned Parenthood nearby has a protester outside 24/7, and it likely will for the whole 40 days. I imagine things will drop off at our clinic after the initial enthusiasm is spent. Interestingly, after their protests began, our schedule got fuller and fewer people were canceling appointments. I feel vindicated knowing that our patients are sure enough of their choice to write off the protesters. If I actually saw a lot of women changing their minds, I would worry more about patients being ambivalent or manipulated into doing something that they wouldn't choose for themselves. But women know. They know that a kid would result, and that's why they are aborting. It isn't like they don't know what they are doing. We ask them explicitly at each step, "Are you certain of your decision to have an abortion?" There's plenty of opportunity to back out, but they don't. It's often an unhappy choice, but they are sure it's the right decision for their lives (and the lives of the kids they already have).

All the protesters do is make patients angry at their pretentiousness.
It was a really interesting day at work. I started off so chipper and perky, because I got up early enough to exercise, eat breakfast, and practice piano before leaving for work. Plus, the morning went very smoothly. I was working in the back office and lab helping with laminaria insertions for the D&E patients. With one exception, all the morning patients were pleasant and chatty.

The afternoon was a doozy. Hungry patients = more discomfort. Seriously, most often it is best to eat something as close to your appointment time as possible. If you can't eat anything after midnight, have one hell of a late-night snack at 11:30. Being well hydrated helps too.

You know what also helps? Not using meth. Ever. If you are a meth addict, your pain tolerance goes down the drain. Also your ability to control your emotions and your reactions to them... and you'll likely be irritable and piss off the staff. Please, if you are an addict (or anyone else, for that matter, but particularly if you are a drug addict), do not ask for "extra drugs" when they are not at all necessary. And don't get mad at us when we deny your drug-seeking "requests."

And, for the love of all that's holy to you, please don't scream, jerk, and tense up so much that it's almost impossible to take the speculum out much less actually do what needs to be done. You'll make it harder on yourself. It will hurt more, because you are clenching down around a metal speculum in your vagina. The tensing will also tighten your cervix, making the laminaria more painful. Your sobbing and yelling will make you hyperventilate, and you may very well pass out or vomit. I don't like cleaning up vomit. I also don't like it when all the patients who were in the waiting room while you were in the OR are scared out of their wits.

Both patients who were in the waiting room after the meth addict and (in my opinion) totally un-self-controlled baby of a woman had their lams inserted were terrified. I went in and tried to explain, but you can't tell them that the patient we just saw was an addict or a big baby. All you can say is that this is very much out of the ordinary, that both women got up and walked out on their own afterwards, and that everything is safe and fine. Not convincing enough, of course, and I don't blame either one of them. Each of them reacted differently, but the result and reasons were the same.

One patient came into the OR, lay on the table, had her ultrasound checked, and then changed her mind. The next patient came in, and got as far as having the speculum in... but not until after she took pictures of the OR with her camera phone and texted them to her mom in the front lobby while we gave her privacy to undress and put a drape on. Fortunately, the mom went to the manager and mentioned it (during a bitchy rant about something else), the manager told me, and I went in with the PA just as the gal was putting her phone away. As she got into position, I explained why we don't allow phones, and why taking pictures is not allowed. She insisted that she hadn't, but she's a damn liar. All we can do is wag a finger at her, but she deserves at least that. Way not cool. Anyway, after the speculum was in, she got scared and wanted to stop. I took her up front and gave her pre-natal info and other resources (as I had with the first girl) and told her that if she changes her mind she can always come back.

She was back twenty minutes later, but the PA wanted her to take some more time and come back next week if she still wants to. I think that's the right call. It's important for patients to not be ambivalent about this. Still, this made me angry. I don't have any problem when women decide to keep their pregnancies. In fact, I'm usually happy. It's nice to see someone really stand up for what they want, whether that is birth or abortion. Seeing an ambivalent patient pick one or the other is great, because you can just see the stress drop off their shoulders. But that's not what happened with these two women. Their was no relief on their faces, only worry and doubt, because this was about their fears rather than what they want for their lives during the next 18 years. I know we'll likely see one of them again, but the first girl is younger than me... and because this is a twin pregnancy, she'll soon be a mother of three. A single mother of three. It's going to make her life very difficult. I hope she finds a way to work it out.

Now, some of you might find much in this entry to be callous. It seems so mean for me to be frustrated by patients who are having a hard time, but you don't have my sense of perspective. I've seen dozens and dozens of women have laminaria inserted, and judging from the reactions of all those women it is generally unpleasant but not unbearable, and the cramps end quickly after the speculum is out. The only time it becomes very painful is when a patient has absolutely no self-control. They are not able to put their mind over matter, for whatever reason. They end up acting like they are seven years old and having a temper tantrum, tensing their whole body, pounding their hands, and crying like babies (which I assure you is different from crying like an adult). I'm probably digging myself a hole here.

Read this paragraph.Look... a speculum is smaller than a penis. If you can have sex, you can handle the speculum. It's the tensing around the speculum that causes most of the discomfort. If you explain to someone how to control their PC muscles and let them concentrate on that (if they need to), most of the time they will at least try your advice because they don't want to be uncomfortable. But when a patient is a frickn' addict or drama-queen, they don't listen to a damn thing you say to try making things easier on themselves. They are bound and determined to make the experience terrible. It's almost like they insist that it must be terrible, because they won't put any effort at all into making it easier on themselves. In some ways, I think these are patients who are trying to punish themselves... or maybe they really are so immature that they just can't get a grip in stressful situations. Whatever the reason, they end up scaring other patients, and that's why I get frustrated. If you want to be in pain, by all means scream and tense up as much as you please. It doesn't bother me if that's what you want, but it might make some of the other patients make hasty decisions that they could regret later, I'm not cool with that.

Anyway, enough of that. I'll end on a positive note. So these two problem patients were also so early that they required the fewest laminaria (3). A special patient of mine (I met her elsewhere) came in and needed the maximum number (7). We chatted happily through the whole thing. She stayed limp like a wet noodle, and she had absolutely no cramping at all. She didn't even flinch during the digoxin injection. There were several others like her today, and it was a joy to talk with each of them about their lives and their interests. Things they did over the weekend in the nice weather, and things they look forward to in the spring. How cute their kids were playing in the park, and what kinds of things their kids are into right now. All kinds of things, just light conversation. A couple were completely oblivious that we had finished up because they didn't feel a thing and were distracted by conversation. That's how it usually is on laminaria and first trimester surgery days. I won't let a few bad apples spoil how good the rest of the day was, and how much I enjoyed making the patients laugh by singing, "Name, name, bo-bame, banana-fana-fo-fame, me-my-mo-mame, NAME!" when I called them from the waiting room.


Funny? Bizzare? You be the judge.

I've been having the strangest dreams lately. Most of them are nightmarish and/or lusty and involve my ex, but I had one the other night that was too strange to not write down (but not as strange as some that I've had that are just too far out to tell many people about).

Anyhow, it was about my job.

Started out like any normal day, with me going through my usual tasks. As the dream goes on, the clinic just seems to get bigger and bigger, expanding into areas I didn't even know existed, so it was like a huge maze-like hospital all on its own. And then I find out that all the work I had been doing up until this point was just training, building me up for the real thing.

The Real OR is huge (the size of a warehouse). The totally obsessive, notoriously hard to work with DR and the meaner CRNA are there, as is most of the clinic staff. There are two tables set up, and both of them are strange. One is slightly higher than the other. Each one has a girl in it, with her legs in the stirrups, and the girl on the higher table has a bunch of tubes going from her arm down into the arm of the girl on the lower table. She's being used to provide the other girl with extra blood. There are loads of tv monitors that will show the abortion from inside the womb at all different angles, and this pregnancy is obviously well beyond the legal limit.

My job is to assist the doctor. I'm supposed to stand on this weird track that runs around the lower table... so I'm spinning around in a circle the whole time, trying to hand the doctor things as I whoosh by. He hands me the suction cannula hose at one point, but because I am moving, I end up losing my grip and it snaps back to hit the doctor in the hand. He just gives me this look. You know the one. That, "God, could you be more incompetent?" look. I'm stressed out as all hell, and I run out of the OR, holding a package of 29/31, 33/35 dilators.

I run into the clinic Manager in the hallway, and she asks me why I'm not in the OR. I flip out and say that this is crazy, there's no way I can work in there like that. She tells me that I'll lose my job if I don't go back in there. At that point, I rip open the sterile package of dilators, brandish them in one hand like a baton (or as I like to call it, a beat-down stick) and scream, "IF YOU MAKE ME GO BACK IN THERE, I'LL SMACK YOU ACROSS THE FACE WITH THESE DILATORS!"

I vaguely remember running into some of my other co-workers after that, and some kind of conversation about how I'm probably going to be arrested and lose my job for threatening my manager. But I woke up shortly after the confrontation, so I don't remember the last little bit.

Seriously, I have the strangest dreams.

On a sidenote, I saw Juno yesterday and really liked it. It's a fantastic movie. It shows how difficult and socially stigmatizing carrying to term can be. How tough it can be to find adoptive parents that you actually want to give your baby to. How emotionally and physically draining pregnancy and birth are, particularly for someone so young. I found it very thought-provoking, and it firmed my resolve that no one should have to go through that unwillingly.


Rise up. Resist. Raise up your fists.

We had an incident at work today. One of our patients was attacked on her way to the clinic. Her mother-in-law assaulted her in the elevator and threatened to beat her once she left the clinic. The patient was in tears, and afraid for her safety. The center manager talked with her and established a way to protect her privacy and safety, but it was still chilling.

Some days, I feel paranoid. I think about all the days that have gone by without incident, our sidewalk empty of protesters, our wide-open door with no security, and our advertisement in the yellowpages. Sometimes it is amazing to me that we've had no problems in a very long time. With news of clinics being attacked over the holiday season, and now this patient, I'm feeling a little more tense.

Plus, the hours at work have been long lately. We're in a busy time of year, apparently, and our patient load is enormous. The staff is getting sick (a nasty flu going around), hands are short, and 10 or 12 hour days are not terribly uncommon now. Morale is low... soon, we'll be losing our lab tech and one of the nurses due to policies put in place by upper management (I've heard rumors that two others might be leaving as well... that's around a third of the staff). We treat each other well, and we work hard together as staff, but the company does not pay us as well as they should, and we lack many of the perks deemed routine at other jobs (and even other clinics in the chain I work at). It's no wonder employees are dropping like flies, but it's hard on the rest of us. To be honest, I'm a little worried. We need a morale boost, and we need more people dedicated to the cause who will work with us. Most people working in my clinic are there because they did an externship there and it was the first place they were offered a job. Convenience rather than conviction.

To boost my spirits, I watched some video clips from the 2004 March For Women's Lives, which was the largest protest in US history with 1.5 million participants converging on the National Mall in Washington, DC.

I wish I had been there. It was an amazing event, and just hearing recordings from speeches, the roar of the crowd during applause or chants... it gives me hope that there are enough people willing to mobilize in the event our government takes a wrong turn with regards to abortion policy. I loved watching the antics of the radical cheerleaders, dance troupes, and musical performers. I hope there is never a need to have such a protest again, but if there is I will certainly be there, no matter what.


From The New York Times.Collapse )

Back to me now:
We had no problems at my clinic over the holiday season. I'm not sure about the other clinics in the area, but it makes sense that the "celebration of Jesus's birth" would energize Christian extremists (as these violent pro-lifers invariably are). I heard it on the grapevine that pro-lifers picketed the houses of contractors who are building a Planned Parenthood clinic in Colorado. Picketed their houses on Christmas day.

I anticipate having to deal with violence against a clinic I'm working at eventually. The fear for my safety hasn't really kicked in, because I don't have a concept of what being shot at or bombed is like. It's obvious to me that a couple of the doctors I have worked with do not have the same sense of immortality. I knew one doctor who took all kinds of seemingly unnecessary precautions. I later found out that he gets death threats against his family, and the antis put up "Wanted" posters for him around the city. They also videotape him and put the videos, pictures, and his personal information (where he lives, his phone number, and anything else they can get) on the internet.

It might be easy to write off some of this as just being a few crazy people, but stop and think about it for a minute. In 1994, more than 20 years after Roe vs Wade was passed, 52% of abortion clinics sustained violent attacks. Now, it's down to 18%, which is much better, but that's still a goodly portion of clinics. It's no wonder that landlords are loathe to rent space to abortion providers with that kind of risk to their property. It can become a serious hindrance to providing access.

Not to mention how influential the Evangelical voting block is. Most antis wouldn't commit such violence themselves, but many of them will applaud (or "not complain") when the few do. Moderates probably don't take much notice of these events, and so it often feels like the only people who give a damn are a few feminists on weblogs and the people who work at abortion clinics. It worries me that ambivalent people might be influenced by flowery rhetoric from "pro-lifers" without taking a closer look at the movement.

But, there's still hope.

We don't preach to our patients, but sometimes we talk about our jobs and our feelings. Sometimes, they mention that they were pro-life. This happened today with a patient in the recovery room. She started to say that she was a hypocrite, but we assured her that no one really knows what it is like until they've walked in her shoes. Take it as a learning experience, grow from this, and think about it. The nurse said, "Think about this when you vote."

I think she will.


On gestational age.

One of the conflicts I've seen between pro-choicers and antis on the intarweb is about the accuracy of captioned anti-abortion photos. I'd like to clear up where the disconnect seems to lie in the claims made about embryonic development.

In doctors' offices, gestational age is measured from the first day of the last menstrual period, because most women don't actually know when fertilization took place. It is a more practical way of measuring. So, on the first day of your first missed period, you are considered approximately 4 weeks pregnant, though fertilization occurred 2 weeks ago (and implantation a couple days after that). Somewhat confusing, but it's all just so there can be a common language to converse in.

Antis measure from the date of fertilization, but they don't generally say so. The appearance is that embryos develop more quickly than most people think they do by about two weeks. It's not false information, but it is generally presented in a misleading way.

Other misleading things that antis do:
1. Present pictures from abortion techniques that are no longer used (old photos, or ones from other countries).
2. Show primarily 2nd trimester abortion pictures, implying that they are more common than they really are.
3. Juxtapose abortion photos with holocaust mass graves, implying that abortion is genocide.



My co-workers are a really awesome group of people. We had our staff holiday party last night at the bowling alley, and we did a Secret Santa thing. There were many baked goodies and boxes of chocolates delivered to the clinic throughout last week (mostly from staff and from other clinics). I've been more in the holiday mood this year than in years past because of the atmosphere at work. We talk with patients about their winter traditions (most all of them celebrate Christmas), presents they are getting kids, and the winter season of movies.

Dr K and some of the other staff are excited to go see Juno, a movie that's gotten plenty of flak from some feminist forums. I think the main frustration is really that there have been three relatively well-known movies in the last year that address unplanned pregnancy in what most would consider a bad situation, and abortion was not really addressed in any of these movies. It doesn't reflect reality, and it supports the stigma against abortion. It would be kind of like having three movies about bisexual women who all end up marrying men. It isn't that the choice made is "wrong," but it is frustrating when the other side of the coin is just never shown.

Some people think that a movie with the end result of the pregnancy being abortion would be too short. That's plain ludicrous. A movie is only around 2 hours long, and there is plenty of material in an abortion experience to take up that time. Some people also think that a movie about a women who gets an abortion could not be funny at all, much less a romantic comedy. I say it can be done! In fact, I think making a movie about abortion that has humor in it would be a fabulous idea. It's a serious subject, and I think that lightening the mood of a film about abortion with a familiar formula and good humor would make it more palatable.

In any case, I really just mentioned the movie because I wanted to point out that at least some people who work at an abortion clinic are happy to go see it. I will likely not be going. Instead I will probably watch Pro-Life by Masters of Horror. A pregnant girl goes to the clinic to abort, and her crazy anti-choice father and uncle (I think) launch a full scale attack on the clinic trying to stop her. Little do they know that the fetus is really demonspawn that will destroy the world if it is born! The clinic staff slowly come to the realization that the pregnancy is evil and supernatural! I can't wait to see what happens. The front cover of the movie is awesome.

Now, that's enough about that.

I'm happy to report that I have a four day weekend both this week and next week, so I can get some much-needed rest. We have been very busy lately, as odd as it sounds to say. Really, the whole staff needs a break. Everyone has something going on in their life right now that's making things a little harder (a lot harder for some). I hope we all come back refreshed.