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Guest Blog

Commentary invited by editors of Scientific American

The First Pass Effect


When I was a third year at Harvard Medical School, I spent 6 weeks at one of our affiliated hospitals rotating through the Obstetrics and Gynecology department. During this time, I devoted a few afternoons in the family planning clinic, where I was able to learn from diverse women seeking contraceptive options or pregnancy terminations. This experience was transformative.

I should tell my readers right off the bat that I am pro-choice, and that I believe strongly in female autonomy and control over her own body. But I’ll be the first to agree that it’s difficult to argue with those who believe that life begins at conception, for even if those fused cells represent potential and nothing more, potential is all-important, all we often ever have. When I stood in my sterile gown, watching the resident dilate the cervix and then introduce a little plastic tube through the opening to suction to the contents of the uterus out, I was a little on edge. And when we then took the jar of liquid and tissue to the sink and rinsed it out with a sieve, to count the little dismembered fetal parts with a forceps, I have to admit that I was shaken. Here was a little arm. And here was a little thigh. And here we were, putting them together like little puzzle pieces to make sure we hadn’t left anything behind. Never in my life did I think I would bear witness to this. I put a finger to my own pulse.

Just a few nights prior, I had been part of a long argument with friends at a local bar about this very subject.

“If you don’t like it, don’t perform abortions! Don’t get one yourself!” I had said, impassioned. “But quit judging something that you will never know yourself.”

I spoke as if I was in the know, and the others weren’t. But now, standing in the clinic, I had to confront myself with the fact that I really had had no idea what I’d been talking about either. Before this day, I too had not a clue about what a termination really entailed. And I never thought I’d ever find myself looking at a sieve full of miniature body parts.

My resident must have seen the ashen look on my face.

“Are you okay?” she asked. “It’s okay if you need to step away, or go back to the workroom.”

It took me just a second to take stock of myself. “I’m okay,” I said, and I continued to watch.

Over the next few days, a classmate, someone who I respect very much, told me that her time in the family planning clinic had changed her views on abortion.

“I used to be pro-choice,” she said. “But now that I have seen what that means, I don’t think I could ever go through that myself, ever.”

I stayed silent. Amazed, she pressed on, trying to convince me. “I mean, weren’t you disturbed by it? Weren’t you challenged?”

Yes, of course I was disturbed. Of course I was challenged. For starters, I was shaken by how the clinic was hidden away in the deep recesses of the hospital. To get there, we had to walk down a lengthy set of corridors that falsely advertised a different department, go down a stairwell, through unmarked doors that opened with a tap of my employee badge, and into a modest clinic, that made me feel, even as a student, like I was harboring a dark and shame-ridden secret. All of this reaction – to avoid and deter picketers who might impede patient care.

But once in this secret annex, those feelings of unease were quickly replaced by a feeling of solidarity and community. The women who walked through the clinic doors came from all walks of life… some were in their teens and in unsafe relationships, others were women who already had children and felt that they did not have the kind of financial and social support they needed to raise another baby in their homes, and still others were there because they had discovered that their fetus carried such genetic abnormalities that going through the pregnancy to term would result in nothing but swift mortality for the baby and unbearable grief for their family. It didn’t matter what the reason. Social workers, residents and attending physicians, most of them women, grouped together to offer their peers generous levels of support and empathy.

I liked seeing women help other women like this, free of judgment. I liked being a part of that fabric, even just for a day or two.

“But the procedure itself? Didn’t you think it was vile?” my friend asked.

It was gruesome. It was infused with a great deal of emotional significance – most of it, at first pass, horrific. But what else had we seen this year? We had seen necks splayed and muscles parted to the very last tendons in radical lymph node dissections, searching for cancer. We had held on to umbilical cords and tugged at the afterbirth, spinning the placentas in our hands as blood dripped to the floor to make sure there weren’t any rents indicating left over tissue in the womb. We smelled the cold stench of cadavers in autopsy rooms. We learned to fight our own feelings of sympathetic nausea when inserting a nasogastric tube over the sounds of our patient retching in reflex. We smelled AIDS on a patient with medication non-compliance and sky-high viral loads admitted for delirium and sepsis.

Getting caught up in the emotion of what we see may be a natural first inclination for any human being, but what differentiates those in medicine from the rest of society is our determination to plough through those initial feelings of distaste in our mission to help. We fight our bodies’ impulses to flee. We don’t abandon our patients when they need us just because the body’s realities are too overwhelming.

And now I know what a pregnancy termination truly entails. I can own it: I can know that I didn’t just support a woman’s right to end her pregnancy while refusing to look at the nature of the act. The personhood arguments are a slippery thing, and I’m still formulating my own perspectives. But I know that I will never again speak just theoretically about the issue. It’s never so simple as mother versus baby, but if what I value about life are the social and intellectual components and the potential for a self-determined future that accompany a living thing, then I will always remember the fear in those women’s eyes before they let the anesthesia close their lids. I will always remember that teenager who asked me to hold her hand before she went under, asking me not to judge her, not to abandon her.

“I won’t,” I’d said to her then. And I never will.

Image: Michael Lane

The views expressed are those of the author and are not necessarily those of Scientific American.

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