Story of Self | The Pillbox

After writing “ Storytelling and Patient Advocacy,” I cuddled up to a cup of warm coffee and reflected on the various moments in my life that inspired me or motivated me to take action. I thought about my story; why I applied to medical school and why I have certain research interests. Then I asked why I want to improve access to and the quality of reproductive health care. Immediately I thought about the question friends and family frequently ask me: “Why would you support Planned Parenthood if you want to help women?” My answer is this story:

As a third year medical student who will soon be applying to an obstetrics and gynecology residency, I am afraid. The recent violence in my community and continued aggression against Planned Parenthood suggests that aligning oneself with the organization is risky. Becoming an obstetrician gynecologist (OB/GYN) has been my dream since elementary school, so I feel anxious when family members share concerns that publicly supporting Planned Parenthood ensures I will not match to an OB/GYN program. Will standing with Planned Parenthood keep me out of a program? Is it OK to discuss abortion training on a residency interview? Or do I need to use code like, “What family planning training opportunities are available?” And in light of the attack on the clinic in Colorado, is my life in danger? A pro-reproductive rights provider and avid supporter of Planned Parenthood wrote to me, stating that she is afraid to rotate at their clinics for fear of an attack. She hauntingly added, “The terrorism is working.” I almost never employ self-censorship, yet I too hesitated to continue to develop a professional relationship with Planned Parenthood. Even scarier is to discuss that affiliation publicly. A friend reminded me that in times of confusion or fear, it is best to have a mantra that can elicit courage. My inner voice reminds me, “Be a rock star woman.”

A couple years ago, after my reproductive and endocrinology module, and after being influenced by readings about sexually transmitted disease (STD) pathology, I requested a full STD screen during my annual well-woman exam. The nurse told me, “We don’t do that here. You’ll have to go somewhere like Planned Parenthood.” I left embarrassed and did not follow-up with another clinic. Enter my third year clerkships when, on a pediatric service, my team treated a 15 year old female who was 21 weeks pregnant presenting with “vaginal pain and fainting during sex.” I was ecstatic to finally manage an obstetrics (OB) case, and I excitedly took a medical history. While writing my notes, I overheard a group of nurses say that this girl would not have “gotten herself pregnant” if she knew how to use a condom. I interjected that the American College of Obstetrics and Gynecology now recommends long-acting intrauterine devices (IUDs) as the leading contraceptive option for adolescents because it is the most effective, safe, private, and does not rely on user consistency (ACOG, 2012). Three nurses and a resident mistakenly retorted that IUDs cannot be given to adolescents or females who have not been pregnant due to increased risks to the uterus. Because an intrauterine device is placed inside of the uterus during an office pelvic exam and contains a small string that trails into the vagina, old theories warned about uterine perforation, pelvic inflammatory disease (PID), and subsequent infertility. They are wrong. There are no cases of infertility following IUD use, no increased absolute risks for PID, and minimal incidence of uterine perforation (ACOG, 2012; ARHP, 2015). Shockingly, this has been known in the medical community for more than a decade, yet there continues to be widespread ignorance about it among healthcare professionals.

I observed a similar case during a later clinical experience. I listened to the physician refuse an IUD to a young woman with a history of unintended pregnancies based on his belief that adolescents are promiscuous and will develop pelvic infections. His words, “We don’t offer those here. You’ll have to go somewhere else like Planned Parenthood.” Do you see the pattern? It is no secret that judgement, ignorance, and prejudice exist in healthcare. What is a medical student to do when faced with blatant disregard for clinical guidelines and scientific evidence that has been undisputed by science for over a decade? I decided to contribute to the advancement of research and education by volunteering with Planned Parenthood, an organization that provides safe, up-to-date, and judgement-free care.

I regularly volunteer at Planned Parenthood as a patient escort, walking patients from their vehicles to the clinic doors. Let me set the scene. My local office is visited by anywhere from three to more than twenty protestors daily. They stand on the sidewalk mostly shouting and waving signs at passing cars. A few people silently pray with a rosary. The first time I arrived, I had to excuse myself to the restroom because the hateful screams of “Baby killer with blood all over your hands!” were too shocking for me to bear. Eventually I became better equipped to disregard protestors. However, that took time, and if I, a student medical provider, was mortified when my gynecologist’s office told me to go to Planned Parenthood for a standard STD screen, can you imagine the emotions a young patient experiences when walking from their car at a Planned Parenthood clinic, listening to protestors scream? So I stand for hours in front of a Planned Parenthood clinic, deflecting the endless onslaught of insulting remarks, in the hopes that people can feel a little more secure receiving an STD screen, a pap smear, an IUD placement, or yes, an abortion.

The fact remains that Planned Parenthood is a leading provider of reproductive health care services. A central focus is prevention, encompassing STD and cancer screening as well as contraception. They provide prenatal services and references for those choosing to pursue adoption, in addition to abortion services and other reproductive health care. The Guttmacher Institute, another source of global sexual and reproductive health, reported in July 2015 that half of all pregnancies each year (greater than 3 million) are unintended; the same statistic that has existed for two decades (Guttmacher, 2015). More than half of women of reproductive age (13-44 years old; 38 million) need contraceptive services, and 20 million of those women require publicly funded services and supplies. In addition, the average Planned Parenthood health center serves significantly more women seeking contraceptive services than all other publicly-funded safety-net clinics.

An interview on Fresh Air with Jonathan Eig, author of The Birth of the Pill: How Four Crusaders Reinvented Sex and Launched a Revolution, made me think more about Planned Parenthood’s role in women’s health care. In the book he describes the challenges scientists and Margaret Sanger faced when trying to develop a “magic pill that would allow women to control when and if they got pregnant”—Wouldn’t that be great? Oh wait, we thankfully have that now in pill, patch, injection, implant, and intrauterine device forms. The developers of the pill studied progesterone’s effect on inhibiting ovulation under the guise that they were studying infertility treatment. I wonder if the current, hostile climate surrounding Planned Parenthood will later be compared to the ludicrousness of 1950s-era United States, when our country outlawed female contraception, while allowing men to easily purchase condoms. When I learn about the backlash surrounding the development of birth control, arguably the most important invention of the 20^th century, how could I let threats prevent me from supporting an organization that is one of the few to consistently provide safe and evidence-based services without judgement? The answer is, I cannot. My career goal is to help women access and achieve the best reproductive care. That is why I stand with Planned Parenthood.

References:

American College of Obstetrics & Gynecology. (2012). ACOG committee opinion no. 539: Adolescents and Long-Acting Reversible Contraception: Implants and Intrauterine Devices. Obstet Gynecol. 117(6):1472-83.

Association of Reproductive Health Professionals (2015). The Facts About Intrauterine Contraception [Fact Sheet]. Retrieved from http://www.arhp.org/Publications-and-Resources/Clinical-Fact-Sheets/The-Facts-About-Intrauterine-Contraception-

Guttmacher Institute. (2015). Publicly Funded Family Planning Services in the United States [Fact Sheet]. Retrieved from http://www.guttmacher.org/pubs/fb_contraceptive_serv.html

Featured image:
Me (far left) escorting guests to the annual Planned Parenthood of Southwest and Central Florida Fundraising Gala.

Yesterday, I received a perfectly-timed message on a group thread. My friend wrote that she loves patient advocacy.

“Me too,” I thought, as I filed away notes from a Planned Parenthood of Southwest and Central Florida Meeting hosted by the Leadership Action Team (LAT). What was the purpose of that meeting? To train volunteers on how to employ storytelling in their advocacy work. Planned Parenthood trains all of its staff members, and now volunteers, in the “Story of Self” curriculum created by Get Storied® , which is a program designed to teach businesses how to create social change through the art of storytelling.

The meeting began with introductions and a moment to safely process the recent shooting in our hometown. A young volunteer explained how the event affected her and her family:

I learned about the shooting on Facebook…And honestly, all I saw was, ‘Massive Shooting,’ and thought, ‘Oh, another shooting,’ and kept scrolling. I didn’t understand the gravity of the situation, until that night while watching the news with my mom. I looked over at my mom and she was crying. She just said, ‘I am afraid for you.’ She’s never before expressed concern about my activities. But now she says, ’I am afraid for you.’

This volunteer was young, but her voice carried a surprising amount of assuredness. I felt her confusion and fear. The next attendee shared their story, and then the next, and so forth as the meeting progressed.

We learned that there are three key components to one’s story of self: a challenge, a choice, and an outcome. Zac, the chair of the LAT, shared his story of self, which described the healthy relationship with his mother and the openness with which she educated him regarding sexual matters when he was an adolescent male. The two-to-three-minute story, complete with a joke about educational materials containing graphic penis pictures, ended powerfully with the line,

When I walk into a Planned Parenthood, it’s the same kind of environment my mom created for me for talking about sex.

We received our first assignment, which was to reflect on the experiences in our lives that have shaped the values which call us to leadership. The program will later have us refine the various details of our stories, practice in one-on-one and group sessions, identify ways in which we plan to use storytelling in our advocacy work, and take action. We had five minutes to silently reflect.

Ok, what is my campaign? Women’s health. Yeah, but what specifically? To help women access and achieve the best reproductive health care possible. Nice. So why do you want to do that? Because reproductive health is the most important thing in the world! Ok, but why?

Figures of maternal morbidity and mortality popped into my head. I could see again the absence of a clitoris and labia in my Nigerian patient who underwent female genital mutilation as a young girl. I remembered the way the vaginal introitus feels beneath my hands—stretched and strong—as a baby’s head begins to crown. The voice of an adolescent girl echoed, “I mean I want to have sex, but like, I’m not a slut.”

It is easy for me to think of patient stories that depict why I am pursuing a career in Obstetrics and Gynecology. But a story of self is just that. A story of SELF. I struggled to think of inspiring personal experiences.

Time is up! No.

Each person in my small group shared their story and received feedback. My turn circled around and I rambled on about women’s health. I managed to state two strong lines, “I volunteer at Planned Parenthood because it still remains the one place to offer judgement-free care. Not even my own gynecologist can say that.” But my story lacked focus and a compelling personal example.

That night after receiving my friend’s text, I began to think more about the meaning of patient advocacy. As a medical student, I think my primary role in patient advocacy is to ensure that my medical team knows about our patients’ health histories and needs. During my internal medicine/family medicine clerkship, in order to help care for a patient, I compiled a short document of excerpts from the World Health Organization, Centers for Disease Control, and American College of Obstetrics and Gynecology regarding HIV prophylaxis treatment in pregnant women with negative HIV status who have regular, unprotected sex with an HIV positive partner. In that instance, helping my resident defend her treatment plan was my way of advocating for my patient’s health. Patient advocacy means that I volunteer monthly to escort patients safely into Planned Parenthood clinics. It is the reason why I study exercise and pregnancy, so that I can advocate for pregnant athletes seeking to find a balance in the pre- and post-partum periods. Additionally, patient advocacy means that I write on the MSPress Blog about topics that matter.

Stories in medicine can break stigma, help people relate to the struggles of others, and empower someone to raise their voice. Stories identify why we should care about an issue, and can inspire others to take action. Although I do not yet have an organized understanding of the many personal experiences that inspire me daily to fight for reproductive health care, I think I am well on my way to becoming a strong patient advocate. Fortunately, I do have a clear goal: support the improvement of access to reproductive healthcare and higher quality of reproductive healthcare for all.

Quoted persons in this paper gave permission to be on the record.

Featured image:
Story by Alexander Affleck