I’d been an activist and in protests since college. But this felt “low risk” compared to standing up as a medical student to the hierarchy of medical education.
Obstetrics was my first clinical rotation. Having worked with rural lay midwives and loving it, I was excited for this rotation. I knew not to wear politics on my sleeve, although the faculty at this hospital cared for marginalized communities. They had a midwifery training program, a progressive stance for 1977. Fifth-year chief residents ran Labor and Delivery, including routine Caesarean sections without an attending present.
It started out like any night on call. Then a woman came in with ruptured membranes and not yet contracting. She had five children, the last two delivered by Caesarean section. She spoke little English. I knew only a few words in Spanish, and we had no interpreters. We had complete prenatal records, and she understood she would be having a Caesarean section.
Another student and I went with the chief to assist. In the elevator, the chief turned and said to the nurse, “She doesn’t need more children. I’ll tie her tubes; get instruments ready.” I felt horrified and sick. The previous year, the Department of Health, Education, and Welfare published regulations requiring standardized consent for publicly funded sterilizations. She had not been counseled, nor had she signed a consent form. The chief didn’t care.
My classmate and I talked privately. The chief would be evaluating us, because we never saw our attending. We could fail the rotation If we acted. If we didn’t act, an unethical, illegal surgery would happen.
Our plan was simple: I stayed in the room to delay surgery by throwing myself onto the patient, if needed, and she ran to find the attending, who we hoped would do the right thing. Back in the room, anesthesia was preparing. No one was rushing. The patient was stable.
As the chief prepared to start the surgery, I perched to jump onto this unsuspecting woman. Seconds before my leap, the attending barged in and instructed the chief to back away and leave.
The chief didn’t do that surgery. He was removed from the service, reamed about ethics, professionalism and the law, and sent back to the other hospital.
The patient didn’t get a tubal ligation. She did get a beautiful son, along with an interpreter the next day explaining the chaos of the night before.