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. 

Two months in review (7-8/2015)

In the past two months, I've been on night float and on the ultrasound service. I've worked an average of 68 hours per week and used 1-2 servings of caffeine per 24 hour period. I've delivered 35 babies, done 5 C-sections (as primary surgeon), and done about 160 ultrasounds of various types.

I'm learning how to admit patients to triage, evaluate them, "dispo" them (send them home or keep them), answer dozens of types of nurse and patient phone calls, and "update the board" (keep abreast of what every patient is doing in labor and delivery). I'm also working on ways to wash laundry only every other week, recycle in my small borough, cook only once a week, make a bed while getting out of it, and shower in the time it takes to sing a Credo. I've replaced a car battery, hung blackout curtains, and bought several loads of furniture. And most importantly, I'm trying to make space in all this work for the liturgy of the hours, meditation, the rosary, confession, and Mass. I've made a lot of mistakes, but I'm being patient with myself as I try to do better. It's been a challenge.

I enjoy the work, especially when the deliveries are beautiful or I get things right. I'm at a good hospital with excellent and friendly nurses and my upper levels and chiefs are paying it forward, being kind to me so that I can be kind to the students and the next generation of residents in the future.

Things to learn in the future are how to not miss morning meditation, how to write discharge summaries in ten minutes, how to round on a dozen people in an hour and a half, and how to do dishes only once a week without starting an impromptu microbiology lab. I am also working on having local NFP resources printed for handing to patients in clinic (which is happening in the next two months) and having my elevator speeches together for when I am doing nothing but seeing postpartum and clinic patients. Any prayers would be appreciated!