This began as a research project about abortion. But not officially, because I am a resident physician working in a hospital system that does not perform abortions, and I would never have received IRB approval for that.
Instead, I decided to research miscarriage management, which requires the same medical knowledge as pregnancy termination. I was concerned, like others at the time, that the 2022 Dobbs v. Jackson Women's Health Organization decision that overturned Roe v. Wade would have an impact on our ability as emergency physicians to care for pregnant patients. After this court decision, my state outlawed all abortions except in cases of medical emergency, though the qualifications for such an event were vague. There were rumors from the OB/GYN residents that their attendings were no longer offering medical management for miscarriage or ectopic pregnancy and instead were taking all patients to the OR out of fear of prescribing medications that were being banned for their use in abortion care.
After a few tries, I got IRB approval and started gathering the data for my project, working on it sporadically during a research elective that doubled as "maternity leave" after the birth of my second child. In 2024, my state passed a constitutional amendment supporting a “fundamental right to reproductive freedom” and some abortion clinics are planning to reopen soon.
I finished the project and ultimately found no statistically significant differences in any of the metrics I analyzed, including ED length of stay, admission rates, and formal ultrasounds, among others. On paper, there was no change in our management of incomplete spontaneous abortion or missed abortion from 2021-2024, despite major changes to the legal landscape during that time.
Which I guess is good news? Even so, it doesn't feel like an accurate representation of the state of women’s health care over the past few years. But numbers don’t lie, or at least they shouldn't. So, as a trainee in the era of evidence-based medicine, I felt like my project was, at best, a waste of time and, at worst, an indication that I was overly biased in my topic choice.
Slightly disappointed, I started a new project that I hoped would represent my overall residency experience. It was a qualitative survey of women I had come to respect and love during my time in medical school and residency. I asked them to tell me about joy, specifically in the context of work. I chose the topic because it's something I've found to celebrate amid endless bad news and articles about chart-topping ED burnout scores and failed wellness initiatives. Because, quite simply, that has not been my experience.
I love my job.
I'm not naïve (something a naïve person would say, you must be thinking). Our job is emotionally and physically exhausting and getting harder all the time with changes to the health care system. We see horrific things daily and walk hand in hand with unfixable social problems. Part of embracing joy, for me, has involved learning to find a place for these experiences that leaves my soul mostly intact and allows me to embrace life at home with my husband and young children.
Buoyed by the project and feedback related to it, joy has helped frame the remainder of the year. In brief quiet moments in the trauma bay and interrupted conversations, I've been considering souls. Not in the metaphysical sense, but in the everyday. As in, Does your work make you more or less fulfilled in the rest of your life and your relationships with others? And if work is making things worse, then why is that, and how do we do better?
Maybe the answer is burnout and metrics and sleep deprivation and decision fatigue. Or maybe it’s something else, something about a fundamental shift in our relationship to why and how we became doctors in the first place. So far, what I've come up with mainly is that thinking about these things tends to be helpful. Searching for and identifying joy and purpose begets more joy and purposefulness. The converse is likely true as well.