Collecting Pieces of Me

Today, I helped to facilitate an ALSO training. ALSO sands for Advanced Life Saving in Obstetrics. The trainees were residents, mostly interns (new docs, most fresh out of medical school) who will be assisting with labor and delivery in the hospital setting.

The trainers were physicians, some retired, who are certified to train clinicians in the area of advanced life-saving in the obstetric realm. Hopefully, you are beginning to get the picture . . . a lot of talk about pregnancy, labor, delivery, effacement, perineum, suction . . . . Actually, you likely weren’t picturing any of this, but, now that I’ve said it, it may help to paint they picture . . Among all the discussion of cervices, lubrication, pre-eclampsia and perennial laceration (torn butthole for those of you withOUT medical degrees . . . . or children) lying on pseudo sterile tables, were models of babies and, dismembered “laboring” “women”.

Down the hall, in mock surgical bays, were mannequins worth more than the car I drive; next door, in five gallon buckets, a colleague was mixing up fake blood; and, my favorite, life-sized models of cervices (crevices, more generally), dilated to different diameters and differing stages of effacement. I donned a pair of gloves and felt a mock up of what my midwife likely felt when, two weeks before L was born, she said these words: “You are 2 centimeters dilated and 50% effaced. You’ll deliver before the end of the weekend.”

I went to get a pedicure, my husband and my toddler made a model cast of my uncomfortable belly and then I breathed and bitched my way through two anxious and uncomfortable weeks of prodromal labor.

Now I will tell you how I ended up assisting with today’s ALSO training: I used to be a standardized patient. I will include a link to the Seinfeld episode where Kramer was hired an SP.

https://www.youtube.com/watch?v=JvCVg4MrhUE

My former job was almost NOTHING like what is depicted above but it’ll give you an idea. Essentially, I was the medical version of a secret shopper . . . except everyone, including the med students/”learners”, are in on it. Often I tell them directly what went well and what can be improved on.

I was doing my job one day back in February except that the interaction occurred over Microsoft teams. It was a three-way video call. Myself; a fellow med school employee and a medical student. The student was playing the role of the clinician, I the patient and, my – now friend – was the timekeeper/facilitator. The topic was “shared decision-making: contraceptive choices”.

Here is where I will mention that I’ve spent a lot of time counseling individuals about sexuality, contraception and sexually transmitted disease. I knew, given that the students would only have 20 minutes, there was absolutely NO way that they would to be able to discuss every form of contraception with me, the patient, making an important decision. The key, and this is almost ALWAYS the key, is that the student would have to LISTEN to my comments and react with interest and concern. At this point, you likely have some idea where this is going.

The first four encounters were with male medical students, none of which could have been over the age of 25. I am not kidding when I tell you that the fourth of those four young men used the phrase “surgical sterilization” as if we were discussing a head cold. I’ll admit, I was pissed. And, honestly, if you aren’t pissed, you aren’t paying attention.

Let me remind you, this encounter would have been a few weeks following the January 6th insurrection of the capital building. Despite not watching the news or ingesting social media, I’d heard quite enough from the scariest misogynist we, as a country, have ever had to endure.

I thought to myself: “These students think that they can just float through this little ‘exercise’ ego intact, talking to a woman who’s carried and delivered actual humans while exhausted and vomiting daily. I get that this is uncomfortable, I get that they are out of their depth but, for crying out loud, have some shred of humility!” One student, presenting as male and one of the three female medical students acknowledged that they could not speak from experience (I suspect one of the three female students COULD speak to her own experience but chose not to; or that, yes, indeed, these contraceptive methods all have some impact on the patient’s body and life.

After the surgical sterilization comment, during a pause between students, I asked the woman, who I now consider a friend, whether she happened to know the ratio of males to females at our particular medical school. Turns out it is 1:1. I just happened to talk with 4 male students before meeting with 1 female student. Anyway, long story short, my now friend, suggested that I apply for a job in another department that she works with and now I do lots of things, including assisting with various trainings such as ALSO.

Last week it was physicians who were learning ways to assist patients during the birthing process and tomorrow, I’ll working an OSCE, Objective Standardized Clinical Evaluation. It’s going to be quite a day! Interns will be evaluated on breast exams, pelvic exams, prostate exams, prenatal exams and how best to deliver very difficult news in a variety of settings. I’m really looking forward to tomorrow! I think the Sim Center (short for simulation) is an amazing resource and an incredible concept: to teach clinicians how to be better using REAL people and or, in last week’s case, sort-of-real-looking mannequins.

Obviously, you cannot instruct a learner on how best to deliver a living human in the midst of a labor and delivery, certainly not when the labor and delivery threatens the life of the mother or the child. The idea is sound and the intentions are all well and good, at the Sim Center, at the medical school, in graduate medical education.

As a person with a uterus, however, living in a post-roe world, there is something oddly clinical, somewhat post-apocalyptical and claustrophobic-is-not-the-right-word-but-I’m-struggling-to-describe-it. .. . Anyone else?? Can you help me to describe the feeling that I have?? What are your thoughts?

*carpe diem*