Eleven Cents

I am struggling with a frustrating reality: a person hoping to do research to build up the culture of life has to do twice as much work as a person who hopes to do amoral clinical research. Becoming a clinician-scientist is hard enough. They have to see enough patients, do enough surgery (when applicable), and earn enough grant money to make their institution value them. This means they have to stay on top of their clinical game. And like it or not, this usually means they have to choose result- and revenue-generating research topics.

Becoming an academic physician who also builds up the humanity of the unborn or builds up the science behind FABMs is even harder. Those topics don't make money and don't make friends, so these people either can't overtly do this research (i.e. they have to cloak it as MIGS or MFM) or they have to do amoral popular research in parallel. In my limited experience of successful pro-culture-of-life physicians, there is a proportion involved: the more pro-life/pro-family research you do, the more amoral research you do. The more you cloak your pro-life/pro-family research, the less you have to lead two lives to put bread on the table.

This initially made me very frustrated. Why should I have to do twice as much work as other people in order to do the research I care about? In this age of non-discrimination, why should I be effectively treated differently because of my beliefs? Of course, I realize that I'm not alone. I'm sure there are hundreds of MDs and PhDs who have pet topics that are non-fundable because they are too obscure, too unstudied, or not flashy enough to earn grants. But still! This is different. Want to do research that builds up humanity and saves the world? Tough luck.

This makes me think of a story from my childhood. I was at a big family reunion as an early teen. I have a lot of cousins that span almost two decades in age, and we were all at the pool. There was a wading pool for the little cousins and a regular pool for the "big kids." Most of the kids who could swim were in the big kid pool. Then the reunion held an event: all the adults tossed coins into the pool and the kids could keep any that they picked up.

The competition in the "big kid" pool was fierce! I was bumping into people and the coins I was diving for would get picked up by someone else. I think I ended up with a penny and two nickels. I was actually pretty pleased with myself.

I was pleased, that is, until I went over to my dad, who was with my younger sister by the wading pool. My younger sister was with the little kids and had collected almost a dollar, just by bending over and picking up coins. She hadn't even gotten her face wet. I was so angry! I worked so hard to get eleven cents and my younger sister, who had no appreciation for money anyway, had easily collected almost ten times what I got! And I hadn't even realized that the wading pool was an option. My pleasure turned into hurt.

My dad took the chance to teach me something I have thought about several times since then. "There will always be people who get eleven cents with lots of work and people who get dollars without doing much," he said. Later in life, he would add, "We're called to be faithful, not successful." So I'll try to apply this attitude to work. I will do what I can to pursue my calling faithfully.

Blogging = Self-Publishing (It Doesn't Count)

I like to think about bioethics, theology, and the philosophy of medicine. I like to write about them on this blog. But I realized a few months ago that burying my essays in a blog is no good. I'm not saying this blog is a waste of time. It's a useful outlet for a verbal processor (me) and a nifty window for a few others to see into the life of a resident. It's also been a tiny hub for OB/GYN residents and students who want to practice according to their consciences.

Having come to this conclusion, I will keep sketching out my thoughts here, but I will no longer keep my thoughts limited to this page. This blog is exactly what the subtitle says: it's my experience. It's an open diary. That's why there are stories, schedules, and random cooking and ulcerative colitis posts.

But to be productive, scholastic dialogue has to happen in existing, professional avenues. That means NCBQ, LQ, Obstet Gynecol, and AJOG. And to be useful, advice on conscience has to be more accessible and more generalized. And that means I'm very excited to announce that I'm helping with a new project. It's called Conscience in Residency, and it's a single place for students, residents, PhDs, and even pharmacists to go for practical advice in following their conscience. (It's technically going live tomorrow, so be excited that I gave you first peek.) Apart from telling you I helped in CIR, I won't ever announce a publication, to protect anonymity. Bummer! Publications are major parties. Maybe every time I publish I'll just put up a picture of fireworks, 0-30 randomly-generated days after acceptance or epub or print? Would that be vain?

This also means you'll see disappearance of a few posts that are being rewritten for publication, or have been published. Sorry if the blog gets a little disorganized and links die! (Rest in peace, links.)

Eight weeks of Freedom!

I am currently on my last of eight weeks of no clinical duties. Free as a bird! What did I do with my time off? Well, I'm an unusual bird....

This was supposed to coincide with interview seasons so that I wouldn't be interviewing while working at the hospital, but I actually only had two interviews at the beginning of this "Christmas break," so I've basically had the time off.

Half of this eight-week break was actually a stay-at-home elective with teaching duties for the second-years preparing for their STEP 1. The other four weeks were pure vacation. Interestingly (ahem), I have done almost none of the teaching duties (I guess I'll do that during those apparently free afternoons during anesthesiology and radiology). Instead, I've been doing other things I'm really interested in:

• Taking courses in four main methods of NFP: Coupe to Couple League, Marquette, Creighton, and Billings
  
• Giving presentations to medical students about NFP (one on Marquette, one on Creighton, and one on all the methods)
  
• Starting a research project! (Late in my med school career but early in my reseraching career.)
  
• Finishing up a required "Quality Improvement" study...basically a shell project for a required fluff course
  
• Continuing to work on the two inventions I'm helping with. Gah, these things move so slowly!
  
• Preparing a talk with FACTS to give to OB/GYNs and to eventually (hopefully) integrate in OB/GYN clerkships and residencies. I'm going to help give this presentation at the AAPLOG conference in February.
  
• Working with a medical illustrator to create the BEST fertility cycle chart EVER
  
• Playtesting a gamebook I wrote and vacillating about publishing it (email me if you want to help playtest, which means reading it and discovering all the mistakes I made)
  
• Planning for residency. I used to think I could float through life without much planning, but third year showed me that you can't float through 70+ hour work weeks without meal planning and aggressive prayer planning. Therefore I am planning a year of meals and a year of Scripture meditations. So much fun/work/screen-staring....

Odd Jobs for an M4

I had no idea M4 would be like this. I am doing several weird jobs that I don't think most fourth-years do. I'm pretending as much as I was third year!

I'm a hiring manager and a travel agent.

This is something all fourth years do, but I'm adding it in just because it's so different from M3. For this job, I compiled a fancy-looking resume for a US senior medical student and packaged it with a nice personal statement. I scheduled some travel for her so that she has a broader experience to draw from as she interviews, and I tried to sublet her apartment as much as possible so that she doesn't break the bank. I managed her travel and get people to rescue her when she makes mistakes. (And boy is she a mess. She is constantly forgetting stuff at home, forgetting that when you don't change your address your new debit card gets mailed to the subleaser, forgetting that driving halfway across the country takes two days and you need sleep).

I am constantly checking my email for her, because interview invites come in fast and if you don't respond in a few hours, you don't get a spot. This chick's schedule is a mess. She's in Omaha for some NFP training thing for a whole week of primo interview time! And I had to schedule like seven interviews during her ER rotation. Hope she's okay with pulling nights and weekends. Hope she can pay for all the flights she's going to have to take. This residency nonsense isn't cheap.

I'm a biomedical engineer.
A weird twist of events led me to an engineering competition, which led me to a research project in which I am somehow the principle designer for a three-dimensional printed medical device. This is an amazing experience and I'd love to have a patent, but I burst out laughing every time I realize what I'm doing.

The engineering competition was an amazing experience. I didn't even know these things existed, but when I asked my brother (a senior engineering undergrad), he said, "Oh yeah, my roommate walked into one of those for the food. He almost won."

Here's what happened. An email was sent out from the College of Engineering (COE...boy that looks wierd after typing COM for years) with an application to a medically-themed engineering contest. It was sent to all the engineering undergrads and to all the med students. Forty engineering undergrads (out of almost 90 who applied) and as many med students as applied (four) were invited to attend. "Sponsors" (companies who fund the event, and you'll see why it takes so much funding in a second) provide the students with "needs statements" (things they want designed). In our contest, the needs statements were all related to rural and elderly health. In 48 hours, the students have to form teams, pick a needs statement, design and build a product (hardware, software, web or cloud components, prototype), and create a presentation to market it. The students get a chance to be engineers while being fed; the sponsors get free labor. At our contest, there was also a cash prize.

They sent out the needs statements the day before the contest. As I was driving there, I noticed that one had to do with gynecology. "Oh no," I said to myself. "I'm going to end up doing that one, I just know it." It didn't sound terribly interesting, and it also sounded impossible do without a pelvic exam on the person using the device. (Sorry if that was too much information.) I would rather have done one of the flashier projects and I had two favorites picked out.

Long story short: when the competition was only a few minutes underway, three teams had already seized my pet projects and there wasn't room for me on the team except as a consultant. And there were four people hanging around, teamless and needs-statementless. So I pitched the gynecology idea. And they shrugged and went with it.

We had ups and downs. Severe ups and downs. We oscillated between "this is the coolest invention since sliced bread" and "all we have is a smoking heap of circuitry." I wasn't extremely helpful. I can't write code, I can't build circuits, I can't sauder, and I have no experience with CAD software.

But I know how to sell stuff. I made the prezi and I sewed the fabric part of the invention. I sought out a nice mannequin to place our product on. This meant that I called half a dozen department stores and asked them the (probably) strangest question they'd been asked that day. "Hi, my name is mmatins and I'd like to ask your manager about female body forms or legs." Stranger still, I was successful. I carried a male torso model--completely unclothed--out of the back entrance of one store and stowed it in my trunk. I tried hard to remind myself I wasn't doing anything illegal. I then went back for a female torso on a stand, which I carried like some enormous, inappropriate lollipop through the food court and a parking lot.

At the end of the weekend, the COE announced that everyone would take home a small prize of $5-10. I thought, "well, that's nice. It covers part of my gas getting here." Then they announced second prize. "If we're going to get anything," I thought, "it'd be this," even though I pegged the two flashiest projects for first and second. Still, maybe.... Second prize wasn't us, so I internally shrugged. "It was a good experience," I began to tell myself. Then they announced first prize.

We won.

And because I later mentioned that I was at this contest when someone happened to be discussing 3D printing, I ended up giving a presentation on my first away rotation about bioprinting, during which I sounded like I knew something about it. And because I used to foodle around with Google Sketchup (now Sketchup Make), I could throw out a design for the product they wanted pretty easily. Sketchup + Google search + Wikipedia = makeshift engineering degree.

I'm a novice mistress.
Because there is no established curriculum for consecrated virginity in my Diocese, I am sort of making it all up as I go. This used to cause me slight distress, because there is such an emphasis on giving over one's will to another in the works of the Doctors of the Church and other authorities on the religious life. I shared this distress with my spiritual director and he smiled and shrugged. "What else could you do?" he asked.

I'm cobbling together a bunch of online classes and my weekly meetings with the other consecrated women. During these meetings, we cover what they think would help me and what I ask for. Recently, we finished a ten-point curriculum for living in intimacy with Jesus daily. (The love of God for the soul, the will of God, Scripture, love of neighbor, mutual love, Jesus in the midst of "two or three," the Eucharist, Love in community, Jesus forsaken, Mary, the Church, and the Holy Spirit.) We're moving on to forming a rule and leading a balanced earthly life. I asked that we do more on affective maturity and the evangelical counsels next. But I feel sort of like I do when I pretend to be an engineer.

My formal application for consecration is complete and submitted. My bishops are right now deliberating and discerning whether to admit me to the order of virgins. If they do (praypraypray), I will add another odd job: wedding planner.

I'm a Codfish

Source

So, once upon a time I was headed back from an awesome CMA conference, poster tube in tow after presenting the results of a literature search on IVF alternatives. I get in line to board the plane and someone gets in line beside me  whom I perceive to be liberal. I couldn't tell all at once, and it's hard to explain or excuse, but I could tell (and I was right) that this person probably disagreed with 95+% of my social issue positions. I don't remember who initiated the conversation (probably me, believe it or not), but eventually the gentleman asked about my poster tube.

"So, what's that?"

"It's a poster," I explained. "I presented some findings at a medical conference this weekend."

"Oh, really? What's it about?"

And I had a chance to say, "it's about IVF alternatives. Did you know that there are methods that are cheaper and more effective than IVF, but IVF is still treated as 'first-line' therapy by most infertility doctors? Isn't that weird? You'd think couples would like to try something better first, especially if it didn't involve drugs and masturbation. And with everyone complaining about our healthcare system, you'd think we'd prefer cheaper stuff. Right?"

But did I do this? No. My fear of being alienated was so strong that I just said, "IVF."

"Oh really?" the gentleman was pleased. (He seemed sort of leery of me before. Like, 'you're dressed like you think you're body's sacred or something. You must be benighted, backwards, and indoctrinated.')

"My sister is doing that," he said.

Feeling wretched and ashamed of myself, and still not strong enough to tell him what the poster was really about, I started the sympathy song: "Oh, wow. That can be really hard."

"Yeah," he said, his tone and body language heartily agreeing. The conversation went on about how I'd been to college in California (facepalm) and how L.A. is a bastion of liberalism (the first true thing said).

I'm such a coward!

But wait, it gets worse. Last month our class had an exam. A few minutes before it was scheduled to start, the classmate behind me and I struck up a friendly conversation about our streams. I told her that I ranked so that I'd get OB/GYN sometime in the winter. "Oh, that's right," she said pleasantly. "You want to do OB/GYN!" And then, "Are you interested in infertility?"

"Yes!" I said warmly. And I'd already hashed out my shame at the airport failure, and resolved to be more courageous and here was an opportunity. I could have said something like, "I'm really inspired by the speed and success rates of fertility-awareness based infertility workups. Have you heard of that?"

But I didn't. And while I was hesitating, she went on. "I'm an IVF baby," she said happily, smiling as though I would be inspired by this.

There was a very small pause, then I said "Aw, wow!" and my delight was real: I am glad that she was born and glad that she was my classmate. But I was also thinking to myself "oh, gosh, IVF right in front of me," and "glad I didn't say anything bad about IVF," and "I guess Mormons must not see a problem in IVF" and "can we please start this GI test so that I can make decisions on multiple-choice questions instead of with conversations and IVF??"

More courage is needed. Good thing it's Lent.

Finally, draw your strength from the Lord and from his mighty power. Put on the armor of God so that you may be able to stand firm against the tactics of the devil...and, having done everything, to hold your ground. So stand fast with your loins girded in truth, clothed with righteousness as a breastplate, and your feet shod in readiness for the gospel of peace. In all circumstances, hold faith as a shield, to quench all [the] flaming arrows of the evil one. And take the helmet of salvation and the sword of the Spirit, which is the word of God. With all prayer and supplication, pray at every opportunity in the Spirit. To that end, be watchful with all perseverance and supplication for all the holy ones.... (Ephesians 6)

Fortnight of Frenzy?

If I survive the next two weeks, it will be a feat of incomparable scheduling gymnastics. Watch what's happening:

1. Sept 17: CMA meeting to decide if our local CMA-SS will be a chapter of the big CMA-SS (involves finances and money, etc yuck)
2. Sept 17-20: Lectures covered by Exam 2
3. Sept 20: MedSFL reception in Houston (I'm going for fundraising and networking) [too crazy]
4. Sept 21: Exam 2
5. Sept 24-27: Lectures covered by Exam 3
6. Sept 23: first (mandatory) meeting of bible study I signed up for
7. Sept 23: monthly Mass with CMA-SS members
8. Sept 25: MedSFL meeting at my school (big event I've been working on for about a year, or maybe since June 2011)
9. Sept 26-30: CMA Conference, at which I am presenting a poster. If it seems odd that I be in Minnesota at a conference and at home taking an exam, don't be confused, because...
10. Sept 25: I take Exam 3 early (four days after Exam 2)

In order to do this, I am studying Exam 3 material now. (It's awesome, it's all about cardiac conductivity; I just wish things were a little more spread out.) I'm grateful that I'm not in the anatomy lab, that I've been taught cardiac physiology at every level of my education since age 14, and that Our Lord is present in the Eucharist all the time, waiting for me to lay the head of my soul on his Heart when everything gets too hectic. 

Hopefully, this won't be a frenzied time, just a very, very busy one where I hang on to Christ's peace until the whirlwind is over.

Law, Tests, and Posters

After taking Spirituality in Medicine and Literature in Medicine, I jumped at the newly-opened chance to take something a little more hard-core: Law and Medicine. We're learning all about the role of the expert witness, which is how doctors (who aren't being sued) see the inside of courts most often.

Also, today I took the first Cardio exam! It went well.

Afterwards, I picked up the printed poster I created for the upcoming CMA conference! I am very excited. Here's the abstract that goes with the poster:

Repair of Fallopian tubes (tuboplasty) was the standard of care for tubal disease before the advent of artificial reproductive techniques like in vitro fertilization (IVF). Tuboplasty is a morally acceptable treatment for women with tubal factor infertility. 

The recession and the upcoming compensation changes in the Patient Protection and Affordable Care Act provide stimuli for mainstream medicine to prioritize what Catholic gynecologists know to be the ethically superior treatment. This year, the Practice Committee of the American Society for Reproductive Medicine (ASRM) edited their Opinion on tubal surgery: where they had recommended IVF as the preferred treatment option for any woman with tubal disease, they now recommend tubal recanalization techniques for treatment of several tubal disorders in young women with no other significant infertility factors. 

This presentation aims to review the research prompting the ASRM’s shift and the potential corresponding shift in medical practice. Surgical techniques reviewed include falloposcopy with a linear everting catheter, guidewire cannulation, coaxial cannulation, falloposcopic catheterization, selective salpingography, fluoroscopy, and hydrotubation. The best of these techniques have success rates similar to those of IVF and should be preferred for medical and economical reasons, if not moral ones. 

In conclusion, there are manifold opportunities to increase availability of IVF alternatives in mainstream gynecology, especially to young women who suffer from tubal factor infertility. At the same time, gynecologists have a chance to popularize ethically superior alternative treatments and raise discussions among their colleagues about other morally excellent practices.

(Like NFP.)

The Stuff I've been Knee-Deep in

So, you probably already know this, but there is a small explosion going on in the world of contraception. I am talking about 1flesh.org, the brainchild of BadCatholic's Marc Barnes plus (an apparently large) number of young adults. They've taken Janet Smith and added all the flippancy of the meme age. PP and Jezebel aren't happy. Excellent.

EDIT! I am also super excited about IuseNFP.com. I was thinking 1Flesh was getting a little negative and needed some positive "this is what NFP is" action, and the next day they linked IuseNFP.com. How perfect!


In other news, I am working on abstracts for the poster session of the CMA. One is about tubal surgery to open/heal fallopian tubes in women with tubal factor infertility. This is an ethical alternative to IVF and growing in popularity in mainstream gynecology because it can allow a pregnancy rate very close to IVF's. I'm super excited about this, because I'm discovering I love surgery and tuboplasty has long been a part of surgical naprotechnology.

I deferred my application to the Pope Paul VI institute's Medical Consultant program because of lots of commitments during this school year. However, I asked them to hold my application for two years, since I hear fourth-years have tons of time.

In the meantime, WYA is launching Fertility Education + Medical Management (FEMM), and with a weekend in New York this September, I might be able to become a FEMM teacher.

I've finished the opening work on my local Med Students for Life and CMA-SS websites (no, I won't be linking those) and I've put out emails so that people can review and offer to add content. Hope that works....

I made really tasty Jambalaya...I soaked and cooked red beans in water with onion powder and chicken bouillon, and there was just enough water from the beans to cook all the rice and shrimp. Admittedly, I used a mix, but I still felt like a chef.

School starts in three weeks. I have that familiar back-to-school feeling: May seems long ago, but at the same time it feels like yesterday.

Maternity Homes: Reverse Morbidity with Hope

This is the presentation I gave at the Research Summit of the International Institute for Bioethics and Patient Care Advancement, modified slightly for this venue.

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I am currently involved in the preliminary efforts to open a maternity home in my community and I would like to explain that I am taking that particular step because maternity homes are among the best remedies to the profound needs of special pockets of the female patient population—namely, racial minorities, adolescents, and the urban poor. (For the sake of brevity, I will only speak about a smaller group made up of adolescent women who are impoverished and among the country's larger racial minorities: non-Hispanic black and Hispanic.)

First, some numbers from 2009, the most recent year that the CDC provides birth and pregnancy rates. Of every 1000 women between ages 15 and 19 in this country, 39 give birth to a child. This number is not evenly distributed among the various racial groups in the US. Of 1000 Hispanic teens, 70 give birth; of blacks, 59 do; of whites, only 25.

Birth rates are not the same as pregnancy rates, since some pregnancies end in abortion or miscarriage. Pregnancy rates are not available for 2009, but if rates have remained relatively stable since 2005 (the latest year the CDC provides), then we can estimate even more distressing statistics: the differences between racial groups are even more pronounced, and the abortion ratios are probably also skewed, as high as 50% among black adolescents compared to maximums of 43% in whites and 36.5% among Hispanics.

International Patient Care and Bioethics Externship

This week I have been at a series of lectures in bioethics as the first part of an externship with the International Institue for Bioethics and Patient Care Advancement (IBPCA). This series of lectures will be followed by five weeks of working with Dr. D, a local GYN (she gave up OB some years ago, sad face).

The preceptorship begins with five days of lectures and research, culminating in a presentation of the results of our research and a plan for project over the next five weeks.

Summer Research into Maternity Homes

I am participating in the first Summer Externship in Translational Research & Bioethics created by Medical Students for Life to train pro-life future physicians to engage in ethical research that furthers a culture of life. I'm very excited to work Dr. D, a pro-life OB/GYN in my area who performed abortions in the past. At the same time, I'm going to research maternity homes (unless Dr. D's research interests change my topic slightly, which would be fine). I want to determine how maternity homes can be made more accessible and attractive to abortion-vulnerable women.

Below the jump is my brainstorming of ideas and initial steps.