Abortion: More Complicated than a Sound Bite

About a week ago, a friend posted a CNN clip that I didn’t watch in which a guest or the anchor seemed to imply that a fetus was akin to an organ in a woman’s body that she might choose do with as she pleases. My friend posed the following question with this post: “Will one of my SANE pro-abortion friends explain this to me?” When no one responded, she took this to mean that her “pro-abortion” friends could not answer something so ridiculous and therefore this meant that they knew deep in their hearts how evil their pro-choice position was. When I tried to go back to the post later, in order to watch the clip and to decide whether to respond, the post was gone. Perhaps things got ugly…Truly, so little good comes from engaging in such conversations on Facebook or Twitter. Against my better judgment, I do engage sometimes but it generally ends with me ghosting out before or after someone dismisses my thinking while telling me how much I mean to them.  Pointless all the way around.  Maybe that is why no one “sane” responded to my friend’s post…

But everyday there is a new threat to reproductive rights, including the choice to abort, in this country. Yesterday, saw the most restrictive law yet move forward in Alabama. Many states now have only one abortion provider and in some cases none.  Yet, the majority of the U.S. population supports the right to abortion in all or most cases. https://www.pewforum.org/fact-sheet/public-opinion-on-abortion/

My opinions have been largely consistent since I was in about the seventh or eighth grade, approximately four years after Roe was decided. As abortion became a possibility in every state, the public debate came with it. I remember the cover of TIME or maybe NEWSWEEK with a picture of a fetus in utero promoting an article that examined the “when does life begin” question.  I read it and decided that should I ever need to, as long as I could have an early abortion meaning before 10 weeks or so, I would do it. That was my own thinking and for a long time I kept that opinion to myself.

My parents each approached the topic of an early pregnancy differently.  My mother told me around this time period, meaning when I was about 13, that if I became pregnant she would want me to carry the pregnancy to term. I remember the scene in great detail. I was in her room. It was summer and I was wearing my favorite multi-colored short shorts. The memory is probably so clear because I was terrified. Not because I was sexually active, but because I believed that it was up to me to never make a mistake; that if I did, I would have no choice over what would happen to me; and that if I wanted to have a choice, I could not turn to my mother for help. I am sure she would be devastated to hear me say that.  And perhaps those were the beliefs of a young adolescent that did not reflect what really might have happened.  But beliefs of teens are often not articulated and as such parents have no way to correct them.

Several years later, perhaps when I was leaving for college, my father gave me a very different message. He wrote me a letter tucked in the trunk of my car where he often left me a little extra cash. In it, he told me to avoid pregnancy at any cost during my college years. I was shocked by this part of the letter. I never talked about such things with my dad. But I did ask him about it the next time I saw him and he was clearly embarrassed. Avoiding further conversation, he simply said, “A girl has to know when to say no, because when you are pregnant and you don’t want to be there are no good options. But if that ever happens to you, you come to me and I’ll help you.” That statement has been etched on my heart ever since.  In so many ways it sums up my relationship with my father. He has always been the person who could simultaneously clearly state his expectations and his beliefs about how I should conduct myself – “pretty is as pretty does” –and at the same time acknowledge the realities of being human.

Fast-forward another seven, or eight years and I was working in a teen clinic in a hospital located in an extremely high need neighborhood. I did all kinds of things in that clinic and one of my main activities was “options counseling” for teen girls who were pregnant.  I was not so far away from adolescence myself and began this work with the view that an early pregnancy represented a crisis.  Overtime, I learned that an early pregnancy represented as many possibilities as there were young women in that circumstance.  For some, it was a joy, a happy accident of which their family was aware and supportive.  For others it was a secret and they were convinced, as I would’ve been, that they could never talk with their mothers about their situation. It was my practice to encourage them to talk with their moms and many times I helped facilitate those conversations. By then I knew that no matter what mothers say to their teens, when the chips are down, they want to help and they do not want their daughters to go through challenging experiences alone.  And, I knew, that the best decisions teens make – 9 times out of 10 – are decisions that fit with their families’ beliefs and values – not mine and not yours.  But notice that qualifier – 9 times out of 10.  There are exceptions. Families that are hardly families at all, where young people have been raising themselves and making their own way for years. There are families whose belief systems are so rigid and a young person desperately wants something different that to involve the family would be to risk harm to the girl’s life or leave her with no place to live unless she followed their wishes. And, these wishes could go either way.  Sometimes families felt that having a baby was punishment for being sexually active. On the flip side, I had family members call me and yell at me because I would not “make” their daughter have an abortion. Never mind that a forced abortion is illegal in this country; a doctor doing such a thing would be prosecuted for assault and battery.  So what I learned in this role was the wisdom both of my profession, which prioritizes individual autonomy, and also the wisdom of my father: my goal was to help them make a their own decision, not tell them what their decision should be.

And so to my friend and so many like her who cheer these repressive laws and the pre-ordained paths those laws produce, I would ask, who would you want me to be for your daughter or your son’s girlfriend or one night stand?  Would you want me to tell her what she has to do because the government has decreed what that choice should be?  Or would you want me to help her talk to people who are important to her. Maybe you, maybe her minister, her aunt, or her father, so that the decision would reflect something thought through, examined, carefully weighed, and freely chosen. Would you want me to shuttle her off to prenatal care without a second look or would you want me help her know her own heart and mind? These laws take away the possibility that a woman might find a non-judgmental ear, someone to help her talk to others who care about her, or simply some space to consider how to move forward.

The arguments on TV and elsewhere about abortion are all ridiculous in different ways. Of course an embryo or a fetus is not an organ like an extra kidney or an appendix. It is sad that we spend so much of our public discourse on red herrings. Abortion is one of, if not the most ancient of medical procedures. http://www.bbc.co.uk/ethics/abortion/legal/history_1.shtml  Cultures around the world have recognized for centuries that there are times and circumstances in which carrying a pregnancy to term is terrible idea. Abortion was made legal across this country because women seek abortions whether they are legal or not.  But when they are illegal, women are maimed, infected, often made sterile, or sometimes die at that hands of charlatans and mercenaries that prey on their desperation.  That is why a network of clergy existed to help women get safe abortions in this country before it was made legal in every state. https://www.npr.org/2017/05/19/529175737/50-years-ago-a-network-of-clergy-helped-women-seeking-abortion That is why physicians campaigned for legal abortion as a matter of public health.

Are there times that people regret a decision to have either an abortion or a baby? Of course. Are there times they regret a decision to place a child for adoption? Undoubtedly. But that is the price of freedom – the chance to make our own decisions, as long as they do not hurt the wider community, and to live with the consequences, whether they are positive, negative, or indeed a complex web of regrets, hopes, and contentment that make up the reality of our lives.

 

Note about the photo: If you click next to the colon below, you will be taken to the site where the photo originates from, the archive of the St. Louis Post Dispatch.

Photo credit: 

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Living Atul Gawande…

 

If there is one book I have recommended over the last five years, it is Atul Gawande’s Being Mortal. Immersed as I am in caring for an older parent and surrounded as I am by friends and colleagues sorting out the same questions, this is no surprise.  But what is surprising is that in spite of how much this book has helped me, I have to return to its lessons again and again.

When my parents entered their nineties, I would return home to the house they shared since 1973.  But instead of envying my mother’s ability to have everything sparkling clean and perfectly organized at every moment, I noticed that every treasure in their home turned from lovely memento to potential landmine.  Persian carpets were tripwires.  The marble coffee table brought back from a tour in Naples, the perfect blunt object for a head injury. Each stair might as well have been the Hilary step.  My anxiety skyrocketed the moment I walked in the door. My goal in life became to convince them to move to a retirement community of their choosing.  There is a lovely one within a mile of their home, a place where many of their friends have lived, with low staff turnover, and everything they would have needed.  There are terrific places near me in North Carolina. My father said no. Again and again he said no.  When I asked him what he thought it would be like to live in such a place he compared it to the Bexar County jail and told me I would essentially kill my mother if I made her move.  That was a conversation stopper.

And then I read Being Mortal.  Not only did I read it, I holed up in a tent in the North Carolina mountains at an annual multi-family camping party to finish reading it while everyone else socialized.  Early in the book, Gwande describes his grandfather, a gentleman over 100 years old living in India. Gwande writes that, in contrast to our stated goals for elders in the U.S., the stated goal for his family in India was to help the centenarian grandfather do whatever he wanted – in this case, to ride his horse on a daily basis to inspect his farm.  This meant that the family secured a very docile horse and walked the horse with the grandfather on it, every day.  Notice what they did not do.  They did not say, “You’re too old to ride a horse.” Or, “ There’s no horse that is appropriate for you to ride.” Or, “Sorry, it is just not safe for you to ride a horse.”  Rather, they recognized that at 100, there is no “safe” and the only thing they could really do for their aging patriarch was to give him what he wanted at what was surely the end of his life. The rest of the book is very good and completely compelling, but if you read no further than this anecdote, I wager it will change you as it did me. I quit asking about the retirement community, stopped seeing the rugs as ticking time bombs, and stopped worrying about how I, an only child living across the country from them, would manage it when disaster came.  And several years later, it did. My mother fell and broke her hip.  But guess what? She did not trip over the rug, nor did she hit her head on the coffee table.  She fell leaving a friend’s birthday party at a lovely restaurant after a lovely meal.  And she didn’t trip over anything, just lost her balance and fell.  When she did she was perfectly coiffed and sporting a smart new dress. Three and a half weeks later she was dead at 93.  There was suffering in between to be sure.  But she died as she lived and there is something to be said for that.

Gwande’s work highlights the competing values we hold but rarely articulate when we are caring for elders.  In truth, it’s not much different than the calculus made when caring for children – particularly adolescents.  Safety versus autonomy.  In the U.S., we lean towards safety, always attempting to mitigate risk particularly for the old and the young. We long for safer playgrounds and safer old age. In the teen years, parents are challenged to know where the line is between allowing young people to make their mistakes versus keeping them safe from their under developed frontal cortexes. Perhaps this is why Being Mortalhit such a chord when it was assigned as UNC Chapel Hill’s 2016 summer reading book for incoming first year students.  When I heard about the assignment, I was perplexed.  Sure, I found the book meaningful as an adult child of older parents, but what would an 18 year old see?  But see it they did.  In the discussion section I co-facilitated, the first year students had read the book cover to cover, were eager to talk about it, and planned to share the book with their parents and grand parents.

It’s now been almost two years since my mother’s death and my dad, now 98, still lives in the house with the rugs, the coffee table, the full catastrophe. And although he picked up a walker the minute my mom fell and has not put it down since, he is weaker, requires more help, and still says no when I talk with him about moving. I promised my mother I’d look after him. “Make sure he turns off the coffee pot!”

She thought, as did I, that this meant he would move to North Carolina. I brought it up days after her funeral and he said no. At first, I thought we needed to give it time, no sudden changes, yada yada yada. But his position has remained stalwart. No, to moving across the country and no, to leaving his house. He explains, “Here, I am surrounded by everything that reminds me of my good wife and our long life. I know just where everything is. So keep me on the list at the retirement place and then, when I decide I need it, I’ll go.”  If I press, he describes moving into assisted living as moving into a “rat’s nest.”  Again, a conversation stopper.

People tell me I need to take a firmer stand with him, take the reins, force the issue. It’s true there have been some problems of late – medication mix ups, a couple of spills that resulted in waits on the floor until someone could arrive and “right the ship” as he cheerily puts it. But although he is weaker in both mind and body, in spirit he is strong. He is still the one who walked with me for hours in the Mark Twain National Forest naming every tree, who guided me into the hills near the farm where he grew up to drink from spring water that came sweet and pure from the earth, who showed me how moss grows and how it might help how to find my way should I get lost. He is still the one who liked to take the scenic route home from church and stop by what he called, “the land of many flowers.” (Check out the San Antonio Botanical Gardens when you have the chance.)  He is still the one who would write a poem in walnut shell and hang it on the Christmas tree for my mother each year. (I always wanted one too. But they were just for her.) He is still the one who, in response to some long forgotten heart break, told me, “Worry and cry as hard as you can about that young man for all of five minutes because that is more than he deserves.” And he is still the 19 year old who went bravely off to war when duty called, who saved his ship when it was lost, and fought for your freedom and mine. Who am I to tell him what to do with his last days, months, or years? Who am I to force him to do anything so that I, and others who care about him, can be assured that he is safe? When I push, he fights hard. And the truth is, although I know I could prevail it is a battle I don’t want to win. It would diminish him and he deserves better than that.  And perhaps, I can be grateful l that he’s not asking to ride a horse.

 

 

Friendship

Soon I’ll leave for a brief trip back to Texas. I go most every month to see my father. Because I go so often now, the reality is I see friends from childhood more often than I see my friends here in Chapel Hill. This trip will be particularly festive since I’ll make a brief stop at my college alma mater for an evening with buddies from those days kind enough to make time for me.  I am grateful for these friendships that have lasted a lifetime and mournful that everyday life crowds out the time for friends in my own proverbial backyard.

For those of you who’ve not followed it, I highly recommend the Dear Sugars podcast. The podcast is over but the archives are available for free download.  You won’t regret any 20 minute interval you devote to listening to these two friends reflect on the complications their letter-writers describe. In one series of episodes, they describe the ways in which friendship is different most other relationships. In others, there are external forces that promote hanging-in-there when, however occasionally, frustration, anger, boredom, or any other negativity that finds a way in. With family, in addition to love, memories, and commitment, we are bound by law, blood, finances, and the rest of it. Webs deliberately hard to escape – a situation that gives us time to regain our appreciation for those we love and are committed to when our better angels get lost.  Likewise, at work, our employment may depend on being able to make relationships work with individuals we might otherwise run from. But friendship, whether we find it in the office, with our partners, in a high school class, a college dorm, or the neighbor next door, happens because we choose it.  Again and again, today and tomorrow, until we can’t or because we decide we won’t. In friendship we choose and are chosen even as we gradually, or sometimes all at once, allow those we call friends to know the good and the bad of all that we are.

Almost a month ago now, I received news that someone not quite a friend, but who ran in the circles I did in college had suddenly and inexplicably lost her beautiful, apparently healthy daughter. I have looked repeatedly at the posted picture, a picture so lovely and filled with hope that it seems impossible such a young woman could ever die. It is friends that are walking with this mother through this terrible valley. She has yet to stay alone or cook a meal. Her friends are listening to the stories, embracing her sobs, and holding her up as her feet struggle to find solid ground. And they are doing that because they choose to; there is nothing forcing them, no obligation, only the choice of friendship.

That beautiful picture of that beautiful girl that I never knew keeps reminding me that our life goes by so quickly and we are all so busy and it can all be taken away in a twinkling. But for this moment, I give thanks and praise for friends old and new, those I talk to every week, every month, and those I see once every few years. You know who you are.

 

 

San Francisco

When we saw her sit down and her tears begin, we dropped to our knees in front of her and joined hands forming a circle with to share and acknowledge her sorrow. What a gift to share our collective grief  with this stranger-friend for a moment.

 

Just back after four days in San Francisco, a city I don’t know well but that has captivated my imagination since I read Armistead Maupin’s Tales of the City series in my 20s. For the most part, I spent my time this visit doing pretty standard work conference activities. But the last night, a colleague cum friend sent a text inviting me to join her and her husband at a Market Street wine bar.  After a longer-than-expected walk, I arrived to a quiet scene.  My friends were there along with two gender bending, male-identified men behind the bar and two women, apparently a couple, sharing quiet conversation.

We were enjoying appetizers and a bottle of wine when my colleague’s husband burst into song with a falsetto that let me know this was going to be no ordinary night.  The three of us are in our 50’s and the songs of our youth were topping the playlist. As my colleague and I talked shop, her husband kept singing and befriended the couple to his left.  Soon enough we put away our workplace concerns and let the impulse to sing and dance take over.  At first, it was the three of us.  One of the bartenders began to act as DJ, taking requests. First Journey, Queen, Pat Benetar, then Bye Bye Miss American Pie, The Cars, more Journey….music that took me back. Another colleague arrived and joined the fun. Eventually, one member of the unknown couple decided to dance with us, and with some trepidation her reluctant partner joined in.  Soon enough the bar tenders were strutting their stuff and we jumped into a joyous, raucous-for-me, evening. I’ve been basking in the glow of the laughter and camaraderie ever since.

But there was so much more to that evening than a spontaneous dance party in a far away city.  Our evening stood in contrast to the news story that had broken that afternoon in which a group of boys from a Catholic school in full MAGA gear appeared to taunt and disrespect a Native American elder at a protest in Washington D.C. What actually happened is now the subject of debate and I’ve not followed every nuance. But our current national life is so filled with stories of open prejudice and hatred that the complexity of this situation hardly matters. We hear similar things almost weekly, incidents that are either ignored or celebrated by our leaders.

Indeed at one point in the night, in the midst of the dancing and laughter, one of the women we met began to cry. A Latinx lesbian woman who valued her Catholic faith even though many who share it would reject her, she was dismayed by the boys’ behavior.  (For the record, many claiming Christ would reject this woman. Her Catholic Church is not alone its exclusion.) For her, because the boys were Catholic she hoped that they would choose to represent a message of Christian love. When we saw her sit down and her tears begin, we dropped to our knees in front of her and joined hands forming a circle to share and acknowledge her sorrow. What a gift to share our collective grief  with this stranger-friend for a moment.

The tears passed and we kept dancing, singing, and laughing. Two very young couples joined the mix, and soon thereafter it was time to call it a night. As we said good-bye, one of the bar tenders explained it was his first night on the job and said we had made it great for him. But really we all made it great for each other. For one evening, by tacit agreement, we all remembered what it was like to be young and open to new people and experiences. We agreed to let our stereotypes drop, stereotypes about how 50 plus straight people, and 40 plus lesbian people, and 30-ish gender bending people are “supposed to” act and relate. Those stereotypes would have kept us in our corners, no spontaneous falsetto, no singing, no dancing, no understanding, no joyful connection. For a moment, as the song goes, we belonged to the light, we belonged to each other, and we belonged together.

 

The Sam Saga

Great words from my colleague, friend, and fellow blogger, John McGowan.

McGowanBlog

UNC Chancellor Carol Folt resigned yesterday—and took the remnants of the campus’s Confederate monument out the door with her.

While the UNC system’s Board of Governor’s met in an emergency session to discuss “Chapel Hill leadership,” Folt stole a march on them, announcing her resignation and her order for the removal of the toppled statue’s still-standing pedestal to an undisclosed location, before the Board’s meeting ended.

Campus work crews had dismantled the pedestal and hauled it away by midnight last night.

Good on her.

Now is not the time, it seems to me, to repine over what could or should have been.  Instead, we should accept where things currently stand and, as a campus, stand braced to fight back against any retaliatory actions coming from the BOG.  Reviling the BOG or speculating about what it has or will do is also not very useful in my view.  But we should…

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Preparation

We stood speechless as we scrolled through the images that she had sent without captions. Utter misery inflicted on desperate people at our Southern border. How in God’s name are we allowing this?

This afternoon I sat in a coffee shop preparing for work later this week with a group of medical fellows. We will be talking about the Latinx immigrant population in our community using an intervention called, “Yo Veo,” meaning “I See.” We will use a series of photographs by the photographer, Janet Jarman http://janetjarman.com to begin our conversation. The images from her story, Marisol and the American Dream, form a jumping off point to consider the ways in which migration experiences shape an individual’s experience with various systems, such as health care or education. As we go through Marisol’s story, we will also spend time with data collected from young people and their parents here in North Carolina. Some of that data comes from studies I’ve done with colleagues through the years and some comes from the good work of others.

Using visual images and the performing arts to promote nuanced and reflective conversation about race, ethnicity, culture, migration, difference, and professional practice is an approach I and others I work with have been refining since 2010. Although we use a particular method to structure these experiences, the conversations are open-ended and unpredictable. Sometimes the mood is tense. Other times the room floods with empathy. Usually, at least at first, there is a mixture of wariness and confusion as participants search for a “right” answer to the questions posed. Gradually, the group grows more comfortable with not knowing, a posture which overtime gives way to understanding, reconsideration, and respect. Although the structure is the same, no two Yo Veo conversations are alike. As a facilitator, comfort with ambiguity, trust in the process, and a willingness to let the images work is key. This flexibility and responsiveness is what gives the approach its power and differentiates it from more traditional “trainings” focused on diversity or difference. Our research indicates that what we do does influence professionals’ attitudes and motivation to engage with clients, students, or patients whose backgrounds leave them open to disparate health and educational outcomes. For those interested, links to some of our published research articles are at the end of this post.
Immigration questions appear to be evergreen in our society, a consistently hot topic. As such, whenever I prepare for a Yo Veo conversation, I end up tweaking the slide deck. Sometimes, I am tailoring for a particular type of audience or a particular timeframe. But usually, I am incorporating images and information that speak to the current moment. A month or so ago, Janet sent me images from her recent time in Tijuana covering “the caravan.” My son was in the kitchen when I opened the file. We stood speechless as we scrolled through the images that she had sent without captions. Utter misery inflicted on desperate people at our Southern border. How in God’s name are we allowing this?

Today was no different. I looked at more images taken by other photographers that document the separation, loss, atrocity, occasional resilience, and faith that characterize the current, shameful chapter in our national immigration story. As I look, I know our Yo Veo conversation this week will be meaningful. But it is hard to focus on the work through my tears…

 

https://www.researchgate.net/publication/256198342_How_images_work_An_analysis_of_a_visual_intervention_used_to_facilitate_a_difficult_conversation_and_promote_understanding

https://www.researchgate.net/publication/316751923_Making_a_difference_in_medical_trainees’_attitudes_toward_Latino_patients_A_pilot_study_of_an_intervention_to_modify_implicit_and_explicit_attitudes?_sg=S7zdUrG8227FpulXPLcUwk2i40_pBF7TXCnkRG1BQX3yJfFDdkACTP_U4HOG6_K3pFui-4hDRWzYKnLpB_Wrg666VffmqQS-1qxgGs4a.NU_7u7ToJ1VTc0TIDKXbtmKhf54TXaOZyl-7LxuODnrtyrHC_UGQCuLV-wYSyg9pND38LuYGQ-lj16rSoxHTpA

 

Photograph Credit: https://static01.nyt.com/images/2018/12/26/podcasts/27daily/26daily-superJumbo.jpg?quality=90&auto=webp