PostCage (premiere recording of dharmachakramudra)
rangzen quartet recording of mf
ImprovFriday CD (includes virtual music 2)
we need to come out and say “enough”
I’m still ruminating over the murder of George Tiller yesterday.
As one of the diminishing number of physicians who performed second trimester abortions, I can state unequivocally that it is never a procedure that is approached in a cavalier fashion. Not every gynecologist can perform it, even if trained appropriately. The sad thing is that we’ve done a really bad job at training the next generation of providers. I taught many residents, but of those, many will not provide abortion services for a variety of reasons. Part of why this is is that abortion has been marginalized. People don’t want to talk about it. My colleagues for the most part didn’t want to deal with it. Some couldn’t say the “a-word,” substituting euphemisms like VIP (voluntary interruption of pregnancy). Abortion is a very common procedure. It is a necessary procedure. But it will be an extinct, forgotten procedure if clinicians are not trained to do it safely and compassionately. We need to get it back into the hospitals so that it is again part of routine gyn practice. Abortion training must be made more widely available within residency training programs. It’s idiotic that many ob/gyn residency programs do not offer in-house abortion services, but must send “interested” residents to outside clinics, often on their own time during weekends.
When I was in practice, I did a lot of procedures in ob/gyn. Including abortion. Some of my most grateful patients were those for whom I performed an abortion. I never performed any abortion without being absolutely certain that the patient desired it and that it was her own decision. That’s what “choice” is about, after all. My abortion patients didn’t wake up that morning and decide “What the hell, I think I’ll have an abortion.” This was a very, very difficult decision for any woman to make. People who have not walked in their shoes should not be making judgments or regulations about this most private and personal of medical decisions.
All of us who either performed or continue to perform abortions need to finally stand up, be counted, and say “enough.” Abortion providers have this terrible stereotype of being slimy, scumbags in the margins of the medical profession. We’re not. A lot of us are academics. We’re honorable. Most of us have delivered babies. All of us provide or provided services that are challenging and that many physicians either can’t or simply won’t provide. Rather than honor abortion providers, society (including many physicians) treats them like criminals. This must change. While I recognize the potential danger in coming out as an abortion provider, there is strength in numbers. And just as the Gay community came out and took steps to remove the stigma of being gay, abortion providers should stand up, be proud, and demonstrate that we’re here to stay. Only when abortion is de-marginalized can we start addressing the onerous restrictions on the provision of abortion services and also combat the insidious demonizing of abortion providers. Such demonizing was absolutely behind the assassination of Dr. Tiller yesterday.
EJ Keith, and 
PassionateProvider 12:56 am on Tuesday, June 2, 2009, 12:56 am Permalink
Hey David,
Great post. Very powerful.
I’m currently in my last year of medical school. I have organized abortion training opportunities at my school since my first year. Now that I am in my internship years, I have also had the privilege of working with and learning from practicing providers. I am looking forward to a career where I can be involved in the full spectrum of women’s reproductive health. An abortion-providing baby-delivering doctor is not an oxymoron. In fact, I think it is a pretty awesome combination.
Your call for “coming out” of providers does not fall on deaf ears. I agree with you completely. I’m not quite there yet, unfortunately. The pseudo-anonymity of twitter et al. has made it easier for me to share my thoughts and passions. As I gain confidence, and, more importantly, a sense of interconnectedness to like-minded people, the need for anonymity is diminishing.
dtoub 1:06 am on Tuesday, June 2, 2009, 1:06 am Permalink
Thanks very much. I really appreciate your comments. And no, it is not at all an oxymoron. I did it as well, although I confess I was more of a laparoscopic surgeon than an obstetrician after awhile.
Don’t rush the “coming out” part. It’s an individual choice. I was very careful when I was in practice, especially after I had my daughter. It changes one’s perspective, since it isn’t just about you. But being careful isn’t synonymous with denial. I never lied about what I did and remain proud and humbled to have provided this service to many women. But it’s admittedly easier to be “out” in terms of abortion once one has left clinical practice. Many of my fellow abortion providers were genuinely scared in the 90′s and with good reason. Several providers were shot and killed, along with courageous volunteers and staff. That changed things quite a bit. So there’s nothing wrong at all with flying under the radar. But still, many established providers need to declare themselves or at least not deny what they do when asked. The more providers who speak out, the better. Good luck with your training. Guess I can’t talk you out of being a doctor.
EJ Keith 11:45 am on Tuesday, June 2, 2009, 11:45 am Permalink
I happened upon your blog in light of Dr. Tiller’s death, and I just wanted to express my utter gratitude for the work you do, and the courage and honesty with which you carry out your duties. I’m a Canadian woman, so things are a bit easier for us up here, and although I’ve never needed to consider an abortion I have friends and family members who have; and I am grateful that I live in a country that respects a woman’s life enough to allow her the courtesy of being the sole decision-maker in the choices that will most affect her.
I was born in 1980, so I grew up as a member of the first generation of Canadian women to go trough puberty post-Morgenthaler (the SC decision that abolished the last legal restrictions on abortion in Canada). Because of this, I’ve never had to go through the agony of having nowhere to turn, nor have any of my friends of similar age. I haven’t lost friends to butchers, I haven’t known anyone – of my age – to have their dreams of future children taken away from them as a result of complications from an illegal operation (although I have met older women who have had to live with this).
And for this freedom, this luxury of choice, I have you, and others like you – doctors, nurses, and other health care providers & supporters – to thank. To you and future doctors like the one who commented above me on this thread, THANK YOU, THANK YOU, THANK YOU. Although we are from different countries, with different laws, the stand you make strengthens us all.
And I can’t thank you enough for having the courage to make it.
Kindest Regards,
EJ Keith, Ottawa, Ontario
dtoub 11:53 am on Tuesday, June 2, 2009, 11:53 am Permalink
Thanks for your kind words. Your country is pretty enlightened regarding abortion, as I’ve noted before: http://dtoub.wordpress.com/2008/07/12/an-enlightened-attitude-about-abortion/.
I’m no longer in practice, incidentally, and regret not being able to provide this service and train residents. Our health care system is very different from Canada’s, and many gynecologists end up either changing states or leaving practice entirely. Hopefully Obama’s health care reform will take hold—we need a better system.