Why Medical Matins was private, even after residency was over

As you may have read, this blog was private from December 2017 to February 2020. While I was thus censored by my institution, I continued smilingly recruiting for it, and then serving as a chief resident. It made the last year and a half of residency (already difficult because of the responsibilities of the role of an upper-level resident, the added weight of administrative chief duties, and the process of applying for fellowships) a white martyrdom.

Inside the Student Jail, Heidelberg, Germany.
CC License. Wikimedia Commons.

Gradually I opened up to more people about this event. But during it, I could tell few people how painful this was: two friends in the residency, one attending who happened to also be a personal friend, my family, and a few friends outside the program. I want to share a short post which was originally written on March 23, 2018. Writing this post two years ago, during outward silence, felt like scrawling on the walls of a strange prison. The topic of the post was what I should do with the now-private Medical Matins.

What should I do with the blog itself? I am tempted to post a lot of very unedited content while the blog is private, then launch it again as public when I am no longer employed by this institution (and no longer bound by amiable agreement not to publish it). I am tempted to leave the blog derelict, floating in the massive amount of online content, for others to find. I want this so that I don't have to do any more work, and yet so that others can think well of me if they find the good things available on the blog. 

I know derelict internet things die, and I don't want Medical Matins to die. It's a helpful outlet for me. The blog gives me an occasion to pray the litany of humility (which I set as the default text of each post before I replace it with the actual content of the post), and then organize my thoughts and prioritize my emotions using the blog.

And I think Medical Matins is good for others. At least half a dozen (I've never counted and I'm trying not to over-estimate) medical students and others have contacted me through this site to ask about pro-life and pro-NFP residency. And it's been found by others who have disagreed, and resulted in dialogue.

So why, you might ask, didn't the blog pop back up in July 2019 after I graduated from residency? Well, at the close of residency, I didn't ever want to fight anyone, ever, again. I didn't want to be called into offices, I didn't want to give explanations, I didn't want to be chastised. I didn't want to diplomatically meet with others about whether my chastisement was just. I didn't want to write letters and discuss issues. To show you why I felt so deeply cowed, here is some more writing from March 2018, three months after I took down Medical Matins. I wrote this post into a draft which remained unpublished for the past two years. (It's also important that you know that I wrote it after a long week of nights, and after some additional personal disappointments, and I know my emotional milieu was messy.)

Should I continue blogging? It has caused me so much pain. This is a blog about my experiences, and I always return to that mission when I feel like a post has strayed. And the experience of my blog being censored is one of the most painful experiences of my residency. Why would I not write about it? Why would I not continue to write after this censorship is over?

I'll tell you why. I am an introvert, I am vain, and I am proud. This is a terrible combination in someone made to fulfill a public vocation, to train long into adulthood and be corrected by others, and to witness publicly to unpopular truths in an unfriendly culture. My introversion and faults are punishingly heavy because of my recent mistakes and failures, with a background of my censorship and another large-scale issue that I might open up about soon. My soul's problems can be a prison, without anyone's censorship! A prison that I am sadly used to, and one that I am striving to grow out of. The introvert grows quickly exhausted with people, and the vain person grows depressed and angry with failure. Perfectionist, the vain and proud cannot cope with failure. So I walk into a prison of my own making whenever I am corrected, disliked, or discovered as less-than. This is one reason why I don't think I can restart MM--I can't spring back when I have so many prison doors between me and the future.

Dore's depiction of Lucifer, as described by Dante in the Inferno.
CC License. Wikimedia Commons 

Faith shows the reality in all this turmoil. Humility makes me acknowledge that yes, I am correctable, not always likeable, and lesser in many ways. But Christ welcomes me in my humility and does not wait for me to become loveable to embrace me. In a way, I say "Thank God!" because to be loved before becoming worthy of love is a warm relief in the coldness of others' disapproval. But in a way, my pride interferes with God's unconditional love and says "But I want to perfect in se, I want to be admirable before I approach God." 

I stand where Satan stood, able to lock myself into a self-made prison. Let me avoid it. I must let go of the desire for any merit in myself and only look to love God and find comfort in doing His Will. If I do this, I will find strength to fight again. I will find the ability to restart MM if that is what God wants.

Inside the Templar's Prison.
CC License. Wikimedia Commons

Let's pull up that litany of humility one more time:

O Jesus! meek and humble of heart, Hear me.
From the desire of being esteemed, deliver me, Jesus.
From the desire of being loved...
From the desire of being extolled ...
From the desire of being honored ...
From the desire of being praised ...
From the desire of being preferred to others...
From the desire of being consulted ...
From the desire of being approved ...
From the fear of being humiliated ...
From the fear of being despised...
From the fear of suffering rebukes ...
From the fear of being calumniated ...
From the fear of being forgotten ...
From the fear of being ridiculed ...
From the fear of being wronged ...
From the fear of being suspected ...
That others may be loved more than I, Jesus, grant me the grace to desire it.
That others may be esteemed more than I ...
That, in the opinion of the world, others may increase and I may decrease ...
That others may be chosen and I set aside ...
That others may be praised and I unnoticed ...
That others may be preferred to me in everything...
That others may become holier than I, provided that I may become as holy as I should…

Please pray for me as I continue occupying this small part of the internet with my own opinions, for my own good and perhaps the good of others.

Why didn't MM's author fight censorship?

CC Andrela Bohner

As I've described before, Medical Matins was a private blog from December 20, 2017 to February 29, 2020, to fulfill a requirement from my graduate medical education department after my blog was discovered and I went through an administrative process which examined the blog content.

My first reaction was deep shame. I have been conditioned over several decades to please others, and to be disciplined was very difficult. This was also my first reaction when I was called into the office in medical school for bringing a fetal model to a lecture containing material on elective abortion.

My second was confusion. What was going on? Was I really in the wrong, or was this about the truth of my opinions on issues like marriage, transitioning, and contraception? When it was over, I felt outrage. I was censored because of the nature of the blog and what I wrote about. (It is my firm impression that had I held the opposite opinions, I would not have been censored.)

Good came from this, and even during the process I could appreciate it. First, I learned to care a little less about pleasing people. If I have something true to say, I should not be ashamed when people are upset. Second, in a safe space with few or no long-term consequences, I went through my career's first little trial for the truth. Third, I encountered persons who I realized need a great deal of prayer and sacrifice, and I believe it is my duty to pray and sacrifice for these people in particular.

However, I felt that the end result (censorship) was not acceptable in a university environment. I know secondary education's lost its soul, but if the university is not the setting for professional, intellectual exchange, what is? I began to go through channels so that the institution would have some intellectual honesty about the importance of different opinions on issues.

Then, I abruptly stopped, and today I want to write about why. 

Shortly after the blog issue was concluded, a patient was admitted for excision of a cesarean scar ectopic. I was on night float, and at first I heard with trepidation that there was CSP admitted because I feared that there would be an ethical mis-step. However, the surgical plan sounded like it would meet the ERDs' definition of an "indirect abortion" and satisfy the principle of double effect. Relieved that I would not have to get involved, I waited for the scheduled procedure a few days later. Then, a few evenings later, the day team announced that the surgical plan had changed. The new plan involved fetal dismemberment. Aware of the culture that anyone can "stop the line," (link if that one is broken) I nevertheless had to think what I could do to help while I was working at night and going home in the morning. I emailed the director of the Ethics Committee, just to notify him of the change in the surgical plan. 

I came back that evening to anger. The other residents perceived that I had been judgmental, holier-than-thou, obstructive, shifty, and simply wrong. I was corrected by one of the residents in front of everyone at evening hand-off. 

Ultrasound appearance of a uterus after a C-section,
with scar between the yellow arrows.
CC License. Wikimedia Commons.

As in other situations, my first reaction was shame. I was basically silent, although (since no one on my night team knew I'd done this) I did have to offer a half-sentence in explanation to them, which I had not planned to do and certainly not in that setting. Later, I formally apologized to a few attendings and the residents involved. There followed a very uncomfortable month when I felt highly disliked. Stray comments praising BTLs and LARCs and disparaging the ERDs (ordinary fare otherwise) felt sharper.

In this milieu, I felt that just finishing residency without being hated would be great, so I stopped seeking further attention regarding the blog censorship. As of this writing (which occurred originally in March 2018), I just hope to quietly finish residency with no more moral discussion.

Good things came from this CSP episode, too. I had a fruitful conversation with the Ethics Committee meeting that month (which I could only attend because I was on nights and I was off-duty at that hour), and recommended an article on CSPs that I think makes a stab at the truth. And the Ethics Committee saw that there were some communication, personality, and practice concerns surrounding the issue, and my "stop the line" email was not the most concerning aspect of the case. It is a relief that at the end of these two episodes, at least some dialogue occurred. 

Welcome back to Medical Matins

It's my pleasure as the original author of Medical Matins to reopen the blog and resume posting, with the original mission of producing original content as a Catholic, who has now graduated from residency in obstetrics and gynecology.

Medical Matins became a private blog on December 20, 2017, due to censorship by my employer. My residency program discovered the blog and discovered that it was mine. Because of my patient stories and posts about Catholic teaching, they supported concerns that readers and patients could find it offensive and could be repelled from seeking medical care as a result. The issue was escalated to a professionalism committee, which reviewed the blog content and heard my position in response to the concerns which were raised. They considered what type of action to take to address my behavior, and among the options was to suspend the blog. This was the option they chose. In addition, I had to read a young adult gay romance novel and write an essay about it. Beyond a few posts (here and here) discussing why I didn't fight this decision and why the blog was still private for about 6 months after residency, I won't dwell on the event much. I want the blog to continue to be what it had been before: a window into thoughts from a Catholic OB/GYN and consecrated virgin. I have so much more to say and do besides moan over unpleasant things of the past. But this blog is, after all, the blog of a Catholic OB/GYN's experiences, and this was one heck of an experience, so it may crop up in future posts as I reference its effects in my life.

There will be two changes now that I'm resuming content creation on Medical Matins. First, the focus may shift somewhat. Importantly, this is not a result of what happened to the blog; instead, it's because my day-to-day experience has changed. Now that I have finished OB/GYN training, ethics is less of a daily concern, although it still piques my interest. You may see fewer clinical stories or posts on ethics, and more content on topics relevant to Catholics outside of medicine. One such topic is the struggle that accompanies the return of tradition to the post-conciliar Catholic Church. Second, the posts will be more sporadic since my focuses have shifted now that residency is over. I did, after all, do without MM for two years, and I have significantly increased time I give to other projects.

Medical Matins will continue to be anonymous. As always, I ask readers to please respect my anonymity both online and IRL.