The everyday pressure of being an abortion provider can be grating: the self-censorship, the disapproving stares of fellow doctors, the social repercussions in small communities. So perhaps it's not surprising that among doctors who said they wanted to provide abortions when they entered their residencies, only 52 percent did so once they were working, according to a recent study published in the American Journal of Obstetrics & Gynecology by Jody Steinauer, a professor at the University of California, San Francisco, and a co-founder of Medical Students for Choice....
There isn't anything nice about abortion, Lesley said, but she does not equate it with murder. "I think it's a necessary evil, no, unpleasant service, we have to provide for the sake of" women's lives and health. But she wouldn't call herself passionate or driven to provide abortions. "I don't have a gut drive. It's more like an intellectual drive. A woman's control over her body is representative of her freedom. I feel the obligation to make sure that service is available and not stigmatized."...
In her e-mail, Christina had hoped to attract participants by suggesting that they'd have fun learning the procedure: "You'll get the opportunity to be shown how to use manual vacuum aspirators using papaya models (apparently papayas bear a striking resemblance to a uterus. Who knew?)" But some of the students who received the invitation didn't see it that way. "This is a serious matter," one told Christina. Those offended by her tone demanded to be dropped from any future Medical Students for Choice e-mails. After consulting a dean, the women didn't remove any names from their list, but they decided to word future missives more carefully....
Now it was the students' turn to try the procedure in the lab next door. Imagining herself working on a real woman, Lesley looked tentative as she pushed up her sleeves and reached for the razor-sharp tenaculum.
"This just seems so awful," she exclaimed as she tried to grab the papaya with it. "Do [patients] feel this?"
Her look turned to fright when the nurse practitioner at her station answered that they do.
After helping to perform a first trimester abortion, Lesley then asked to sit in on a second trimester abortion.
This time, the procedure took 10 minutes instead of five. The dilator was bigger; there was more tissue to remove; and the patient, although sedated, was awake and moving with discomfort. Lesley watched as the doctor counted the parts of the fetus, and, to her surprise, she didn't find it jarring. To her, the parts appeared doll-like.
"It was definitely gruesome," she said. "You could make out what a fetus could look like, tiny feet, lungs, but it didn't look like a person." She knew this abortion was an act that her friend Litty considered tantamount to murder. She herself expected to be very upset. She'd felt that way at her first autopsy, that of a teenage boy who'd shot himself in the head. For weeks, she could not shake the image of the boy. But this was different. She didn't regard the fetus as a person yet. She said she was happy to help the woman: "I feel like I was giving [her] a new lease" on life.
Later that morning, though, while conducting a pelvic exam, Lesley noted that she wasn't her usual slow, gentle self. That evening, discussing the second-term abortion with her mother, Lesley described a process that she found disturbingly brutal, especially the stretching of the vagina.
"It's a lot more invasive than I thought," she said. "A papaya doesn't bleed and scream." Women do.
Lesley didn't want to have to steel herself emotionally to perform abortions, and she was coming to realize that that's what she'd have to do....
The things she cared about -- taking care of women, seeing them through the process -- hadn't happened. It was the nurse practitioner who cared for the patient. Vacuuming out a uterus and counting the parts of the fetus did not seem like a desirable way to spend her work days. It took a unique person to do that on a daily basis, she said.
Lesley still believed passionately in abortion rights and was proud of what she'd accomplished at Maryland with her activism. She didn't want to let people down. Even so, she had to follow her heart. Somebody else -- maybe Laura Merkel, the new chapter president of Medical Students for Choice -- would become an abortion provider. But it wouldn't be her.
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