Identification: Stories about who we are

This week, we present two stories about identity in science, from a neuroscientist's experiences with racism to an OB-GYN's struggle with her own feelings about motherhood.

Part 1: After a thoughtless remark from a colleague, neuroscientist Devon Collins reflects on the way racism has impacted his life and science.

Devon Collins is a neuroscientist, podcaster, and educator from the Midwest. Currently a PhD candidate at the Rockefeller University, he studies how common genetic variation affects the brain’s responses to drugs and stress. He is one-third of the team behind Science Soapbox, a podcast about science and how it interacts with our personal and political lives. Passionate about making the future of STEM more diverse and inclusive, Devon also works as an educator in a STEM-focused after-school program for high school students from low-resource backgrounds. When he’s not doing science, talking science, or teaching science, you can find him baking, running, container gardening, or napping on his sofa with his cat and dog.

Part 2: OB-GYN Veronica Ades tries to save a pregnant woman’s life in South Sudan, while struggling with her own feelings about motherhood.

Note: You can read more details about Veronica's experience on her blog here.

Veronica Ades, MD, MPH is a board-certified obstetrician-gynecologist. She attended medical school at the State University of New York at Downstate in Brooklyn, NY, and obtained residency training in obstetrics and gynecology at the Albert Einstein School of Medicine in the Bronx, NY. After residency, she obtained a Master’s degree in Public Health with a concentration in Quantitative Methods at the Harvard School of Public Health. Dr. Ades then completed a three-year fellowship in Reproductive Infectious Disease at the University of California, San Francisco, in which she lived and worked in rural Uganda, and  conducted research on placental malaria in HIV-infected and –uninfected women. Dr. Ades also completed a Certificate in Comparative Effectiveness at the NYU School of Medicine. Dr. Ades has worked with Médecins Sans Frontières/Doctors Without Borders on assignments in Aweil, South Sudan in 2012 and 2016 and in Irbid, Jordan in 2013. Dr. Ades is currently an Assistant Professor of Obstetrics and Gynecology and Director of Global Women’s Health at the New York University School of Medicine (NYUMC). Her clinical work is at the New York Harbor VA and at Gouverneur Health. At NYUMC, Dr. Ades has created an educational and research partnership with Korle Bu Teaching Hospital in Accra, Ghana. She is also the Director of the EMPOWER Clinic for Survivors of Sex Trafficking and Sexual Violence at Gouverneur Health on the Lower East Side. Dr. Ades’ main research focus is on post-sexual trauma gynecologic care. She runs the Empower Lab at the College of Global Public Health at NYU, where she has active research projects on sexual and gender-based violence, intimate partner violence, military sexual trauma, and global women’s health.

 

Episode Transcript

Part 1: Devon Collins

So I’m a scientist.  And as far back as I can remember, I've wanted to be one.  And for the past few years, especially with recent events like the March for Science and all the attacks that we in the scientific community feel, I’ve thought so much about why I became a scientist in the first place.  That naturally leads to what got me into it. 

It really comes down to the fact that I actually have three people to thank for my scientific career.  Like any good son, my mother, a shitty kindergartener, and Gene Roddenberry.  And if you're not down with sci-fi, Gene Roddenberry, I'll just let you know, is the creator of the original Star Trek series from the 1960s and most of the franchise that grew out of it.  I promise this will make sense at some point. 

So let me tell you how I figured all this out.  A couple of years ago, I was in a meeting with some colleagues and a professor at my school.  I mentor a lot of students during the spring and summer, and it was summer 2015.  I brought two of my students with me, Tiana, a brilliant black young woman from Long Island, and Sylvia, a Bronx native of Lebanese-Jewish descent. 

So we’re in this meeting.  I have them with me, and for some reason or another, I don't know but it was kind of that like crazy summer… it was actually literally, for a little bit of context, the day after Sandra Bland was found in her cell. 

So the subject, for some reason, of racism and sexism in the academy came up.  And as professors are wont to do, the professor who was leading this meeting started giving a lot of unasked-for advice.  A lot of it centered around dealing with discrimination in the academy.  She, in doing this, was recalling this former trainee of hers.  This black woman who was starting her career in the 1980s.  She said, “You know, the best advice I ever gave to her was, ‘Don’t worry.  Don’t worry about being black in science.  Just worry about being a woman in science and you'll be okay.’” 

That’s the shittiest advice I've ever heard.  That’s so terrible.  I was so incensed it was almost like I'd never been black before.  Like this professor, a white woman, was telling me, was telling my student, was telling other black scientists in the room that we had to check our race at the door.  That we could only understand ourselves and our careers through one lens -- an important lens, gender.  But only one.  We couldn’t bring our whole selves to the lab.  

That’s not true.  I know from experience that it’s not true.  At my home institution, in my program, I can count on one hand the number of black students other than myself.  And I've interacted with over ten generations of grad students.  I've met even fewer black postdocs.  Just last year, we got our first black full professor head of lab, in a hundred and sixteen years of the institution’s history. 

We’re funded -- black scientists are funded at abysmal rates compared to everybody else.  We are mistaken for janitors most of the time -- especially black women.  I carry, I have my ID in the most accessible place all the time, just in case.  Just in case somebody decides that I don't belong there. 

So with all this in mind, I was furious.  As much as I was furious for myself, I was furious for my students.  Because what were they supposed to get out of that?  They had never seen me like that.  We had gotten to know each other for over the course of a couple of weeks, and they could tell that something was up. 

So it was a struggle.  It was a big struggle to figure out exactly what I was going to say to them, how I was going to make sense of this shitty, shitty thing that had just been said to them.  And in that struggle, I actually was forced to think back to why I became a scientist in the first place. 

It led me to this point, actually the point when I first realized that I was black.  So it was kindergarten.  I was five years old and it was recess time.  For some reason, I don't know why, we were having an indoor recess period. 

My classroom had one of those play kitchen areas and so we did what little kids do.  We decided a couple of us were going to play house.  It got to the point where we were going to figure out who was going to be who, and one of my friends said, a girl said, “I’m gonna be the mom.”  And I thought, Cool, I’m going to be the dad.  I’m five but I’m a mature five so it will be great.  We’re going to do this. 

So I said to them like, “Hey, I’m gonna be the dad.  Is that cool?”  And without skipping a beat, one of the other boys said, “No, you can’t.” 

I was kind of taken aback because I had no idea like why he would say that.  Then I asked, I said, “Well, why can’t I?”  And he said, “Well, cause you're black.” 

It’s hard to remember exactly what was going through my mind at that time, but I do remember how I felt.  I was exposed and isolated and ashamed, even though I had done nothing wrong.  Then I looked around and it dawned on me like, Holy shit, I’m the only person in this group who’s not white.  And apparently, because of that, I can’t even pretend to be the dad in a make-believe family. 

By the time I got my wits back about me, everybody had started playing and I had to hold that with me.  I went back home later that day and I told my mom what happened and she had to explain to me.  She had to have the talk.  Not that “talk.” The talk that black parents have to have with their black kids. 

She told me, “Devon, sometimes what you imagine for yourself is not what the world imagines for you.  And sometimes what the world imagines for you is a lot less than what you deserve.  But you have to keep imagining because the world is wrong.” 

I can thank my mom for a lot of things, that talk especially, but honestly, the thing that… ugh, god, please, anybody who knows my mom, never tell her this.  But the best thing she ever did was to introduce me to Star Trek

I’m pretty sure that that night, like many other nights, my mom introduced me to Star Trek and she would let me stay up late sometimes.  We’d watch episodes of the original series until I would fall asleep or she would fall asleep sometimes.  It was amazing. 

Like many scientists before me, I was an indoor kid.  I was always a little bit more content sitting in my room playing with Legos, pretending to be like a prodigious inventor or a brilliant scientific mind who had just unlocked the keys to eradicating disease and starvation.  And I fell in love with Star Trek because it, among other things, is such an amazing shining beacon that can show us what we could be and how much potential for progress we have. 

See, Star Trek takes place in a world where poverty and disease and starvation haven't existed for generations, where people build starships that take them to the stars at unimaginable speeds, where we build medical devices that can heal injuries almost instantaneously.  And something, even as a kid, it prompted me to think like what are we going to have to do to make that a reality?  I want to see that.  I want to be a part of it.  I want to get us there. 

What is this?  Well, it’s science fiction.  So I guess I like science.  Science is cool.  Okay, cool.

But there was something else that was there.  Or I think actually a better way to put it is there's something else that wasn’t there.  See, Star Trek also took place in a world where racism and sexism and war were unheard of.  They were the exception and not the rule, except for a couple of really unfortunately designed costumes and some really crappy scripts.  These things were unheard of.

And it was a place where the brash, sexy Iowan Captain Kirk would adventure alongside the sardonic and cool and logical half-alien Spock.  Where George Takei would play Hikaru Sulu, who would pilot the Enterprise along with the cartoonishly Russian Pavel Chekov.  Where Scotty, the most aptly named Scotsman you could ever meet, would keep the ship running while the southern gentleman Leonard “Bones” McCoy would keep the crew running. 

And there's one name that I haven't gotten to yet but that’s Lieutenant Uhura played by the illustrious Nichelle Nichols.  And just for a little bit of context on why she's so important to me, Star Trek premiered in September of 1966 and that was, of course, in the middle of the American Civil Rights movement of that time, not that we’re really out of it. 

But here was this black woman, this black woman born on the fictional United States of Africa being beamed, pun intended, into living rooms across a very real, very segregated United States of America.  And she wasn’t a nanny or a cook or a maid.  She was a bridge officer on the flagship of an interstellar defense force and exploration force.  She was an engineer, she was a scientist, she was an expert on communications and linguistics.  And she would save the lives of her crewmates and of humanity and of the galaxy.  The fate of the day would rest on her shoulders. 

On some of the extra-special nights, my mother would let me stay up even later and I got to watch LeVar Burton in the first Star Trek spinoff series, The Next Generation.  You might know LeVar Burton from Reading Rainbow.  He played a man named Geordi La Forge, who was the chief engineer on a new Starship Enterprise with a new generation of explorers. 

And even as a kid, it wasn’t lost on me that LeVar Burton, the man who played the enslaved Kunta Kinte in the Roots miniseries of the seventies was the same man who was in charge of the warp engine, which is the beating heart of the Enterprise.  It was in one person of almost poetic juxtaposition of where black folks like me had been and where we could be. 

So fast-forward to now.  I still watch old episodes of Star Trek albeit on Netflix instead of on like a local FOX affiliate or whatever I was watching before.  I made a promise to myself when I was a kid, and I kept that promise.  I became a scientist.  I’m trying to save the world by studying opioid addiction and teaching science to kids instead of, you know, saving the galaxy. 

But most of my students are brown like me.  A lot of them are brown women like Lieutenant Uhura.  A lot of them want to… no, all of them see themselves in a world that needs to be made better.  And they want to be scientists.  They want to use their science to make the world better. 

Which brings me back to that meeting.  So, still fuming, I took Tiana and Sylvia back to my lab bench and I told them, “Look, whenever somebody tells you that you can’t bring your whole self to this, to science, that person is lying to you.  If they ever say that you have to ignore one part of yourself in order to come to work, then they don’t know what they're talking about.” 

So we spent the rest of the day talking about identity and gender and science and discrimination.  I learned a lot about my students, but they also led me to realize something about myself.  Tiana told me that she wanted to work with me, me in particular, because she was a young black woman looking for a career in science. And she knew that science has a very real, very terrible gender problem, but she had no idea how those things were going to come together, how her race was going to come together with her gender to make her life in science.  And she was looking to me for answers on how to be a black person in academia. 

That’s an awesome, awesome responsibility.  See, when I was a kid in kindergarten, I learned that I wasn’t even safe from racism in my imagination.  I had to look to fictional heroes to figure out what I could be and come up with the options from my own life.  As a teacher, I get to be that real.  I get to be in the flesh in front of somebody actually living out their dreams, living out the best things that they could imagine for themselves.  I could be somebody’s Geordi.  I could be somebody‘s Uhura.  Only, right here, in front of them and not on TV.  I can be a part of somebody’s yet unrealized future.

Thank you.

Part 2: Veronica Ades

About a year ago, I found myself in South Sudan.  It was two or three o’clock in the morning and this was actually my third straight night awake -- three days, three nights.  I was in the hospital.  I was standing over a patient’s bed, and I was holding this freezing bag of blood.  And I was squeezing it and I was just trying to press the blood into her veins as fast as possible.  And I was thinking, I will not let this woman die. 

To understand why I was there, I have to give you some background.  So I am an OB-GYN, or obstetrician-gynecologist.  So I deliver babies, I take care of pregnant women, I do C-sections.  My whole life I knew that I would have an interesting career that I was passionate about and that I would pursue wholeheartedly. 

But even though I spent most of my life or my time delivering babies, I wasn’t actually super sure that I wanted to have them.  It seemed conventional, limited.  It seemed like it derailed your career.  And I really hated it when people would say these condescending things to me like, “Well, you won’t care so much about your career when you have children.”  If that’s the case, then maybe I don't want them.  I don't know that that was true, but I just didn’t like the prospect of being so limited by my biology. 

So I went to medical school, I did training in OB-GYN, my residency, and then I ended up doing a lot of global health work and that’s how I ended up working with Doctors Without Borders, which is known by its French acronym MSF. 

This was my third mission with MSF.  We were in a town called Aweil in South Sudan, which is in northern Bahr el-Ghazal, if anybody is familiar with that state.  We were in South Sudan because there was a need. 

So South Sudan used to be part of Sudan, if you're not familiar with the geography.  It’s the newest country in the world.  Sudan was at chronic civil war for fifty years and finally, in 2011, there was a referendum, a peaceful referendum that split the country into Sudan and South Sudan. 

That did not end the war so the fighting continued in South Sudan.  So after fifty years, the country has really been decimated.  There's almost no infrastructure at all, almost no educational system, almost no healthcare system, almost no government.  And that means that the most vulnerable populations, which are pregnant women and children, are the most likely to die.  In fact, they were dying in very high numbers in this area. 

So MSF came in and they went into the Ministry of Health Hospital.  They were invited and they took over these wards because the hospital needed help.  There were very few trained personnel there. 

So this was my third mission with MSF and I was the OB-GYN.  There are expats and there are local workers, so I was the only expat OB-GYN.  I was actually the only surgeon.  There were expat midwives, there were internal medicine doctors, pediatricians, logisticians, administrators, and then there were local midwives and nurses but there were no surgeons.  So that meant that if anybody needed a C-section, I had to be there.  And if anybody needed, had an obstetric emergency, it was all me.  That is how I ended up being awake for three days and three nights straight because there were so many emergencies and so many C-sections.  I actually ended up being four days straight. 

So there I was and I had just come out of a C-section.  I had delivered a woman’s twelfth child, because that’s how it tends to go in South Sudan.  She was okay and I was looking forward to getting to sleep.  The nurse came to talk to me and she said, “I have a patient I want you to evaluate.”  It was one of the local nurses. 

To be honest, I was kind of irritated.  They were supposed to call the midwife before me and I was in a surgery, so if it’s urgent, you really shouldn’t be waiting for me.  And besides that, I’m so tired.  I’m so tired, I don’t even feel tired, which is the most dangerous kind of tired so I did not want to see this patient.  But how can I go home if there's somebody potentially in need? 

So I said, “Okay.  What’s wrong with her?” 

And she said, “Well, her hemoglobin level is two.”  Okay, some people understand what that means.  Two. 

So hemoglobin is the concentration of red blood cells in your blood.  And normal for a woman is about thirteen, for pregnant women it could get down to about ten or eleven.  At seven, we transfuse, because you're at-risk of dying.  And at two, almost anybody would be dead, except South Sudanese women for some reason. 

I have seen people actually walk in with this hemoglobin level and be like, “I don’t feel great.”  And then we transfuse them to like four, which is still dead-level, and they go home because we don’t have that much blood.  So I was like, okay.  I guess like she could be really sick, but she could be fine, but let me go see her. 

So I go over to see her and she's lying on her side in the fetal position and she's apparently sleeping.  So I actually just kind of looked at her first.  She's very emaciated, but every pregnant woman and child in South Sudan is emaciated.  And her belly looks a little small.  The staff is telling me she's full term but, to me, it looks like about thirty weeks, maybe seven months. 

So I turn her on her back and I realize that she's gasping for air.  [makes gasping sound] Like that.  So oh my God.  Okay, this is bad.  This is not one of those just-walk-in-and-transfuse-it’s-fine.  She's sick. 

So I have to figure out is this acute or chronic?  If it’s acute, she's losing blood and then that’s the reason that she's so anemic.  If she's losing blood, where is it going?  Well, usually, unless they were stabbed or something, it was vaginal bleeding.  So I asked the staff is she having any vaginal bleeding?  They said no. 

So okay, it could be chronic.  I've seen people with this before, but they don’t usually look like this.  She looks really sick for chronic.  Everybody has severe malnutrition in South Sudan.  They have multiple consecutive pregnancies.  Life is really hard there.  So it’s possible, but then what’s making her so sick? 

There is one thing that could be causing her to have severe acute anemia that would make her so sick but we wouldn’t see the bleeding, and that’s placental abruption.  That’s where the placenta tears off the uterus a little bit and bleeds but it can get trapped behind the placenta and so we don’t see the bleeding come out. 

The staff has actually told me that the baby is dead and so an abruption would be consistent with that, so I need to do an ultrasound to see if that’s the case.  They bring over the ultrasound and I do it and I think I see some fluid.  Not a hundred percent sure but it looks like there's fluid.  And is it behind the placenta or is it by the liver?  It’s really hard to tell on ultrasound.  But either way, it would be bad and that I need to get this baby out because it really could be what’s causing her to be so sick. 

So I do a vaginal exam to see if she's dilated and actually she's fully dilated ten centimeters.  She's ready to deliver. 

So one of the nurses actually scoops her up.  Most people in South Sudan are over six feet tall.  They're like six-foot-five. This particular tribe is the Dinka tribe, they're very tall, so they scoop her up.  She's tiny.  This nurse, a male nurse - most of the nurses and midwives are men there - scoops her up and carries her tiny body over to the maternity ward. 

The maternity ward is four maternity beds all lined up next to each other.  There's no privacy in South Sudan.  There's not even an expectation of privacy.  And they have footrests and so we put her legs up there, but she's so weak that she can’t even hold her legs up.  So I have the nurses hold up her legs and we have her push.  And because she's so weak, we help her by pulling with a vacuum. 

The baby comes out really easily.  It is dead.  And the placenta comes out easily.  But as soon as it comes out, I realize that her uterus isn’t contracting.  That’s called uterine atony, and the uterus needs to go from about this to this in seconds.  If it doesn’t, the blood vessels are wide open and they're just pouring out blood.  A woman can lose her entire blood volume in a matter of minutes.  It’s actually the number one cause of death around the world for pregnant women. 

So what I do is… sorry, it’s about to get very vaginal.  I put one hand into the vagina and I massage her uterus and I put the other hand on top of her abdomen and I massage.  It’s called a bimanual massage.  It’s actually one of the most life-saving techniques you can do.  It’s actually pretty simple.  But it tamponades the uterus until you can get medications on board and get it to contract. 

So I’m massaging and starting to call for medications.  So we can give one dose every five minutes of various medications, so I’m calling for them.  Then I realize this is bad.  She has no blood, almost, and she doesn’t have much to lose.  This is an emergency.  I should be directing this as a most senior person in the room. 

So I ask the expat midwife, Cecile, to come and do the bimanual massage.  So she does.  She takes over.  And so I’m timing the medications and thinking about all the coordination. 

The blood arrives and they hang the first bag of blood, and her mother comes in the room.  The patient’s mother.  So I briefly turn to her and I use a Dinka interpreter to tell her that I’m very sorry but the baby is dead and your daughter is very sick and we’re just working on helping her.  So she says, “I knew that the baby was dead.  I’m not worried about the baby, just please save my daughter.” 

So we keep working, we give medications and we’re transfusing the blood, and that’s how I end up just standing over her, holding this freezing bag of blood and I realize that she's getting very cold and actually hypothermic.  It’s because the blood is so cold and we haven't had time to warm it up properly. 

So I turn to the blood bank guy and I say, “Is there any way to warm up this blood?”  And he goes, very South Sudan, just put it in your armpit. 

So I didn’t do that.  We just wrapped her in wool blankets and that tinfoil blanket that they give to marathoners that helps keep you warm.  What are you going to do, right? 

So we’re squeezing the blood in and Cecile is massaging her and we’re giving medications and we get to the limit of our medications.  We've given everything that we could give.  At this point, the only thing that we can do is a hysterectomy, but she is not going to survive that surgery.  So we’re at our last resort and, just as a temporizing measure, we put in a balloon into her uterus. 

So Cecile prepares the balloon and that should give us a tamponade and hopefully give us time.  But as she goes to insert the balloon, she can’t get it in because the uterus has contracted.  Finally.  So we’re relieved that the bleeding has stopped and we can finally take a minute to figure out what’s going on, because we haven't even been able to think about it.  We've been so busy just trying to save her life. 

So the local midwives are actually great and they are now taking care of her and we can leave her with them for a couple of minutes.  We step outside and just take a breath and say what is going on.  So it didn’t seem like abruption.  There wasn’t any blood behind the placenta.  It could be preeclampsia, which is high blood pressure in pregnancy, but her blood pressure is not high.  But maybe she's so sick that now it’s back down to normal, which is low.  I don't know.  We’ll put that on our list. 

It could be sepsis, it could be HELLP syndrome, it could be Kala-Azar, it could be tuberculosis, it could be so many things.  That’s what’s hard in South Sudan.  They don’t have prenatal care so I don't know what was wrong with her or if there were problems in the pregnancy.  And they have so many diseases that I have never seen before that I didn’t train to see and wouldn’t know how to recognize.  So we just needed to try to figure it out and we have to figure it out fast, because whatever is hurting her could still be going on.

So we ask for a bunch of labs, and you can’t get that much South Sudan.  It’s not like here.  So we just fill out whatever we can that we think will help and we give the list to the midwives.  We come back to check on her and she actually seems better.  The first unit has gone in, she's not gasping anymore.  She's quiet and calm.  She's still weak.  And the second unit is going to start so we’re relieved that we've kind of gotten through this period. 

I realized that if I’m going to take care of her in the morning, it’s probably 3:00 or 4:00 at this point, I need to get some rest.  So we give strict instructions to the local midwives they're going to hover over her and they're going to call us for anything, and they’re going to get this second unit running and draw the blood.  

So Cecile and I take the car back to the living compound.  It felt like as soon as I lay down, Cecile was knocking on my door.  She is pounding and she's saying, “Veronica, she's very sick.  We have to go.” 

So I throw some clothes on, we go running to the car and this white MSF SUV is just careening through these really, really bumpy roads just to get us there faster.  As soon as the car, like pretty much before the car stops, we throw the doors open and we’re racing to Labor and Delivery.  What’s going on? 

We get to maternity ward and she's there, and she's dead.  I couldn’t believe it.  I was not going to let her die and I failed.  Everyone is standing around and it’s just happened right now.  They're just stunned and the staff are just standing there staring at her.  And her tiny body is still wrapped in these wool blankets and this tinfoil, and her mother is standing at her head in shock.  What happened? 

The staff can’t really figure it out.  They say that the second unit went in and she actually started to feel better.  She started talking normally.  She wasn’t slurring her words anymore.  She said her chest pain and shortness of breath were gone.  She actually wanted to sit up and she was talking to her mother.  They made her lie down to rest but she looked okay.  Then all of a sudden, her oxygen saturation went from a hundred percent to nine percent to zero and she died. 

I don't know what this means and I don't know what she has but I know I’m about to cry.  I don’t cry very much anymore.  I've seen a lot and I've a little bit lost my ability to cry, especially in front of other people.  I kind of wish I had it more.  But I’m realizing I’m about to cry and I don’t want them to see me cry.  So I step out of the room and I cry. 

And Cecile follows me and I see that she's crying too.  And one of the local midwives, who’s just the most sensitive soul I've ever met, is also very upset.  We gather ourselves together and we go back in.  Cecile has to go see a woman who’s delivering twins and I go back to see this patient. 

She's still there, still wrapped in those blankets, and her mother is there still.  But now she's crying and that is really striking because women in South Sudan almost never cry.  I actually don’t think I've ever seen anyone cry, and I've seen them been through horrible things, losing babies, hysterectomy, major surgery, complications.  They're incredibly stoic.  And I don't know if it’s the environment or how hard their lives are or just cultural, but you don’t see them cry.  So the fact that her mother is crying…

She's not just crying, the tears are just pouring down from her eyes and then they're pooling on her prominent cheekbones, and then they're just cascading down.  It’s like a waterfall.  As soon as she sees me, she looks right at me and she starts speaking in Dinka.  I don't understand so I call an interpreter over who says, “She's saying that she will never blame you because she saw how hard you worked to save her daughter, and she knows that you tried.” 

And I started crying and I said, “Tell her that I did everything, everything that I could and it wasn’t enough, and I’m sorry.” 

Sometimes you do your best and it’s not enough.  That mission was really hard.  I lost another patient that I really cared about and I got sick.  I lost ten pounds and ended up actually getting medevac-ed at the end of my mission. 

When I got back to New York, MSF has you meet with a therapist to process the experience and make sure you're okay, and it’s great.  So I sat down with Dorothy, the therapist, and she said, “Tell me about your mission.” 

So I said, “You know what?  It was really hard.  I had these interpersonal conflicts that you always have when you're working and living with people twenty-four-seven.  They're very stressful and I think it made the physical toll of it harder and the maternal deaths harder.” 

So we talked through the interpersonal conflicts.  She was really supportive.  And then she said, “Tell me about the maternal deaths,” and I just burst into tears.  

I cried for an hour in her office.  I thought I was okay.  I always think I’m okay.  I've seen maternal death before.  I've seen several and I know how it goes.  I know how they sink a hook into your heart when you work that hard to save them and when they die, it brings you down.  I know that you need to just mourn and you need to give it time and eventually put it in this box that you carry around with you forever, but you're okay. 

But I was not okay yet.  In fact, I was depressed for a good month after I got back, but I didn’t realize it until I was in Dorothy’s office. 

So I told her about this death and the other one that broke my heart.  She listened and she said, “What are you thinking about when you reflect on these experiences?  I mean, it’s sad, but why did it feel so personal?” 

I thought about it and I realized that in both of the cases where the patient died, the patient’s mother was there watching her own daughter die giving birth.  I thought about my own mother who loves me so fiercely, like more than anything I've ever seen in my life.  And I think about what, if that was me and my mother had to watch me die giving birth, I can’t even handle it. 

Dorothy points out that I spent a lot of my life taking care of pregnant women and helping them deliver their babies safely and that I've made a lot of sacrifices to do it, and this fire in my belly is really a profound anger that women have to die in childbirth. 

So Dorothy says, “What does motherhood mean to you?”  The question goes so deep I can’t even answer her for a few minutes. 

I realize that I have been thinking about motherhood all wrong.  Motherhood is love.  It’s fierceness.  It’s sacrificing yourself for your child.  Motherhood is taking care of someone else.  It’s putting their needs before yours.  Motherhood is powerful in this way I had never appreciated before. 

In many ways, my own career, taking care of others, is a form of motherhood.  I don’t feel anymore like it’s this biological need that will limit my life and my destiny.  Motherhood is something that I could be really good at, something that I’m kind of already doing.  Motherhood is part of me. 

Thank you.