Sybil's death

Being a few days after the showing of Downton Abby season 3 episode 4, I hope I'm not spoiling it for anyone.  However, consider yourself warned that this could be a spoiler for someone living completely under a rock, or maybe in 3rd year or residency or some other all life-consuming activity.

Sybil's death brought with it a flood of emotion for me.  I always find myself crying when a character dies regardless of the medium.  This dates all the way back to my obsession with "doom and gloom" and reading Luriene McDaniel books in middle school.  I still love books that make me cry and I often find myself crying in movie theaters (though airplanes are the only movie theaters I have time for now a days) so it comes as no surprise that tears flowed as Sybil died. 

The flood of emotion though was because of HOW Sybil died- in childbirth, from eclampsia.  While skewed in accuracy, especially with modern monitoring and treatments for pre-eclampsia and eclampsia, is still brings light to the gravity of birth.  Evolutionary pregnancy and birth have to happen for us to continue and so it does, but it does with great risk.  According to the CDC, "at the beginning of the 20th century, for every 1000 live births, six to nine women in the United States died of pregnancy-related complications".  Reported rates in Brittan were closer to 40 in a 1000 births.  Today, the rate is closer to 12.6 per 100,000 births in the United States, putting us at a rank of 21st in maternal mortality.  21st!!!  That's pretty shitty.  The rate is even more horrific in other parts of the world, and often from preventable and/or treatable causes.  We need to do better.

I believe the episode also brought to light the fact that practicing medicine is an art and not a science.  It requires knowing your patients and trusting your instincts.  Doctors are human and make mistakes.  Communication between doctors, patients, and families is key.  So are medical surrogates, medical power of attorney, and living wills.  If you don't already have one, take this as a sign to make one!  Have conversations with your loved ones about what you might want/not want to happen to you if you are ever in a situation where you can't decide for yourself.  Talk about organ donation. 

I know, I know.  It's only a television show.  Maybe I'm reading too much into the plot, or transposing too much of my daily life into it.  Oh well, so be it. 

Also, before anyone starts blaming western medicine on the risks of childbirth (I too have seen Business of Being Born), that is not what I'm implying.  To say this again: birth more often than not is VERY safe and does not require much, if any, medical intervention.  But, when things go wrong, they tend to go wrong fast and can have dire consequences.  Even during my 3rd year clerkship I saw both the beauty of birth and the devastation from horrible unexpected tragedy.  I try to focus on the beautify and fragility of human life in this amazing feat of the body; humbly remembering that I cannot always be in control of, or know what to expect from, every situation.

Humbling reminder

A beautifully written article from The Washington Post, "A mother's joys and a family's anguish shared via Facebook", is a humbling reminder of exactly what I am getting myself into. Read it, but have Kleenex near by. It highlights the limitations of modern day medicine in such a highly technologically savvy world. More importantly, it is a potent reminder that every patient is a person: a mother, a child, a friend, a sibling, a unique and valuable entity in this world. I pray that I never forget this; that I never see a person as a just a medical case. Also, that I never forget how fine the balance is. That in a brief moment things can change from completely joyous to utterly devastating.

A picture is worth a thousand words

This is from "Stirrups and Stories", an amazing attempt for patients to reclaim the OB/GYN experience. Looking through the site I am very much reminded of what brought me to medical school in the first place and why I want to be an OB/GYN. I want to empower women to reclaim their own bodies.

It reminds me of my college thesis. I spent a year examining elements of power and agency in pregnancy that lead to a woman being educated about her pregnancy and birth options. Using anthropology and photography, I created a multi-dimensional ethnography with a corresponding photography gallery exhibit. I was blessed to spend my year engaging with women who opened up to me, sharing their stories, families, homes and images of their bodies with me.

On a similar note, here is a pretty awesome article on home birth. The article illuminates the reason that I choose medical school over nurse midwifery: the desire to advocate for reversing the over-medicalization of births from the top. Additionally, I want to empower ALL women to embrace their health and trust their bodies, instead of just working with women who choose midwifery care. I strongly agree with a lot of what the article is saying, especially the following paragraph: "In anthropology, we say that "normal is simply what you are used to." The power of socialization and the dominance of biomedicine have kept us from systematically examining a variety of birthing environments and providers as viable alternatives to the expensive and interventive hospital delivery that has become the norm in the U.S."

Here is to hoping that we can start listening to women's voices and remembering that birth happened long before western medicine came along; and that I don't forget my background as an anthropologist and a labor doula as I progress through my medical training.