Reclaiming My Identity: My Path to Becoming an OB/GYN Physician
Aly Wayne
I am often hesitant to discuss why I chose to attend medical school; however, as I now look toward applying to residency, I ponder this question more deeply. My personal experience with an eating disorder is what initially motivated me to pursue medicine. More specifically, I was inspired by the physician taking care of me when I was first diagnosed with an eating disorder. At the time, I exhibited denial and ambivalence. There were moments when I hated my physician and I wanted to do exactly the opposite of what she was telling me to do. But something about her swayed me to lean into recovery just enough to stay afloat. Perhaps it was the way she embodied true holistic care, recognizing my humanity as much as she addressed my illness. Her treatment goals for me reflected the values of my true self, such as staying in school and being a competitive runner. She listened to and accepted me after I spent many years trying to disappear because I felt my existence didn’t matter to anyone. I wanted to be a physician so I could impact others like she impacted me.
My eating disorder and my recovery continued well into medical school. I left school twice my first and second years to be hospitalized for treatment. During my third year, the year that my providers warned me would be the perfect set-up for another relapse, something shifted within me. I finally came to the realization that my eating disorder was no longer serving me. Through my small but steady efforts at recovery, I had accumulated enough glimmers of what life could be like without an eating disorder that I no longer wanted one. But on my clinical rotations, I still felt drawn to patients suffering with eating disorders.
During one of my elective clerkships, I rotated for a week on Adolescent Medicine. One day that week, my preceptor asked me to see a patient, a seventeen-year-old female with a concern of secondary amenorrhea.
***
I enter the room slowly, peeking my head around the door and introducing myself to the patient and her mother before I step inside. The patient is dressed in black yoga pants and a black sweatshirt. The sleeves of her sweatshirt are pulled over her hands, a sign that she is either cold or nervous but regardless is minimizing exposure of her body. She has reddish brown hair pulled back in a messy bun and she is not wearing any makeup, yet she exudes an aura of natural beauty. I suspect that she is a perfectionist by the way that she carries herself, and she radiates a sort of poised anxiety. “Tell me more about what’s been going on,” I start. She replies, “I haven’t had a period in eight months. Before my periods stopped, they weren’t regular. I had a period this past January, but before then I went three months without having one. Since January, I haven’t had any periods.” “What does a typical day of eating look like for you?” I ask. She tells me she eats cottage cheese and rice cakes for breakfast, ground turkey with tomato sauce and lettuce for lunch, salmon, quinoa, and broccoli for dinner, and turkey slices as a snack after the gym. Already, her nutritional history raises my level of concern about disordered eating, but I remain open and curious. “What are you doing for exercise?” I probe further. She replies, “I go to the gym six days a week, and I’m usually there for an hour and a half each time. I mostly do strength training, but some days I’ll do a little bit of cardio too.” I ask, “Do you feel cold all the time?” Her mother chimes in, “Oh, she’s always cold, but it’s because she has no fat on her body.” The patient looks at me and smiles nervously. “Do you find that your hair falls out in clumps?” She nods. “If you and your friends decide to go out for ice cream, are you able to get ice cream and enjoy it with them?” She hesitates. “Probably not,” she replies, a look of defeat washing over her face. I pause for a moment, then ask if it’s okay for me to share my thoughts. “I think you aren’t getting your period because you aren’t eating enough,” I say to her with genuine understanding. “I’ll talk to my preceptor and we’ll come back and see you together, but my guess is that she is going to say the same thing.” I explain to her the many physical consequences of undereating and not having a period, but I don’t yet mention the word eating disorder. “I know this is probably a lot for you to take in,” I say. “I’ve been in your shoes, and the idea of eating
more can be really scary. It feels good to be thin and you care about your appearance, so you don’t want to do anything that might change that right now. But I care about your health and well-being, and eating enough is important. I want you to be able to enjoy desserts with your friends and live your life without having to think about food all the time.” She looks down at her hands, still covered by the sleeves of her sweatshirt. I sense she needs a moment. In my preceptor’s office, we both agree that she meets criteria for anorexia nervosa. My preceptor commends me for my critical thinking skills, but she does not know my history. At first I feel excited about the diagnosis I just made, but soon that excitement is drowned out by soul-sucking eating disorder thoughts that remind me of the deep despair I could so easily revert to.
***
It’s 7 a.m. on a Tuesday morning in early November, and I’ve been dreading this day for as long as I can remember. My fellow medical student David and I are standing in the corner of the workroom, holding our laptops as the residents occupy all the available seats to sign out to each other. I have no idea which list to follow along with on Epic, so my mind inevitably drifts to the impending doom of the OR. Today might be the day I finally step foot into one. I am anxious because I am one to have a vasovagal response at pretty much anything. And the dizziness I feel just standing during sign out does not exactly inspire confidence.
Following sign out, the chief resident comes over to David and me to introduce herself. “Hi, I’m Kayla, and welcome to your OB/GYN rotation. There’s a scheduled C-section happening in a few minutes. Which one of you wants to go?” My heart pounds. David and I look at each other disconcertedly. I don’t want to do this, I know I’m going to pass out. Or maybe I should just go and get it over with so I’m not thinking about it all morning. “I’ll go!” I blurt out, unsure of what inner force I just summoned to unleash these words from my mouth.
Kayla shows me the OR and introduces me to the patient. She guides me towards the sinks where I can scrub in and then departs, leaving me to fend for myself. The attending and the resident who will be scrubbing into the surgery with me arrive at the sinks and begin to scrub in. I attempt to follow their lead, but I can’t even figure out how to turn the sink on. I wave my hands beneath the nozzle, thinking it may be motion-activated. Nothing. I turn to the attending and nervously ask her how to turn on the sink. She looks at me apprehensively, then instructs me to push into the sink with my leg. How could you be so stupid, I scold myself with embarrassment.
Thankfully, the scrub tech is kind and walks me through the whole process of gowning and gloving. My heart is thumping, my legs shaking beneath me, and I am so nervous I start to shiver. Once I am fully sterile, the scrub tech instructs me to stand next to the patient and put my gloved hands onto the sterile field. The surgery then begins, and with the first cut I have a full blown panic attack beneath my surgical attire. You can’t leave the OR this early in a surgery or how else are you ever going to get through this rotation? I fixate on the numbers of the clock mounted on the wall across from me, adding them up as a distraction. 3 plus 4 is 7. 12 minus 5 is also 7. Breathe. Once I start to panic a bit less, I periodically observe the surgery, but I only make it a few seconds each time before panicking again and getting slightly vasovagal. You just have to make it to the baby, I reassure myself. I then look over right as the resident and the attending proceed to pull violently on the patient’s belly. Oh dear God. But what I don’t realize is that taking the baby out of the uterus is the next step. In between my fixation on the clock, I watch the resident make an incision into the uterus. Suddenly calm, I follow along intently as the resident places her hand on top of the baby’s head and carefully maneuvers the baby out from the uterus.
The baby is quite small and does not cry. I also note the NICU team of doctors huddled around the incubator, hurriedly resuscitating the slimy blue newborn. This is the first time I have witnessed a baby being born, and the more I think about it, the more my anxiety dissipates. I just watched a new life come into this world, one that started as a tiny embryo and can now survive with medical assistance as a premature neonate born at 29 weeks. And my patient is now a parent! This is magical. I watch the rest of the surgery, occasionally experiencing a surge of panic necessitating a clock break, but I am much more at ease than before. Eventually, I watch as the resident sutures the final skin layer, and I realize that I made it through my first surgery without passing out.
Following the surgery, I find David sitting in the workroom on his computer. “How was it?” he asks me, and I can’t help but smile. “This may be the best day of third year so far,” I reply.
I went on to love my OB/GYN rotation. So much so that I began to consider a career in the specialty. But could I let go of my desire to someday care for patients with eating disorders? As I plan for residency, I am choosing to apply into OB/GYN. In doing so, I am willing
to give up the idea of being deeply connected to eating disorders for the rest of my life. Sure, I can and certainly will incorporate some eating disorder care into my practice, especially if I have patients with secondary amenorrhea like my patient in Adolescent Medicine clinic, or patients in need of weight-inclusive care. But I don’t have to make a career out of my eating disorder. It can, and always will be, a part of my life, but it doesn’t have to define me like it has for so long. Love heals, and my love for OB/GYN was a gift because it gave me something to live for that matters more to me than my eating disorder. My experience of being an eating disorder patient is woven into the fabric of my being, however. I will use this experience as motivation to provide my patients with care that is driven not only by science, but also by whole-hearted compassion.
Aly Wayne is a third-year medical student from Lowell, MA about to enter her fourth year of medical school. She has a passion for mental health and interest in surgery and she will be applying to residency programs in OB/GYN. Her favorite genre of writing is creative nonfiction and she often writes about her personal experience with chronic illness to help inspire others in recovery. She has previously been published in the Psychiatric Times and she received an Honorable Mention Award in the 19th Annual Gerald F. Berlin Prize for Creative Writing. She is currently composing a memoir to be published in her fourth year of medical school.
