Dying

I'm reading a book called Final Exam; it's a memoir by a surgeon detailing her journey towards her understanding of death as she went through medical school and became a doctor. It's bringing back several memories, some of which I already wrote about in my Haiti journal, but I felt like re-visiting them here.

I have already been the one to pronounce a patient dead. It was in the back of a pickup truck in Haiti; they rolled in with a man unconscious in back and we're not sure when his heart had stopped beating. A nurse took charge and jumped in with me, and we starting doing CPR, while the American doctor came and tried to feel for pulses. Nothing, nothing. The nurse and I switched off, and every now and then we would pause so one of us could listen for a heartbeat. The most unnerving sound I have ever heard in my life was when I placed my stethoscope on a man's chest and heard - nothing. So we go back to CPR, and after about 15 minutes the doctor catches my eye and says, "Do you want to call it?" I kind of looked at him and then back at this man lying in the dirty bed of a pickup truck, eyes closed, mouth open, and I said, "yes." The nurse stated the time and someone wrote it down, and that was that - the first time I pronounced another human being dead. It didn't really feel weird at the time; I mean, dead is dead, and I was just saying what the facts were. But now reading her book I realize that was a big moment, a really big step for me, and a really saddening one too.

I'm not going to pretend that seeing several people die in Haiti did not affect me. Watching the man who had been shot through the groin as his breathing stopped and his heart monitor all of a sudden went flat; seeing his wife's eyes fly open and hearing her soul burst into a wailing mourning piercing shriek - I'm not going to pretend that didn't send chills down my spine. I still can see the eyes of the 16-year-old girl gasping for breath as she looked up into my eyes as she died of tuberculosis; I'm not going to pretend it doesn't disturb me. I don't understand death yet, and I'm still afraid of it.

There was a woman working with us in Haiti, a respiratory therapist, who noticed me the first time I saw someone die. She must have seen me go pale, or my eyes open up wide, or heard my breathing stop, or whatever I did. I don't remember exactly what she said. I do remember that it was incredibly tender. I don't remember what she said, but I know I was comforted, and I knew it was going to be okay. I'm glad she was there to help me in that moment of complete helplessness and confusion, and I hope I will be able to continue to progress in my understanding of this scary, peaceful, incomprehensible event of death that will be such a huge part of my profession.

Dear President Obama

9 February 2011

Mr. Barack Obama

President, The United States of America

1600 Pennsylvania Avenue NW

Washington, DC 20500

Dear President Obama,

I am a firm supporter of your actions while in office. I have been impressed with your management of the wars in Iraq and Afghanistan, and strongly applaud your handling of the situation in Libya – I believe you represented the United States as a firm supporter of democracy without committing us to another major conflict overseas. As a medical student, I am a staunch advocate of your health care bill, as I believe it contains legislation that will help all persons gain access to good care and bring down the cost of health care across our country. I support your tax policies, and I believe that your economic recovery packages did good in helping our country recover. I am impressed with your confidence and leadership, and particularly the fact that you are a strong family man who is loyal to his wife and supportive of his daughters. Finally, I appreciate your recent “We Can’t Wait” approach to enacting policies that will help our country move forward as Congress continues to stalemate.

However, I am deeply unsettled by your decision to require religious institutions to provide insurance covering contraceptives. I am a budding physician and understand the importance of these tools to family planning, and I have no personal misgivings about the use of contraceptives from a moral standpoint. However, this policy directly destroys the religious freedom that is a cornerstone of our nation. For many religious institutions, it is a moral sin to use contraceptives of any form. To mandate their endorsement of contraceptives is akin to requiring Muslim women to remove their veils and wear short-sleeved shirts while at work, even in private institutions. It is a small step away from requiring all physicians to perform abortions, which is something that I will not ever be able to do.

I believe that the eventual consequence of this policy will be that fewer people receive health coverage of any sort. When faced with the decision between adhering to their moral beliefs and continuing to provide insurance coverage to their employees, many of these institutions will choose the former. As an alternative to your current policy, I would advocate for a separate state-funded health insurance plan that would only provide family planning coverage, which individual employees of these religious institutions could choose to purchase as they see fit.

As stated above, I firmly support your progress in office and your management of our nation at this troubled time. I would be extremely disappointed were another candidate to take office and overturn such excellent measures as your health care bill. However, your requirement that religious institutions be required to provide insurance covering contraception frightens me immensely. Unless this policy is reversed, my vote will go to any other candidate who pledges to strike it down, even if it means losing all of the progress our nation has made in every other area under your administration. Please, Mr. President, reconsider your decision.

Sincerely,

Chelsea J. Slade

MD Candidate, Class of 2014

The George Washington University School of Medicine

cjslade@gwmail.gwu.edu

Pro-life

I am pro-life. I can't argue against the fact that a pre-born child is just as human as a regular child, and after watching http://livestre.am/1fp7A from 02:53:43-3:47:34, you won't be able to, either. This speech argues for life from a strictly logical (rather than theologic) point of view, and it is brilliant.

I have, however, what may be some unique views on abortion. I don't necessarily advocate for outlawing abortion - I recognize that some women really will refuse all other options and will get an abortion, and I want those women to be safe, rather than having to go to sketchy, back-alley, untrained providers. Rather, I would like to see abortion become an overpoweringly undesireable option on an individual level, in two ways: 1) make sure that each woman is aware of what an abortion entails - the stopping of a beating heart, the end of a life. And 2) developing huge layers of support for women so they can carry their pregnancies to term, by expanding adoption services and growing support for single, young, and busy mothers.

Today some classmates and I spent the morning drawing hundreds of hearts in sidewalk chalk at a busy intersection, and writing "Abortion stops 3,500 hearts a day." We passed out flyers with the same message, and provided a phone number for people affected by abortion or facing an unplanned pregnancy to call for help. What surprised me most was the vitriol spewed by some passers-by. I understand that not everyone sees abortion the same way I do, and I respect those views, though I believe they are wrong. The statements we were making were not hateful or bitter accusations; they were statements of mourning of a terrible fact. So what I was most surprised by were the flyers that were thrown back at us when the person read what they said; the passers-by who purposefully scuffed out our drawings as they walked over them; the people who swore or cast angry words back over their shoulders as they walked by. I was particularly impacted by one woman who, after staring at our chalk for several minutes, dragged her feet through it to scuff out the letters and said, "I'm not impressed!" On some level, obviously, she WAS impressed; she WAS impacted, or she wouldn't have reacted that way. What provokes such anger? Is it that this fact, that 3,500 hearts are stopped each day by abortion, is too real? Too much information? Too close to home? We were seeking to make people aware of a hard-to-swallow truth, and offering help to those affected by this truth. Why would people try to, literally, scuff it out as if it isn't true?

I'm also a bit surprised by the incredible hatred spewed by some of my colleagues towards the Susan G. Komen Foundation, for pulling their funding for Planned Parenthood. Perhaps surprised isn't the best word, just curious, maybe. As I understand it, Planned Parenthood provides STD testing and treatment, contraception, sexual education, and pap smears. These are all amazing services, provided at little to no cost to their patient population. Planned Parenthood also offers abortion, obviously, and according to them (http://www.plannedparenthood.org/files/PPFA/PP_Services.pdf), they performed 329,445 abortions in 2010, compared to 841 adoption referrals. That is over 390 abortions per adoption referral, which makes me question whether they really are helping women look at all of their options. Because of more blatant and questionable practices (detailed at http://www.aul.org/executive-summary-2/), the federal government is investigating Planned Parenthood's usage of federal funds and business practices. Because PP is undergoing federal investigation, new Susan G. Komen Foundation policy dictates that funding for PP be removed. Whether this is politics or an actively pro-life move by the Foundation is anyone's call. I think the fact is that if Planned Parenthood really is a sound, helpful, healthful organization, it will come out unscathed from this federal organization, and the Susan G. Komen Foundation will resume funding it.

In the end, I see the pro-life movement as loving. My experience has been that they love babies, love life, and love women, and will do everything in their power to make sure that women facing unplanned pregnancies are supported and loved, and that their children receive the best life possible - whether that is through adoption or through supportive measures for the birth mother after birth. My experience with the pro-choice movement has framed that movement in a more bitter, angry, and selfish light. All we can do is keep loving.