What Illegal Abortion Looks Like

Many are linking to this story around the blogosphere and I encourage everyone to read it. In it, a Ob/Gyn describes her emergency care of a woman who arrived in her ED in hemorrhagic shock from a botched illegal abortion. Though clearly it was touch and go and there was some panicky action, our heroine thought fast and saved a life. My mother once worked in a labor and delivery ward to put herself through medschool in the days before Roe v Wade and this type of situation was common.

This is a great story because it illustrates two points. One, the war on abortion by the right wing is futile. We know abortion is more common where it is illegal and cases like these are more common. Banning abortion does not save lives. It results in more abortions, and more lives lost. Worse, in countries with strict bans even treatment of ectopic pregnancy is forbidden where there is still a beating heart detected by ultrasound. Doctors in these countries can literally go to jail for saving a woman’s life, all for the sake of a non-viable embryo that will kill the mother. The hypocrisy of calling this position pro-life is demonstrated by cold hard data. More women die. More fetuses are aborted.

Second, it shows how a well-trained doctor can save a life with some quick thinking. Hemorrhagic shock is something I’m pretty familiar with after my second year rotation in Shock Trauma, and in a few spectacular cases of bleeding on the wards. There are many times when as a doctor you think you’ve probably saved a life. Every case of appendicitis, dropped lung, or kid with a gastroschisis technically is a save but situations like those don’t have quite the same visceral terror and immediacy of someone who is bleeding to death right in front of you. It’s hard to keep a cool head when you’re elbow deep in a pool of blood. One case in particular that sticks out in my mind was during a nice calm Saturday in the fall. I had just finished assisting in an open appendectomy and was doing my usual neurotic repetitive rounds through the ICU I always did when I was on call. At this particular hospital, when on call I was responsible for all ED surgical consults, all the surgical floor patients, as well as the surgical ICU (I had to carry 4 pagers). So since I’d been in this case for the last hour or so I decided to check in with the ICU folks. It wasn’t the sickest ICU I’ve ever worked, nothing like the U Maryland Surgical ICU or Cardiac Surgery ICU, but, like the ocean, it’s never a good idea to turn your back on the ICU patients. So, I was passing by one patient’s room and I seen on the monitor a blood pressure of 60/40…
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Two great obesity articles from the NYT and what they mean for you

A few weeks ago Tara Parker Pope wrote The Fat Trap for the NYT and once I read it I started sending it to other doctors I know. It is a great summary on the current knowledge of why we get fat, and more importantly for those of us that already are tipping the scales, why is it so damn hard to take that weight back off. (I’ll discuss Young, Obese and Getting Weight Loss Surgery nearer the end)

Beginning in 2009, he and his team recruited 50 obese men and women. The men weighed an average of 233 pounds; the women weighed about 200 pounds. Although some people dropped out of the study, most of the patients stuck with the extreme low-calorie diet, which consisted of special shakes called Optifast and two cups of low-starch vegetables, totaling just 500 to 550 calories a day for eight weeks. Ten weeks in, the dieters lost an average of 30 pounds.

At that point, the 34 patients who remained stopped dieting and began working to maintain the new lower weight. Nutritionists counseled them in person and by phone, promoting regular exercise and urging them to eat more vegetables and less fat. But despite the effort, they slowly began to put on weight. After a year, the patients already had regained an average of 11 of the pounds they struggled so hard to lose. They also reported feeling far more hungry and preoccupied with food than before they lost the weight.

Who among us can’t identify with that story? If you can’t you’ve been thin all your life and can go suck an egg. But for those that have carried extra pounds it’s part of the yo-yo routine of dieting. But why is this? Were we permanently programmed for a preset weight and will feel as though were starving below it? If this is the case, why is obesity increasing now, in the last 20 years? The answer suggested is more subtle, but the fascinating thing is, your body’s set weight might be a real thing. It’s just not programmed from birth.

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