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Home: The Toast

T.R. KNIGHT, CHANDRA WILSON, KATE WALSHEmily R.’s previous work for The Toast can be found here.

At the start of medical school my classmates and I all had great aspirations: dreams of oncology research, of cracking open chests in the emergency department, saving the day, transplanting hearts. But over the next four years it became clear that those things were harder, and less glamorous, than they once seemed in the abstract. Emotionally, a month in oncology was like being hit repeatedly over the head. The emergency department was full of people who had sustained minor injuries in improbable ways. Any kind of transplant seemed to take as long as an entire season of Grey’s Anatomy, with more blood and less romantic intrigue.

As all one hundred and eighty of us could not end up as sports-medicine specialists in aviation and deep-sea diving, we saw a little bit of everything over the years, helping us to form a more realistic idea of the fields in which we might eventually specialize. Some things I found mildly interesting (anaesthetics, head and neck surgery, dermatology, infectious diseases). Some I found downright repulsive (ophthalmology). Others were bewildering (haematology, pathology, renal medicine) or just faintly unpleasant (paediatrics: young patients vomit everywhere with no regard for societal standards or infection control). With a growing sense of unease I began to realize that nothing was sticking. Everything was more or less fine and vaguely engaging, but nothing caught my imagination and made me want to know more; to get up early in the morning and go do it. Maybe I wasn’t meant to be here after all.

Then Christmas 2013 rolled around. It was cold, windy, rainy — dark when I left my house at seven a.m., and again when I arrived home at five. I had just finished my time in urology, where I had more dealings with prostates than I would ever care to discuss. I found myself working in the maternity hospital. It was full of women shouting, every kind of bodily fluid conceivable, sore feet, stretch marks, catheters, raging hormones, indescribable destruction of pelvic floors. And I loved it.

What a privilege, to be literally the first person to see a new life come into the world, to hold a woman’s hand as she realizes that she can do it after all, to stand with new parents as they go somewhere they’ve never been, to be even the smallest part of the best day of someone’s life. The maternity ward was busy and hot and always seemed to be dripping with damp umbrellas, but there was a happiness, an excitement, in the corridors that I just didn’t feel removing gallbladders. Obstetrics! Finally, I thought, maybe I’ve found it

*

Medical school takes five years in Ireland, and during the summer after fourth year (last! summer!), everyone does an elective placement. You can choose any specialty you like, and — this is the best part — you can do it anywhere. Thus a plan takes shape: I’ll go to Paris. I’ll deliver French babies. When I’m not doing that I’ll eat pastries. Such is my plan in all its detail.

A maternity hospital in Paris agreed to take me and I began trawling Craigslist for a place to stay. The majority of responses were unhelpful (Yes, I would be delighted to welcome you to my large, well-located, reasonably priced apartment. By the way, we shall sleep in the same bed). Finally I found somewhere that looked safe, with a housemate who presented no obvious murderer red flags. My medical school, busy contending with the insurance requirements of thirty-eight of my classmates travelling to Africa, were only too happy to sign off. Paris is a conveniently malaria-free zone.

I had some French thanks to a term spent in a Paris school at sixteen, but no medical vocabulary whatsoever. I bought a textbook online and enlisted an Erasmus student at my university for help with pronunciation. Although somewhat bewildered by my enthusiasm for French gynecological terminology, he helped out gamely. In return, I edited his electrical engineering thesis.

Early one Saturday morning I arrived at a beautiful old apartment building: pale stone, wrought iron balconies, red geraniums. It was near to Gare Saint-Lazare; there were several violin makers on the street and a bakery across the road. The building had a lovely entrance hall, a sweeping staircase, and a non-functioning elevator. I lurched up to the fourth floor, lugging my enormous suitcase.

My new housemate answered the door with disheveled hair, an immaculate shirt and pants, and no shoes. He was cheerful, gratifyingly glad to see this sweaty Irish girl arrive at his apartment. The space had high ceilings, light flooding in the tall windows, wooden floors, minimal furniture. I was introduced to his three friends. Just as I was wondering what they were all doing hanging out together at nine in the morning on a Saturday, one of them told me, “We’re going on a road trip to Normandy — don’t worry, this is not a trap!” They all laughed heartily, I laughed along nervously, and then they left without any attempt to harvest and sell my organs on the black market. A good start.

On my first day in hospital, I saw my first abortion. Ireland is in many ways a very conservative country, with highly restricted access to abortion. As of 2013, it is theoretically possible to terminate a pregnancy if there exists a “real and substantial threat to the life of the mother.” No provision exists for a threat to a woman’s health. Legislation is still extremely restrictive and demands certification of the specified threat by several doctors. This being the case, the majority of Irish women who wish to terminate a pregnancy travel to another jurisdiction, most often the UK. The hospital service estimates that just twenty abortions are performed in Irish hospitals each year.

The average Irish medical student does not have extensive experience with abortion. We don’t see it, we don’t practice it, we don’t talk about it. In France, medical or surgical terminations up to fourteen weeks are carried out as per the wishes of the woman; after that point in the pregnancy, a strong medical reason must exist to terminate. However, if a medical indication does exist — one example is a fetus with Down’s syndrome — terminations may be carried out up to 37 weeks. To come from a conservative country where abortion is in many ways taboo and find yourself practicing in a more liberal system is to feel your baseline shift beneath you.

In general, theatre was a relatively peaceful place to be as a non-native French speaker. I soon mastered a limited vocabulary (“Scissors. Sutures. Clamp. Retractor”), and found a soothing rhythm in the procedures. Here is a problem. Take into account this, this, and this, and fix the problem. There, now it is fixed. In the background, minimalist Norwegian jazz played on the surgeon’s iPhone. The exception to this ordered calm was, of course, emergency surgeries — either emergency caesarean sections or haemorrhages. It always amazed me that women would come in apologizing for haemorrhaging all over the place. As a general rule, doctors would much prefer you bleed all over them in theatre than at home; that’s why hospitals are full of wipe-clean surfaces. Your decreasing circulating volume is not a personal inconvenience.

Another place with strategically placed cleaning supplies: the labour ward. Giving birth is a sweaty job, often flat on your back from the epidural, legs in the air, with several masked strangers standing at the end of the bed smiling  encouragingly. Two fingers in gently to examine the cervix; there, pressing down somewhat less gently, is the baby’s skull. With a jolt, I realized I was the first person to ever touch this baby.

“Look me in the eyes, Pierre!” one woman implored her husband. “Only in the eyes!”

Some fathers were afraid to leave for even a second lest the baby arrive without them. These were generally the fathers who, ten hours later, would tombe dans les pommes: “fall in the apples,” or faint. “He’s very sensitive,” panted one woman, as her perineum continued to stretch in new and exciting ways.

I’ll never forget my first delivery, the moment I pulled that slimy new life out and up onto his mother’s heaving stomach. A wriggly little dude, caught under the arms with my heart in my mouth. Before I left, his parents took a picture of me holding their son: the sweaty blonde girl with the weird accent and sunburnt nose who delivered their Eden. I like to imagine them talking about that picture, perhaps now in the child’s album, for years to come (“Where was she from again?” “I dunno, England?”).

Meanwhile, all was well on the housemate front. We saw each other infrequently — I left early, he got home late — but we got on wonderfully. Not only was he not a serial killer, he turned out to be a perfect gentleman who would lend me his roller-skates and take me to gigs. When my friend came to visit for the weekend, he took us both to his best friend’s stag (enterrement de vie de garcon: literally, “burying your single boy life”). The stag, mostly attended by nice engineers in their early thirties, was considerably improved by the presence of two young Irish women. As an English speaker in Paris, my main selling point was that I knew all the words to “Thrift Shop.”

Over the summer the World Cup was in full swing. Some evenings, my housemate and I would go to his friends’ apartments to watch the matches. You have never seen desolation until you have seen a Spanish friend watch his team go down to Holland, sitting on the floor mournfully stuffing lumps of cheese on bread into his mouth. La solitude. Each time there was a French goal — and there were many — everyone would rush to the windows to wave the flag, shout down into the street and across at other apartments. Summer evenings, deserted public transport, beers on the balconies, shouting and gasping at the television. Once they even allowed me to hold the flag.

A few weeks later, my boyfriend came to visit. He is an enthusiastic photographer, so despite my protests (“I’m not a TOURIST, why do you want to do TOURISTY THINGS”) we went to see the Eiffel Tower at sunset. Afterwards we had planned to see the city lit up at night from the top of the Tour Montparnasse, an enormous and somewhat ugly skyscraper that boasts quite the view of Paris. (The best view, say the Parisians, because you can’t see the tower itself.) The tower’s enormous size made it seem closer than it actually was, and at quarter to eleven it became apparent that we would not make the closing time of eleven o’clock unless we were to run. Thus I found myself hauling my wheezing self through the darkened streets of Paris, staggering after someone infinitely more fit (“We’re nearly there!” “No, we’re not, it only seems that way because it’s so big!”). By the time we finally arrived (with thirty seconds to spare, and significant tension in our couple relations), I was puce in the face and ready to vomit. I would like to take the opportunity to sincerely apologise to all those who were obliged to share the elevator to the 56th floor with us. The view was spectacular.

*

Patients are vulnerable. Women who come to the OB-GYN ward are often worried, in pain, under stress, and afraid. For all our progress, there are complex issues at play — issues built up around women and sexuality, reproduction and choice, self-esteem and societal expectations — and I saw these every day on the front lines in hospital. The labour ward is wonderful in its own way, but there’s more to obstetrics than that. There are terminations, surgeries, cancers, emergencies, miscarriages. In no other specialty will you find so many exhausted patients coming out of anaesthetic, crying quietly in the recovery room.

I know that I won’t ever discover the cure for cancer. I won’t be a pioneering transplant surgeon. It seems unlikely that I will ever work in war zones or aid victims of natural disasters. But later, looking back on my career, I will be able to say that I supported pregnant women. That I worked hard to be a kind, understanding doctor, the sort you felt you could ask anything and not be judged; calm under pressure, reassuring in a crisis. That I helped create a safe environment where women could access healthcare and contraception. That I contributed to the conversation on reproductive choice, and talked to teenaged girls and enabled them to take responsibility for their own health. Maybe that will be good. Maybe that will be for the best.

Emily is a fourth-year Irish medical student.

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