From nucleus - autumn 1995 - Be Prepared! [pp20-22]
Abortion and intimate examinations - these are what I knew would face me on my Obstetrics and Gynaecology (O&G) firm. I was scared. Now, preparing for finals, I can look back at the worry I felt at the start of the clinical course. I was concerned about the ethical issues I knew would be involved, as well as all the possible embarrassments. I anticipated spending the eight week firm on edge, waiting to be asked to compromise, ready for persecution and difficult questions, but in fact ended up thoroughly enjoying it. I learned to insert speculums, cried at a father's joy as I delivered his wife's baby, and was made to develop my thinking on the controversial issues.
I would like to pass on some experiences and hints for the benefit of future students so that if they're doubtful, as I was, they can relax slightly, but still start the firm prepared and wise. I will concentrate on the two issues that concerned me the most.
The information we were given at the beginning of the firm was that we were expected to become proficient at VEs through practising on anaesthetised patients in theatre.The law surrounding consent is complicated, but, in summary, patients who give consent for an operation or procedure do so for one which is 'necessary and in my (the patient's) best interests, and can be justified for medical reasons'. Clearly this does not cover students performing VEs, and so if a VE was performed on an anaesthetised patient without extra specific consent, written or verbal, a charge of assault could be brought.
As I was aware of the law concerning consent I knew I would have to obtain it from every patient prior to their operation. However, I was also aware of other students' experiences. It was not unknown for them to be told to perform a VE on a patient they'd never seen before, let alone consented. Should they argue with the consultant or break the law? I was not looking forward to this scenario!
Armed with this knowledge I set forth, determined to ask consent from all my patients. After each history and general examination I asked permission to perform a VE in theatre, emphasising that I would be supervised. To my immense surprise every patient I asked gave consent without hesitation.
What about theatre? I easily completed the required number of VEs and was well supervised. It was an atraumatic experience.
This was my second area of concern. I was fortunate in that neither of my consultants did abortions on their lists (for time reasons), and so I was not expected to see any in theatre, nor go to abortion clinics.
I did have to ask myself whether I should go to see the 'termination of pregnancy' (TOP) that found its way onto our list as an extra one day. In the end, out of curiosity (and a desire to be shocked, I think), I went along. I went with a non-Christian friend and witnessed the removal of these 'products of conception' (the termination of a first trimester pregnancy), using suction.
I was shocked and numbed. The surgeon whistled through his teeth during the procedure and sent the tissue off for histology. In a few minutes it was over. I couldn't believe that that was all there was to it. I asked my friend whether she thought we'd seen a baby die. She thought not.
'Well, when does life begin then.......... conception?'
'I don't know.'
She hadn't thought of a sensible answer to this question and yet was prepared to defend a practice that, as far as she knew, may have been killing babies.
It was then clear to me why the procedure is legal, and why it is carried out so easily and calmly - even to the accompaniment of whistling (or was that to cover his unease?) People don't think, or won't let themselves think, what is actually happening.
So then, what did I learn that I can pass on?