I’ve always thought of myself as a pretty impatient person with a low tolerance for setbacks; but apparently I am also incapable of deliberately giving up on a bad situation. (This is why it’s a good thing I’ve never started gambling.)

Every single morning, all week, we were in trouble with the two interns. It appears that the students’ responsibilites for the mornning are 1) print a list of all the postpartum patients with marks for how long since the baby was born, and the baby’s sex, and have the lists ready by 5am; 2) see all the patients who are going home today and have notes written about them before 6:30, and also have that note on the chart before the resident writes their note, ie 5:15am; 3) track down all the babies who need circumcisions that morning, have them corraled in one or two nurseries, and have the lidocaine and everything set up for that, by 6am. As you can see, this requires getting to the hospital around 4:30am, as well as careful coordination between the four students.

Yes. Well, Tuesday no one told us any of that; Wednesday we gathered that we were supposed to write notes. Thursday several residents of varying seniority told each other and us contradictory stories about what our job was. Friday the interns collected all four of us and read us a lecture on being responsible and meeting deadlines. None of us tried to say anything like, if you had told us all this on Tuesday or Wednesday, instead of expecting us to read your minds, we wouldn’t have spent the whole week without getting with the program. . .

Moral: If the intern is the one directly in charge of you, don’t believe anyone else if they tell you to do something different and less difficult than what the intern said. Also, don’t let yourself be intimidated on the first day into not getting a clear list of your responsibilities. I’m still debating whether nonresistance to unfair criticism is the best approach, or not. The problem is that I always get too emotional to make a calm statement, so it’s really better avoided. Also, don’t trust other members of the team; I have to check on everything myself, and be prepared to do half the work, on a team of four people, so I don’t get blamed for things being missed.

The other girls are all bitter and disenchanted. I am too, but I can’t afford to stay that way. They don’t really want to try to please the interns anymore; but I still want to be an ob/gyn, and there’s at least a 50% chance I really want to be in this residency program, so I’m all set to try again Monday. Get there before 4:30, see half the patients myself, put skeleton notes in the chart before the residents get there, and find all the babies myself. It doesn’t help that I hate waking postpartum women up at 4:35 to pester them about how much they’re bleeding, just because I’m trying to avoid another unpleasant session with the interns.

I still like ob/gyn, because if you have to be stuck in clinic, this clinic is interesting. If you have to be on call, babies are a good thing to wake up for. And I still want to do some surgery. I still want to have a chance at this residency, because the residents get along well together and the attendings are good, mostly cheerful and not particularly mean. It’s just these two particular interns who are a pain; although actually they’re fairly good about answering questions, and trying to teach the basics. And this is really crazy, but I like this hospital. It’s a huge complex, and I love looking out of different high windows and appreciating how the pieces fit together, and the view over the drab, grey, wet city.

Well; so in addition to all that, I am developing a huge ethical hang-up over birth control pills. All the residents are all about prescribing birth control to everyone, and acting snide if women leave the hospital saying they don’t want any. Which is understandable in this population, women of 23 having their sixth child, women of 17 having their second in two years, and you know they have no constant father figure for the children, they have no education or job, most of them are doing drugs, and the children are going to be swept up into the hopelessness of the inner city. So it’s reasonable to want to help them slow the cycle down. But then there’s Plan B. Thursday afternoon in clinic I was with one of the chief residents, who is a Plan B activist. The attending stated that although he is Catholic, he prescribes Plan B because he feels that 1) it prevents thousands of unwanted pregnancies, and thus thousands of outright abortions, and 2) he thinks it acts by preventing ovulation, not implantation, so it’s not abortion at all. He was very persuasive.

So I looked up in the (wildly activist and heavily slanted) handbook of birthcontrol methods we were given, and it also stated flatly that Plan B, as a progesterone-only pill, only inhibits ovulation; but then under “disadvantages” it said that women who disapprove of stopping pregnancies after conception would have to be talked into it. Then I looked up the minipill, which is a daily progesterone-only pill, and it said that only 50% of the time does that pill inhibit ovulation; the rest of the time it alters the endometrium so the zygote can’t implant. Ok, so how can one progesterone pill be 50% post-conception activity, and the other one be only before conception? Moreover, does this mean I now have to object to minipills as well? And what about IUDs? Everyone agrees that those are supposed to disrupt the endometrium and make it almost impossible for the conceptus to implant.

Ok, great; I just talked myself into moral objections to most of the commonly used birth control methods (among medications only the estrogen-and-progesterone pills are left, and they have more side effects). Which is really impracticable; you can do OB, and avoid abortions; but there is no way I could get through residency without prescribing birth control.

And anyhow, is that really a logically tenable position? In addition to all the millions of abortions, do we also have to mourn uncounted millions of babies aborted right after conception by such pills? Not to mention that millions of such conceptions are ended naturally, all the time, by the zygote dying of mutations incompatible with further development, or a normal period disrupting the endometrium at the wrong time, and so on. I cannot really think that there are that many millions of real people who turn up in heaven after having existed on earth for only a few days; where do their personalities develop, for one thing? But am I now going to say that a baby is human only after it implants in the uterus? How’s that for a sliding line to define humanity? One might as well say it’s not human till it’s visible to the naked eye, or whatever.

Bother, bother, bother. And it’s snowing today, but only in the afternoon; so no skiing this week.

Rereading this while moving archives at the end of fourth year: this bad experience with the OB interns, and my ethical questions about birth control both contributed to make me move away from ob/gyn to surgery. I guess you could say I have a knack for coming up with black-and-white answers (progesterone-containing pills and IUDs are abortifacients, and therefore wrong), but avoiding dealing with consequences (actually dealing with the pregnant women who would result from refusing to prescribe these things to the usual residents’ patients). Which is partly true. But in surgery I’m going to be dealing with comatose patients on ventilators, which is an even fuzzier ethical mess. . .