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The Other Side of the Speculum


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July 1, 1986 was a day I felt like Alice falling down into Wonderland; I knew I would never be the same after walking through the doors of the Pennsylvania hospital for the first day of my internship in Obstetrics and Gynecology. It was the first year of a four-year training program that promised me little sleep, high stress and extensive learning. As I passed through the doors I remember feeling my stomach twist with fear, my mind contorting with anxiety and excitement, my ego see-sawing with confidence and self-doubt. Already, in medical school I had realized I had a different way of looking at healing than my peers and I was pretty sure this difference would cause for some challenges. Sure, I had a MD after my name, but that was earned simply by memorization and observation, with little practical experience in healing and understanding the human body and all its complexities. Additionally, since I had chosen OB/GYN as my life work, there was also the “second” patient- the baby in the womb and his/her entrance into the world, which I was responsible for. I was afraid, but I knew I was not alone. As all the first year interns gathered in the conference room that first morning, it was obvious the unified emotion was a cautious thrill combined with sheer terror. Thankfully, the chief of the department was a kind and knowing man who realized teaching by humiliation was a vestige of the past and immediately affirmed our emotions as appropriate and necessary. “Without fear,” he said, “new doctors are dangerous”. He confirmed we would be working harder than (most of us) had ever experienced and that there was a plethora of learning and practice over the next four years that sometimes would feel insurmountable and alternatively, richly rewarding and profound. He was supportive and compassionate. I felt I was in the right place for learning.

The next day, I was “on call” on the labor and delivery floor. This meant that I was responsible for assisting women who might be in the maternity department both delivering their babies or postpartum from 5pm (after a full days work) to 6am the next day. Although it was only my second day, I was expected to jump right in and BE THE DOCTOR. On the maternity floors, there were both private practice clinicians (who had been practicing for many years) and doctors in training (called residents, in their third or fourth year of the program) so I was at least not entirely alone.

It was 12 am; I had been awake for 18 hours. Along with other responsibilities throughout the afternoon I had been assisting one of the private physicians with one of his patients. The patient was ready to deliver her first child. He told me to join them as they took the patient back to the delivery room. These were the days when ladies were placed and sometimes strapped into stirrups, cleaned with betadine, shaved and often alone, without their partner or supportive family in the delivery room; a sterile, white, cold and vacuous space that doubled as the operating room. It was also a time when episiotomies (the cutting of the perineum to assist in the delivery of the baby) were routine. The patient was exhausted. The doctor had her strapped into the stirrups and with no attempt to see if the baby could be delivered with maternal effort, he numbed her perineum and cut a very large episiotomy. He then proceeded to scream at her to deliver the baby and continued to do so until the baby was delivered. He handed the baby to the nurse in attendance (and told her to leave the room) while the mother wept from pain, fear and relief. The mom was never given the opportunity to see or touch the baby. He stitched up her episiotomy never once speaking with the patient, ignoring her weeping and her pain. Finally, after being sewn with not enough numbing medicine, she was taken back to see her family and her new born child.

In a state of shock, I followed him to the nursing station where he proceeded to tell me to dictate the delivery note and stomped off the unit. I remember feeling utterly ashamed; having borne witness to such a violation to this woman and not saying anything (since I couldn’t possible question this prominent physician) and then being asked to document it for medical and legal reasons, not knowing at that time how to describe what I saw other than feeling like I had witnessed abuse under the guise of medical care. I remember feeling helpless and sad, afraid and furious. How was it possible that this physician could have behaved in this manner; angry, uncaring, arrogant and what I felt had been violent. How was it possible that he held so much power? How was it possible that I would learn under this regime?

Shortly after the one patient delivered, I was asked to accompany another doctor to assist again with a delivery. This time, despite being in the same austere delivery room, the ambience was totally different. This time, the doctor spoke with the patient throughout. There was no screaming. There was no huge cutting of the patients perineum and instead, a gentle manipulation of the babies head into the world. The baby once delivered was placed on the mothers’ abdomen and nursing began shortly after. The tone throughout was of gentle service, honoring the mother for her efforts in the delivery. The contrast with this delivery and the former was daunting.

That night, I learned a great deal but much was under duress. I realized very quickly that as an intern and perhaps throughout my residency, I would have to witness other doctors behaving in a manner that was misogynistic and inhumane. Moreover, they might make medical decisions that drastically differed from my own. I would have to learn how to get along in the face of this knowledge since I was determined to get through the program. I had to keep my feelings hidden and separate from my daily work. The only real but important power I had was for me to treat women with the humanity and respect I knew deeply, they deserved; within the small sphere of my practice I realized I could possibly make a difference in the way my patients experienced their health care and healing. But within that same world of medicine, I was going to encounter other practitioners who would abuse their power and the relationship they had with their patients. I would have to find my voice amidst the chaos.


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Amy Novatt:
My life as an obstetrician - gynecologist started in Pennsylvania in 1990 working in a community hospital delivering babies and learning the art of gynecologic surgery. As hard as residency was, I realized early on that I had chosen a career that suited me. The practice merged my interest in women’s health, reproductive policy and surgery perfectly. I spent many years assisting woman deliver their babies and then decided to focus on gynecology (only)- appreciating that in most offices, the concerns of adolescents and women not having babies, were often marginalized by doctors. I was interested in creating a professional arena for women to discuss these non-OB related issues. I have worked in a private practice for 14 years in Rhinebeck, NY. I have seen over 10,000 patients during those years. My work includes office GYN and surgical interventions, including advanced laparoscopic surgeries while lecturing both to professional peers and lay audiences.

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