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Washington Post Magazine: A Hard Choice

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Patricia Meisol and Lesley Wojcik
Washington Post Magazine Contributor; Medical Student
Monday, November 24, 2008; 12:00 PM

Lesley Wojcik is committed to a woman's right to choose. But when she entered medical school, she had to decide whether she was willing to become an abortion provider herself.

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Medical student Lesley Wojcik and freelance writer Patricia Meisol were online Monday, November 24 at 12 noon ET to discuss Meisol's Washington Post Magazine cover story, "A Hard Choice."

A transcript follows.

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Lesley Wojcik and Patricia Meisol: Hello all, thank you for all your questions. We're excited to hear your thoughts and comments. We started this story almost two years ago and there are so many parts of it we'd like to discuss. We welcome your questions.

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Arlington, VA: Thank you for a unique look into an emotionally and politically charged issue. I expect today's discussion to be heated, but I wanted to thank both of you for your courage in sharing this story.

Lesley Wojcik and Patricia Meisol: Thanks for your response. I'm glad I got an opportunity to bring to light all the nuances and decision-making that goes into this process.

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Washington, D.C.: So, Lesley - are you in this year's Match? What specialty did you end up choosing?

Thanks for this story. It was an interesting read.

Lesley Wojcik and Patricia Meisol: I ended up choosing Anesthesiology, and yes I will be in this year's match!

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Philadelphia, Pa.: I have to admit an ignorance of medical practices. I presume a lot of procedures are designated to specialists. Let me please ask: could you give an abortion, or are there instances where you would be able under current rules to perform one, or are you prohibited from performing one even though you learned how to perform one? I appreciated your article on your own struggles over the issue, yet I wonder whether you procedurally could perform one and if so, when could that occur?

Lesley Wojcik and Patricia Meisol: I'm not sure about the details, but before one can independently perform the procedure, one must go through a training program (residency) and be insured to do the procedure afterwards.

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Arlington: Your story is already being used by pro-life bloggers as proof of how horrible abortion is and that even people who are pro-choice ultimately can't bring themselves to perform abortion. Were you concerned about that reading of your story?

Lesley Wojcik and Patricia Meisol: This is Pat. I have to say my first concern was an authentic story. As Dr. Meyers said, abortion is not a black and white issue - though we often try to treat it as same

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Bethesda, Md.: As a physician and medical journalist, I admired the hard work and depth of reporting that went into this wonderful feature, but it seems to me that in the end Dr. Wojcik's decision was more a verdict on the inhumanity of her experience on her ob/gyn rotation than one about the ethics of becoming an abortion provider. She encountered a technocentric hospital environment in which residents were brusque, nobody seemed to spend time talking to patients or teaching students -- and she spent the first 10 days on the rotation without witnessing a single vaginal birth! Medical students no longer learn from doctors who model empathy and support for patients - doesn't the popularity of specialties like anesthesiology or radiology stem from a resulting desire to limit and control the amount of time they will spend in what has become an unsupportive, often overwhelming work environment? A different ob-gyn experience might have set the stage for a different kind of exposure to the provision of abortions. What do you think?

Lesley Wojcik and Patricia Meisol: This is Lesley. I think the kind of experience you have during your rotations in medical school is your first impression, and it makes a deep impact which can turn a student on or off of a specialty. I think definitely there should be an emphasis on making students feel part of the team, welcomed, etc. in order to attract them to the field.

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Pro-Choice, VA: As someone who always thought of herself as vehemently pro-choice, I found myself rethinking when I heard about a woman who after going through fertility treatments to conceive aborted it because she didn't want to be tied to her cheating husband. That shook me to my very core, so I can't imagine how incredibly difficult it must be for med students to find and keep their convictions regarding abortion. It's such a complicated issue.

Lesley Wojcik and Patricia Meisol: It certainly is a subject that can be revisited so many times! Pat

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Than, KS: I just want to say thank you for such an honest and unflinching article. You explored an aspect of abortion (doctors' feelings) that is rarely even mentioned, much less discussed in depth. Excellent job, and thanks to Lesley for allowing this detailed look into your life.

Lesley Wojcik and Patricia Meisol: I'd like to thank Lesley, too! It's not easy sharing your life with a stranger, first me, and then so many of you. It was my pleasure to get to know her. Pat

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Richmond, Va.: For Lesley: Have you heard any, or are you concerned about, backlash from the article? People who didn't know these things about you, or didn't know you as well, or who may now recognize you? Negative or positive reactions from acquaintances and/or friends and family?

Lesley Wojcik and Patricia Meisol: My friends and family, regardless of their views, are very aware of my stance and have come to accept it. With strangers, I know there will be people who don't agree but I'm not overly concerned about it.

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Federal Hill, Md.: I was shocked that you can get into medical school without acknowledging that a fertilized human egg is a human being. How do you explain that?

Lesley Wojcik and Patricia Meisol: This is Lesley. My thought is that yes, a fertilized egg is a living thing but not a person. And yes, one can get into medical school with these or any beliefs... questioning your belief system is not a part of the admissions process.

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Los Angeles, Calif.: Lesley: at the end of the article, it appears that you are considering anesthesiology as a specialty. Do you think you may do OB/GYN anesthesiology? I have heard that in some areas, late-term abortions are done with epidurals, so that is a way you might be able to support women's choice to have an abortion without being the OB/GYN yourself.

Lesley Wojcik and Patricia Meisol: This is Lesley. I have considered doing OB anesthesia, but this is really a peripheral way to be involved with the pro-choice movement. I'd like to be more involved in policy and education as a more direct contribution.

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Red state: Thank you for an excellent article. I too was a member of MSFC and considered Ob/Gyn. I was happier in Pediatrics, however, and now work in a Peds ER. I can't count the number of teens (girls, even) who I must tell that their pregnancy test is positive. And after telling a teen that her test is positive, I don't say "congratulations," but "how do you feel about this?" Most go on to complete their pregnancies, but some choose to terminate. We can't assume that the news is happy OR sad. It just is. I am familiar enough with my state's laws to know where to send those who ask for information about termination at various stages. And I am thankful for those providers who continue to work.

In a perfect world, abortion would not be a medical necessity (SEX ED AND BIRTH CONTROL AND STD PREVENTION PLEASE!!!). But we do not live in a perfect world. Lesley, I am not sure which specialty you have chosen (good luck on your interviews and with match!), but you might want to consider Adolescent Medicine (as a Fellowship). And thank you both for telling this story.

Lesley Wojcik and Patricia Meisol: This is Lesley. I did consider adolescent medicine, but decided that the pediatrics fellowship and other aspect of the field were not a good fit for me. I tried to separate my political belief system from the process of choosing a specialty, because if the day-to-day work is not going to make you happy, the belief system will not sustain your job satisfaction.

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Silver Spring, Maryland: Dear Ms. Wojcik: I was heartened to hear that in the end you decided not to perform abortions. Because, if you had not, I would have asked you if you could have looked Chris Burke, the Down Syndrome actor who did "Life Goes On," a friend of mine who had Spina Bifida, or Trig Palin in the eye and said that they should never have been born.

I hope your decision to not perform abortions leads to compassion for the disabled and what they have to offer. Abortion is not the answer, the answer is getting more of a word out that parents expecting a handicapped child or other parents dealing with a difficult pregnancy have other places to turn.

As far as the article talking about the dangers and harassing of abortion doctors, I want you to know that if you had become an abortion provider, I would have been as against any harm coming to you or your family as the abortion itself. I mean you no harm and will continue to hope that you decide not to perform abortions.

Lesley Wojcik and Patricia Meisol: Thank you! Lesley

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Arlington VA: Thank you for that wonderful article. I am staunchly pro choice. It annoys me when people assume that means pro-abortion, because no one wants anyone to have to go through the pain (physical and emotional) of an abortion but one should always have the choice. Do you plan to do more articles on this topic?

Lesley Wojcik and Patricia Meisol: Not at this time, but I have met many wonderful classmates of Lesley's and other students in Med Students for Choice this year. Pat

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anonymous: I don't know if you'll get very many of these types of posts - I had an abortion many, many years ago - shortly after the passage of Roe v Wade. It was, of course, an intensely personal and difficult decision. Looking back, I still see that at the time it was the choice I had to make. It's something I wouldn't repeat, though, it was that difficult. I don't discuss it even today with close family, yet I have to say that, without the right to choose a safe medical procedure, things would have been much much worse for me. I'm all for an unflinching look at a complicated issue, but losing this path would be a devastating blow to women. Remember, those opposed to it never have to utilize it, but that opposition is ONLY your own personal choice, and that's as far as it ever should go.

Lesley Wojcik and Patricia Meisol: Thanks for your story and comments. Pat

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Silver Spring, MD: Though I don't agree with your belief on the issue of abortion. I do respect your honesty in the article, and I am glad you were able to address the emotional aspect for you, and the issue at large.

Do you think it is a depravity that the medical schools do not more openly address the human person? That is, so much focus is on the technical. I work in the medical field (oncology clinical research) and I know the use of euphemism is extensive. I suppose this is an attempt at objective perspective. But, it is a poverty that terms like "products of conception" are used. It seems to me there is such a loss in that attitude/posture/mindset.

Lesley Wojcik and Patricia Meisol: I learned in my research that medical school is trying to change the way it addresses the human aspects of doctoring. I think you will see a big difference in years ahead. Pat

I think there is a need for teaching compassion and dealing with the emotions of doctoring, but there is also a need for objectivity and distance, or doctors would not be able to do their jobs. Lesley

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Stafford Virginia: Hello and thank you for the article, it was a cliffhanger if you will. But I have some at risk teenagers that would benefit from this up close glance at abortion, could something like what you have done be arranged even though the teens are not going to be doctors?

Lesley Wojcik and Patricia Meisol: When I was in high school, I shadowed doctors. It is really up to the doctor and the patient giving permission. I'm sure that because of the nature of the procedure, it would be more difficult to arrange but certainly possible. -Lesley

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Arlington, Va.: I found your story fascinating, as someone who's in the midst of a high-risk pregnancy and spending a lot of time at the hospital and OB's office. Thank you for sharing. I'm wondering how much of your decision not to become an OB was influenced by what sounded like an unpleasant working environment in the Labor and Delivery wards? Do you think you would have gone forward with those plans if you had been at a different hospital with a more supportive environment? (even if you had ruled out providing abortions?) It seems like my OB's office -- mostly female and relatively young practitioners -- and Virginia Hospital Center in Arlington have a totally different, much better atmosphere.

Lesley Wojcik and Patricia Meisol: It wasn't just my experience on the wards, but also discussions about and research of the field. There were many factors going into my decision not to do OB, only one of them being my negative experience on my rotation. Lesley

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Bethesda: What advice would you give to a person in college right now considering a possible career in medicine? The concerns we have regard quality of life -- do you have one? :) -- and the future of medical practice. We hear there's a lot of tedious filling out of forms, dealing with bureaucratic insurance issues, etc.

Lesley Wojcik and Patricia Meisol: I am very happy I decided to become a doctor. There are fields out there that have a good quality of life, and whatever field you choose can be tailored to you if you put in the effort. Paperwork exists in all professions, and if you are passionate about going into it, medicine is very rewarding and interesting. Lesley

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Maryland: Thank you for answering questions. What do we need to do to prevent unwanted pregnancies? Is the problem access to contraceptives or is it lack of factual education?

Lesley Wojcik and Patricia Meisol: This is Lesley. We need for adolescents and teens to have free access to contraceptives without stigma or red tape. Ideally, I would like to see school nurses able to give the Depo shot. However, I realize the societal limitations and also that contraceptives need to be accompanied by counseling. But yes, education and access are the keys to preventing pregnancy, in my mind.

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Laurel, Md.: Please don't let others pressure you into performing abortions if you have a conscience which would tell you otherwise. While I appreciate YOUR freedom of choice, what about the choices and other pleasures which are taken away frorm those not yet even born? I believe VERY strongly that doctors kill one of God's children every time they perform abortions. If the mother's life is in danger, that would be considered "mitigating circumstances" and might justify killing the baby. However, cold-blooded murder, for the sake of convenience, is never morally justified. It's NOT a baby's fault his/her mother is too stupid to use birth control! Why should (s)he pay with his/her life?? -I- feel the baby should at least be given a chance to make his/her own decisions. I'd like to hear Ms. Wojcik's comments on this. I wish you well!

Lesley Wojcik and Patricia Meisol: I understand your point of view. I realize our beliefs systems differ, but I hope we can work together to ensure that women get the appropriate medical care.

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DC: I was also disheartened by your experience in the labor and delivery wards. There is such a dearth of good OBGYNs now because the pool is shrinking (I know several doctors who have stopped doing deliveries because of the high insurance costs). Your experience at that hospital is the one I fear I will encounter when the time comes for me to have a child.

Lesley Wojcik and Patricia Meisol: This is a real concern. There are so many issues facing the field today that are discouraging good people from pursuing it. I feel that the system has to change, lawsuits need to be curbed, insurance needs to come down, and the field needs to project a more welcoming image to would-be applicants. -Lesley

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Pro-Life, VA: After reading your article, would you agree that in our country of freedom and choice, that we should also allow room for doctors who do not support, perform, or refer for abortions, as their freedom and their choice? I read in your article that family planning and preventative medicine coincides with your politics but pro-life OB-Gyns coincide with mine. Can I be represented too?

Lesley Wojcik and Patricia Meisol: You need to draw a line as to where it's appropriate to interject your own belief system on somebody's medical choices. Just because a choice is right for you doesn't mean it's the best choice for an individual patient. A patient relies on a doctor to give them all their options, and I believe it's a disservice to the patient to withhold the chance to make a choice for themselves, or to influence them unduly. -Lesley

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Washington, D.C.: Do you think the way medical schools approach abortion and trainings on the procedure contribute to the decreasing number of abortion providers?

Lesley Wojcik and Patricia Meisol: Yes, definitely. I think the lack of exposure to any field will discourage people from going into it. -Lesley

Research of residency programs shows that doctors who are exposed to abortion clinics or the procedure itself often have a more compassionate approach to patients asking for an abortion or, in some cases, agree to refer patients for abortion even when they might not agree with it. - Pat

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Washington, DC: Pat -

I was wondering if you might consider doing a story on post-abortion syndrome (all the emotional and physical struggles women deal with after abortion sometimes lasting decades)? This too seems to be an issue that is often overlooked when the topic of abortion is addressed.

Lesley Wojcik and Patricia Meisol: I have read some good stories on this subject, but don't plan any myself soon. The subject of recovery after any health procedure is often a valuable perspective for the rest of us. Pat

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Anonymous: Wow - once again the antichoice people have presumed to know all the reasons why a woman may make the INTENSELY personal choice to terminate...all the knee-jerk "look this kid in the eye" statements, etc. I thought this was a great article, and even the graphic description of the procedure does not change my belief that all women deserve the CHOICE when it comes to this issue. I'm surprised though that you picked anethesiology, which means you'll have very little interaction with patients. You seemed so caring. I've had many many experiences in hospitals with my husband, and I know how much time we spend with the anethesiologists.

Lesley Wojcik and Patricia Meisol: It was a really hard choice, but in the end anesthesia is what interested me most in a medical way. My politics and ethical beliefs are what made me interested in fields like OB and pediatrics, but I realized the fields don't provide me with the day-to-day work that will give me the most job satisfaction. I feel like I had to separate my personal beliefs from my intellectual curiosity in a way. -Lesley

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Thank you: I really appreciated this article. As someone who is pro-choice, I never thought of what it must be like for the doctors who have to perform these procedures. I was pretty shocked to read that abortion providers (or whatever the correct term is) isn't something discussed more in depth when people are in medical school, especially compared to other fields.

And I have to agree with a previous poster, just b/c you are pro-choice does not mean if you get pregnant you'll automatically get an abortion. I think pro-life people need to know that and it's about women have the right to choose what is best for them.

I just wanted to say thank you for this article and the honesty. One of the best ones I've read by the Post.

Lesley Wojcik and Patricia Meisol: Thanks! When this story began, I didn't know what decision Lesley would make at the end. The idea was simply to find out how anybody decides to be trained to provide abortions. Pat

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North Carolina: To Lesley, My brother has been an ob/gyn for nearly a decade and is one of very few people in his area who performs abortions. I have seen him at work (not doing procedures, obviously, but in office settings), and I know that there are hundreds of women who are grateful that he made the difficult choice of doing these procedures. He often feels isolated and threatened, but maintains his commitment to help others. I hope that even though you chose to take a different path, you (and others) will still support those who do this work.

Lesley Wojcik and Patricia Meisol: I, as well as many others, are grateful for the service your brother provides. I plan to continue working for this cause, even though I will not be performing abortions myself. -Lesley

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Baltimore, Md.: That a patient was screaming in "obvious pain" is highly disturbing. The tenaculum does sound barbaric. Some doctors are highly insensitive to the people they are supposed to be helping, and this extends beyond abortion to the medical profession in general. Unnecessary pain should not be a routine part of medical procedures. Lesley, your dedication to the right to choose and your thoughtfulness are admirable. Please don't ignore your instincts about patient discomfort and pain, even if other doctors are desensitized and dehumanized.

Lesley Wojcik and Patricia Meisol: Thank you. I hope to continue to be sensitive to my patients' needs as I go through my training. -Lesley

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Arlington, Va.: Thank you so much for this article, and for opening up your experience. I unfortunately had to make the decision to have an abortion about ten years ago, and I am still sure I made the right choice. I've also accompanied several friends to Planned Parenthood to use their services: birth control pills, the day after pill, etc. I am ashamed to say the doctor's decision to go this route was never in my mind, so I thank you for opening my eyes. I look forward to the new vision of fewer abortions, do you think that's being supported in the medical community?

Lesley Wojcik and Patricia Meisol: There is a general lack of discussion of abortion in medical school. Fewer abortions would certainly be desirable, but we only spend a day or two learning about contraceptives in the classroom, and many students aren't trained on how to counsel young women on their use. I think there needs to be much more emphasis on prevention if we want abortion rates to drop. -Lesley

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Baltimore Md.: I too want to offer my thanks for producing such an honest and informative article on this topic. For me it underscored my personal definition of what it meant to be pro-choice: that abortion should be legal, rare and safe. I am currently and joyously pregnant and am completely disheartened by how difficult it was to find a good OB/GYN - apparently, due to the high costs of liability insurance doctors must take on, few are entering the specialty. I shudder to think of what happens to women's health when fewer physicians actually know how to perform safe abortions.

Lesley Wojcik and Patricia Meisol: There is encouraging news in other specialties, like family medicine, for those who want to preserve choice. Those professions are increasingly offering abortion training to residents. Pat

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The woman in the red heels: Is it really legal to have an abortion in the second trimester without any concerns about the health of the fetus or the mother? I thought that abortions were limited to the first trimester. I am pro-choice but found that patient's story really disturbing.

Lesley Wojcik and Patricia Meisol: The law varies from state to state, but 20 weeks is generally when most medical communities draw the line. Every patient has a different experience with local anesthetics and pain relief, so it can really vary. Some women have no pain at all. -Lesley

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Anonymous: another back story to this is that choosing a residency often becomes more about what is financially rewarding and doesn't have crazy hours like OB-GYN, not just what is personally rewarding or meaningful - the telling point was the line about her board scores being high enough to get into the competitive (and lucrative, and flexible hours) specialties.

Lesley Wojcik and Patricia Meisol: Anesthesia is not very competitive and has lots of nights and weekends. If I wanted to make a lot of money and have good hours, I could have gone into radiology or dermatology. It attracted me because it challenged me intellectually and appealed to my interest in manual procedures. I love the field and an thrilled to be going into it. -Lesley

I must add that I quizzed Lesley about "selling out" but as soon as she started comparing anesthesiology to a game of chess, I knew she had met her perfect match. - Pat

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Lesley Wojcik and Patricia Meisol: We must end so Lesley can return to school!

Thank you all for such compelling and provocative questions. And thank you for being such involved readers.

Pat and Lesley

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Editor's Note: washingtonpost.com moderators retain editorial control over Discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions. washingtonpost.com is not responsible for any content posted by third parties.


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