Body

Published on November 5th, 2018 | by Dena Moes

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Know What We Lose When the Clinics Close

I sat charting on my computer and clicked the button to send a patient’s prescription over to her pharmacy. Then I glanced at Google news and read that our newest  Supreme Court justice might favor overturning Roe v. Wade and conflated birth control and abortion in his Senate hearing. This, when we already have a Senate bill on the table to remove Title X funding from all clinics that provide abortion services.

The loss of Title X federal funding could mean the closure of Planned Parenthoods and other reproductive health clinics across the nation. I know firsthand what shuttering these clinics would mean because I am a clinician at one. For three days a week I practically run from room to room to see the patients who line up to receive our funded, and therefore free to them, reproductive health services. Everyone should know by now that these women’s clinics provide much more than abortions. At our clinic, abortions take place one day a week, and during the other four days, a range of health services are offered. To truly understand, let me take you through some typical visits in a typical clinic day. Of course, the details have been altered to protect the identity of my actual patients, but they are representational stand ins for the dozens of people we see every week.

My first patient burst into tears the moment I walked into the room. Unlike most medical offices, we take walk-ins and same-days appointments so people can be seen right away. After all, when a woman is in pain down there, she doesn’t want to hear “Our next available appointment is four months out”. This client might have been nineteen, away from home for the first time like so many of the university students in our college town. Or she might have been sixteen and still in high school. Or thirty-five busy with three children and a pending divorce. On this morning she was a college student who could hardly walk due to the pain between her legs, and was desperate for relief before her final exams. After listening to her symptoms, I pulled the foot-rests out of the exam table and guided her feet to their soft fleece coverings. I helped her scooch her bottom to the edge of the table. I gloved up, turned on the light and took a look. Then I helped her sit up.

“Take a deep breath,” I said, “and I will tell you what is going on.”

I paused because this was a tender moment for an already distraught woman. I wished there was better news.

“You are having a herpes outbreak. Have you ever had genital sores before?”

 She shook her head, no.

“Then this is your primary outbreak, which is the worst one you will ever have. Your body will build up immunity to the virus which means future outbreaks won’t be this bad. But it will never go away completely.”

I counseled her about hygiene, stress management, supplements  to take and trigger foods to avoid, and how to protect sexual partners from contracting it. I gave her handouts with everything I had said written out. I also ordered gonorrhea, chlamydia, syphilis, and HIV testing. She left with a bag of thirty six condoms and a prescription for Acyclovir, which would hasten the healing. She would feel better in time to take her finals.

As I opened the door to leave, she said, “Thank you so much. I did online research so I was not that surprised it is herpes. But your help today, getting the medications, kinda saved my life.”

My next patient was a twenty year old male, who could have been a thirty five year old grad student or a fifty-five year old father. Hands thrust deep in jeans pockets, he sheepishly admitted that pus was leaking out of there. It started five days ago, after a night when, you know, he had a few drinks and got with this person. His was a classic case of The Drip, otherwise known as chlamydia, a sexually transmitted disease up forty percent in our college town since last year. (How high will it go if our clinics close?)  His urine was sent off for testing, but I treated him presumptively based on the symptoms. He swallowed the gram of Azithromycin, grateful it could be treated right away. I asked him about his sexual partners in the past six months and made sure he understood they needed to be treated too. And I used this teachable moment to give him my Talk.

“Look,” I told him, “Chlamydia is a red flag. It is easily treated with antibiotics, but it is a warning that you are taking risks with your health and your number is up. Next comes Syphilis, herpes, and HIV.”

He nodded, eyes wide, calculating the newly revealed costs of irresponsible sexual behavior.

He also left with a bag of condoms, and the understanding that he can come in every month for a bag of thirty-six, for free.

Photo credit: Lorie Shaull

During the day, I saw five other infection checks. I treated vaginal infections including yeast, bacterial vaginosis, and the sexually transmitted trichomoniasis, little buggers that danced in circles under the light of my microscope. A woman tested positive for syphilis and was sent to the Health Department for treatment. Three women were diagnosed with urinary tract infections, which can climb into the kidneys if not rapidly treated.

Six of my appointments were for birth control problems. Women with nausea and headaches from the pill, women with bleeding and mood swings from the shot, women whose boyfriends decided they didn’t want to use a condom last night, and now needed a Morning After Pill. Women to get an IUD in, women to take an IUD out. Women trying the NuvaRing, the Patch, the Nexplanon implant in the arm. Women trying one thing and then another, and then going back to the first.

If you have a penis, or do not engage in penis/vagina relations, you may be wondering why the hassle around birth control.

Let me enlighten you.

While it is my job to provide birth control, I am also the first to admit that every birth control option sucks, in one way or another. The dance is to find the one whose suckiness is most tolerable to each individual woman. The only method that males are directly involved in is the condom. And if in the moment, that male decides not to wear it, who has to face the consequences? This is where true inequity between the sexes exists. The message our culture sends to our youth is this: Boys! Girls! Study hard! Achieve! You are equal! You can be anything you want to be! Pursue your dreams! Delay marriage and wait to have babies until you are financially and psycho-emotionally stable! Get laid– it’s fun and everyone is doing it! Enjoy the fruits of these modern, liberated times! Oh- but don’t get pregnant by mistake! Sorry girls – actually that one is your problem. I am sure you will figure it out!

Figuring it out is where I come in. Women come to our clinic for help with health issues wrought by their birth control, such as bleeding for weeks at a time, or depression and emotional lability. For many all this while living away from home for the first time, in the hectic conditions of a college dormitory. Think about it: We mothers are tasked to raise our children with care and attention. Yet as soon as they fly the nest, Trump’s version of society intends to abandon them to sink instead of swim, simply because they are, God forbid, having sex? Not on my watch.

Yet it is not only college students that need birth control. I care for women with medical problems that make pregnancy dangerous, women with mental illness or addictions who simply cannot raise children at this time, or women who already have seven children and need a rest.

Our clinic also provides free pap smears, breast exams and mammogram referrals. Every day, uninsured women come for these cancer-screening services. They include Spanish-speaking immigrant women afraid they will be deported to Mexico if they apply for health insurance. And they include women recently divorced, previously insured under their ex-husbands’ policies and now…not. And those who make too much to qualify for Medicaid, but too little to afford market health insurance. They come in tentatively, tearfully, to show me the lumps and bumps they have found. We get them free diagnostic tests, free biopsies, and then our referral specialist even finds funding for free cancer treatments. With breast cancer treatment, everyone knows the earlier, the quicker, the better to save lives.

My last patient was a woman with light menstrual-like bleeding that had lasted for months. She was too busy, or didn’t want to make a fuss, so she kept putting off coming in. I found a mass in her pelvis and referred her out. She didn’t have health insurance but I sent her to the ER anyway, explaining that the hospital can retroactively enroll her in Medicaid. A week later she called me in the middle of clinic to say she was on her way into surgery, to have the tumor removed. “Thank you,” she said, “They are not sure if the tumor is cancer of not. But I am pretty sure you saved my life.”

On my way home,  I swung by Home Depot for gardening supplies. An employee, a puffy middle aged man wearing a hefty back-brace, escorted me to my car to help load the bags of mulch. He looked at my bumper sticker that says “Celebrate Life – Call a Midwife!” Then he told me he was going to be baptized this weekend in a special Anti-Abortion Church.

I stared at him, baffled.

“I hope that makes you happy,” I said. “And I hope you never need an abortion.”

And I drove off into the twilight, pondering what it means to be truly pro-life.

 

Feature photo (c) Lorie Shaull

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About the Author

Dena Moes

Dena Moes is a Hollywood born, Yale educated midwife with a BA in literature and an MS in Nursing. Dena is a songwriter, storyteller, and the author of The Buddha Sat Right Here: A Family Odyssey Through India and Nepal, forthcoming in April 2019. Her book is a memoir of adventure, motherhood, and love, with a spiritual quest woven in. As a nurse-midwife Dena has provided compassionate healthcare to women, mothers, and babies for twenty years. She lives in Chico, California where she is gestating her next book,Rebel Midwife. Learn more about her at www.denamoes.com



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