Friday, August 14, 2015

Consecrated Virginity FAQ

On June 20, 2015, I became a consecrated virgin living in the world, according to canon 604 of canon law (the body of legal principles governing the Catholic Church). This vocation is ancient and new, and it's viewed positively by traditional Catholics. There is already an excellent FAQ on consecrated virginity in general, but because of previous posts and the very worldly nature of my schedule, I wrote this post.

What do you do?
As of this writing I'm an intern in obstetrics and gynecology, so I work fifty- to eighty-hour weeks at a hospital in labor and delivery, the emergency room, the operating room, and the women's health clinic. I also pursue research in fertility. But what I do is less important than what I am: a bride of Christ. I will live a life of prayer and penance and remain without marrying a human person (and without physical children) in this life.

You're a consecrated virgin and you spend seventy hours a week with pregnant people and researching fertility?
Yes. God has a sense of humor. (But there's also a long precedent of consecrated women caring for women, mothers, and children, so I'm not that strange.)

So! You're childfree?
I suppose it depends on how you define "childfree." If you mean "without children," then yes. I have made a permanent, irrevocable commitment to preserve my physical virginity, so I will never voluntarily have sex and thus won't have children. (Not only will I not bear my own children, but I cannot act as a surrogate or adoptive mother, since these actions don't dignify children according to their right to be raised by their father and mother. Accepting the moral teachings of the Church is part of being a Catholic, which is a prerequisite to consecration.)

But I thought "without children" was the meaning of the word "childless." I am not an expert, but I thought "childfree" meant at least two things besides "without children." I thought it implied 1) sexual activity and 2) a belief that children aren't desired. Even though childfree men and women often sincerely acknowledge that they love children (and some choose to be childfree to care for children of others), they have decided that for them, or for now, or forever, children are not desireable as a fruit of their sexuality.

Although I'm a sexual being and still live my sexuality, I don't have a "sex life," so I can't make the decision to be childfree (as I understand the word). Of course, if "childfree" only means "without children," I am childfree. (So's the pope, and he has plenty to say about the decision not to have children.)

So, you pretty much just had a wedding ceremony by yourself?
No. Human persons are meant to give themselves completely to the infinite Love that is God. Whether they do this through another human or directly (by God's grace!), they must make a total sacrifice of self so that nothing is left. To "marry oneself" is impossible--one can't give everything away and also be receiving it. The woman in the story I linked to was having a wonderful epiphany about the independence of her strength and happiness from the lives of other persons, but she wasn't marrying herself.

So no, I'm not marrying myself. Am I marrying anyone at all? Yes. "Virgo est qui Deus nubit," St. Ambrose said, "the virgin is she whom God has married."

Oprah covered the final vows of several Dominican sisters and pointed out that their vows are a marriage. However, she said that "the groom is present only in spirit." I remember watching that episode and laughing a little sadly. God the Son is more present and more real than any human person, even far away from the blessed sacrament.

God is not some imaginary thing we think off to. He stands under and continuously creates everything. It's because He has you in mind that you're existing right now. So no, I'm not marrying a vague spiritual idea. I'm marrying He who Is, who is more terrifyingly real than any thing.

Is this because you want to be a priest? Would you be a priest if you could?
No and no. I want to be the saint that Christ has in mind when He loves me. That saint is feminine, and has quite a lot on her plate without trying to be an alter Christus as God shapes only men to be. I love my call. I think it's probably the most fantastic one He's ever created!

I don't think the second question makes sense. It's like "what animal would you be?" It might tell a little about me, but it's bound to misrepresent me if it's taken absolutely. Just as I can't (and don't want to) become an eagle, I can't become a priest, since God gave us a fatherly priesthood. But just as I could (and might) say at a dinner-party "I'd like to be an eagle" because I would love to fly, I can say (like St. Therese) that I would love to be a priest because I want to resemble Him in every way I can imagine.

In reality, I have that flight of priestly glory in my consecrated virginity. Each of us has it in our calls to sainthood--we just have to take it, and bowl between the rails.

Did you choose this for more freedom from obedience? Habits?
No. Consecrated life developed from the second half of the first millennium to the end of the second. The developments were beautiful and helpful for the Church and the world of that time. And, like every development that the Holy Spirit rolls out, there is something perennially helpful about it. It is good that some wear "distinctive dress." It is good to have a structured community. But it is not necessary. Otherwise, how would so many early virgin martyrs and anchoresses have become holy?

In North America, most Catholics in the new evangelization associate orthodox consecrated life with full habits, thriving communities, and a return to the rigors of the evangelical counsels. All these things are fantastic and support orthodox religious life! However, living the counsels to the fullest, as Raniero Cantalamessa and Thomas Dubay point out, does not have to involve obedience to men, or a set degree of exterior poverty.

This was a hard pill for me to swallow, because I was wary of "consecrated women" who didn't wear habits, live in convents, have a rigorous rule of life and schedule, and exhibit the forms of obedience and poverty. Slowly, I began to recognize that I this state in life entailed complete submission to the counsels, although in a way I did not understand.

Is this something for ex-nuns?
I know consecrated virgins who left convents. In one case I know of, this was because there was not enough contemplative prayer after the novitiate in the order she joined. Consecrated virginity is not something for people who don't want to love our Lord.

Are consecrated virgins basically nuns?
Consecrated virgins have been called brides of Christ since the years of the early Church. This title that has also been accorded to nuns and religious sisters for centuries as well. But in important ways, we are not like nuns. Important aspects to the religious life include the charism of a founder, community life, and distinctive dress. Consecrated virginity does not have these elements of consecrated life, which developed later in Church history to adorn religious life.

So, you're a layperson (or in a lay movement, or you're a lay consecrated woman)?
The words "lay" and "layperson" have changed in the past century. "Lay" used to refer to anyone who was not in orders (anyone besides priests, deacons, and bishops). It then came to mean anyone who was not in consecrated life or in orders. In either sense, a consecrated virgin is as lay as a cloistered Carmelite.

Is consecrated virginity the same as making private vows?
No. Vows are made by a human soul to God; God consecrates a consecrated virgin. Because consecration is an act of God, it is permanent and irrevocable.

I do make a threefold propositum during the consecration, which beautifully lines up with the three counsels. However, I am not made a bride of Christ by my propositum. I am passively swept up as God deigns to consecrate me at the hands of His bishop.

Why isn't this a sacrament?
There are seven sacrosanct signs producing grace (signum sacrosanctum efficax gratiae). These are primary channels of grace God gave to save us, that will not change until the end of time. At the end of time, their purpose will be complete, and there will be no more baptisms, no more marriages, no more ordinations, and no more Masses. Sacramental realities will give place to non-sacramental realities.

Consecrated virginity is a non-sacramental reality. It belongs to the world to come, which is why it seems like a lack-of-something (e.g. like being childfree) here on earth.

What do consecrated virgins wear?
They wear modest clothing that suits their time, place, and work. They might dress a little more modestly than a faithful Catholic woman in their age group. Practically speaking, I wear scrubs in the hospital, conservative professional clothing under my white coat in clinics, and long skirts and modest shirts to Mass. Some consecrated women do not wear pants so that they can witness more completely to God's love in the gift of femininity. I wear pants because otherwise, I'd put up unnecessary barriers to friendships and evangelization.

Do you have a rule of life? An horarium? Superiors?
I do have a rule of life. My spiritual director approved it before my consecration. I do have an horarium, although prudent direction helps me adjust it as rotations change. I do not have superiors, although I treat my bishop as a loving father, for whom I would do anything that wouldn't jeopardize my moral or fiscal stability.

How do you live the evangelical counsels if you don't make vows?
This deserves a post all on its own! The counsels are meant to change our hearts to Christ's and make us thirst for God the Father. I live poverty by leading a radically simple life; this was rather easy as a medical student (living on loans) and is still easy as a resident (living to pay back loans). There is no money spent that is not spent for Christ and with Him in mind.

I live chastity by working to increase the purity of my intentions, so that I can be chaste in body and mind as I become single-hearted like Christ, wanting only whatever the Father wants. For instance, I often want to ask my upper-level residents for feedback because I'm want praise. That thirst for confirmation is better quenched by Him, so I choose chastity when I purify my intention and only ask for feedback when I want it.

I live obedience by constantly looking for the will of God. Paying attention to the circumstances and holy desires I find in the present moment, I look for ways to advance God's mission to save souls. For example, perhaps I choose to listen carefully to a patient's slow explanation of what is going on, even though I have so many more to see. Perhaps I accept my ignorance during my training as a way to be with Him during his humbling human childhood.

Friday, July 31, 2015

Quick Takes

In the spirit of Jen Fulweiler, I will now give you seven mini-posts on the last day of July of my intern year.

Fireworks on Call
My first call was the nights over the Independence Day weekend. It was busy (as one of my upper levels said of me, "She got slammed"), but I had fantastic support from my chief. On July 4 he let the whole team sneak through the attic and onto the roof to watch fireworks. We aren't supposed to leave the hospital, but we crouched on the tarpaper, hiding the lights of our pagers and phones as we watched the magic. They were the most beautiful fireworks I've ever seen, possibly because I was so sleep deprived. While I watched, I remembered choosing a stock image of fireworks to put next to my first ever blog post, when I was given the news that I was going to med school. It's been a long four years since then.

Triage is Stressful
Most of the intern's job is to work Triage, which is like a mini-emergency room attached to Labor and Delivery. There are only six beds in Triage, but you'd be surprised how busy it can still feel, especially with my pager going off and the phones ringing and me not knowing how to prioritize. I make mistakes a lot: misdiagnosing wet mounts, forgetting to print patient's prescriptions, not thinking to collect a certain specimen, not starting IV fluids fast enough, not writing good notes, not writing the appropriate notes, not routing the notes to the right people.... I don't like the regret that comes with these mistakes, but I'm learning quickly and I'm trying to remember to be patient with myself.

First C-Section
I did my first C-section on that call. It took me about an hour. I was only a little nervous, mostly because I was very confident that my chief couldn't let anything go wrong. I'm still in med student mode: I don't take the final responsibility, so I don't need to worry about bad things happening. It went well. The baby was cute and the closure, if you were interested, was lovely.

Nobody Likes My Choices,
But People Still Like Me
So far, I've worked with three very pro-contraceptive attendings during my clinical time. They are three different shades of displeased that I'm not prescribing (one very discrete, one very ruffled), but they have nevertheless treated me like any other resident (except for the ruffledness of the one physician). There's a little bit of ignorance about how NFP works (both how the methods work (never mind how well) and how the system works (e.g. I don't teach the method in one office visit)), but they are still treating me like a person. I admire their ability to separate someone's choices from the person herself.

Catholic Hospital, Promise.
Our hospital looks so Catholic! There's a life-sized statue of our lady with the Infant on L&D. There's an Infant of Prague on antepartum. There's a Sacred Heart in the ICU. There's a chapel with daily Mass (and I've made it half a dozen times!). But earlier this month the ethics committee (which also approves tubals) permitted an elective abortion. In response, I'm joining the ethics committee.

Look, sunlight! I forgot what it
looks like! (Only kidding.)
Project Overload
I'm currently working on two medical device studies (peon on one, PI on the other), a sociological study (peon, de facto PI), a proposal to start a half-day naprotechnology clinic in my residency, a brochure of NFP options in my new area, and two potential studies: one in student and resident mental health, and another in fetal surgery (!). I'm also joining the ethics committee (see above) and trying to be a good resident. I've commissioned two medical illustrations, I've promised my parish priest a talk on NFP to the parishioners, and I've obtained some funding (and nothing else...) for a mini-documentary on interviewing as an NFP only. It's a little too much.

Blogging in Residency
I will have less time to blog during residency, so please expect about one post a month. I'll update you with what happened that month, and perhaps tell a quick story or two. Ethics posts will continue to come as well, and so will advice/materials on how to be a Catholic in today's field of obstetrics and gynecology.

Monday, July 13, 2015

What Can a Catholic on OB/GYN Do and Not Do?

Let's be practical: what can a Catholic medical student on his OB/GYN rotation do? What about a Catholic resident working in OB/GYN settings (including family and medicine residents)?

The Do's

Be confident. You have the truth, which is not only a set of beliefs, but a Person who is pleased that you want to do the right thing, and will protect you.

Answer test questions as if you toed the party line on contraception, sterilization, and abortion. We can "prescribe" on paper.

Prepare an elevator speech so that whenever you must state your choices, you can do it smoothly and briefly.

(For residents) Tell your program director.

(For medical students) Do not tell any higher-ups unless you know they will be receptive. Tell clinic attendings at the beginning of any day (the evening before if possible) when there is an objectionable procedure scheduled; tell surgical attendings before the first sterilization you do with them.

Be an awesome person and a hard worker. We must "be perfect," to challenge those who think we're bizarre.

Find as much in common as possible. For instance, be loud proponents of "teens shouldn't get pregnant" and "STDs are terrible," and "no, condoms aren't enough!"

Counsel patients on family planning. To counsel is to present the dosing, routes, side effects, and mechanisms of action of available options. Counsel patients as frequently as possible, because only our counseling is truly presenting the whole truth about all three mechanisms of action (MOAs) of hormonal contraceptives (including thinning the endometrium which may lead to post-fertilization pregnancy loss, per the package inserts) and the existence and benefits of NFP or fertility awareness.

Happily volunteer to take out IUDs and nexplanons.

(For medical students and interns) You may observe one or two insertions of IUDs, nexplanons and Essure. Your participation is remote, it improves your counseling (i.e. you won't remember to mention ibuprofen premedication before IUD insertion if you don't realize quite how much cramping can occur), and you can pray for the patient and physician more vehemently. Students, it's best to speak with your preceptor beforehand, as soon as you see an IUD/nexplanon/Essure insertion on the schedule. If somehow that doesn't happen and you're offered the chance to do the procedure, just say, "I'm not comfortable." (Residents, your PD should already know.) But (students) if they press you (and residents, if this attending didn't get the memo), say confidently: "Thanks for the chance! But I'm choosing not to prescribe contraceptives."

You can participate in endometrial ablations. These are usually done for gynecological pathology (e.g. excessive menstruation) and are not a form of sterilization; however, they do have a sterilizing effect. If everyone's intentions are correct, the principle of double effect at work. Because we cannot see into other souls, we can pray for the best and operate as if the principle applies. (If the patient makes it clear that she wants the sterilizing effect, it's your duty to tell her that this procedure does not sterilize and you cannot guarantee that.)

You can participate in hysterectomies. Everything that applies to ablations applies also to it. Our bodily integrity is important, but this procedure is sometimes necessary for patients who fail conservative management (i.e. ibuprofen, lysteda, napro).

You can scrub into C-sections during which they plan to do a tubal ligation (BTL). You can assist with the section, but do not do anything during the BTL. To protect yourself from acting during the BTL, speak with your attending or chief resident (whoever the highest person in the room will be) beforehand.

(For medical students) Some attendings will not let you scrub because you're refusing to participate in the BTL. This is unjust, but take it gracefully and ask if you can observe. If they say no, go peacefully back to the floor or L&D.

(For residents and sub-interns) You can scrub into a BTL to practice laparoscopic access techniques. Make it clear to your attending that you will not be participating in the ligation, but are grateful for the opportunity to learn from their experience in entering and closing the abdomen safely.

You can participate in dilation and curretage (D&C) when done for missed abortion (miscarriage). There is no moral quandary here, if fetal death has been verified by lost heart tones, absent cardiac motion, negative hCG, obvious ultrasound findings (e.g. separation suggesting the decay of remains), or obvious history (e.g. three days of heavy bleeding with fetal parts). Always say to the mother and father of the child, "I'm sorry for your loss." Not only is this what they feel, but it builds up the identity of the unborn child as a person.

Obviously, you can participate in D&C for non-obstetric indications or retained placenta.

(Not usually for students) You can induce labor for missed abortion. If the loss is verified as above, console the patient and father and help with cervical ripening and augmentation.

Counsel on elective abortion (EAB). You must know at what gestational age different procedures (RU486 (mifepristone), D&C, and dilation and extraction (D&E)) can be done. You must be able to describe these techniques to women gently but without euphemism. You must also know the rates of post-traumatic stress symptoms and PTSD among abortion victims, the rates of live birth following abortions, and (if you're a gunner) laws in your state about waiting period, parental notification/consent, ultrasound, and upper gestational age limit.

Care for EAB patients before and after their abortions. This includes preop and postop care in the hospital, and follow-up visits in clinic. Ask about how the patient is handling the loss. Be ready to offer local post-abortive healing information (i.e. carry the cards with you in your pocket), but don't push it.

You can participate in training activities for D&C and LARC/Essure insertions. A D&C is a legitimate operation for indications like excessive bleeding and missed abortion, and scooping out a papaya to learn how to do it is not a big deal. Mirena can help nonsexually active patients who fail other pharmacological therapies. Pick your battles and don't fuss about this. Use it as a chance to observe to your peers sitting next to you about how weird it is that you'd do a D&C when there's still a heartbeat, or how there's gotta be some way to plan pregnancy without sticking a 16 gauge needle in someone's arm (nexplanon).

Counsel on perinatal hospice. Perinatal hospice should be offered to any patient with a fetal anomaly that is "incompatible with life." This is a period of parenting the unborn child and mourning the loss of the baby the parents hoped for. It also involves services like Now I Lay me Down to Sleep (a no-charge project). Students and residents have a particular power in suggesting perinatal hospice (which is uncommon at most centers that offer termination for lethal anomalies) because we go in before the attending and can make suggestions that the attending would not.

(For residents) You can consent patients for BTLs and IUD/nexplanon insertions. To consent (like to counsel) is to offer a full picture of risks, benefits, and alternatives. We are the ideal people to consent for BTLs, nexplanon insertions, and IUD insertions, because we can stress that these things affect something valuable (fertility and integrity of lovemaking), and we can emphasize the permanence of sterilizations, and the fact that many regret their procedures. If you help a patient opt into a less permanent form of birth control, you've helped! It's painful to consent and counsel when people make the wrong decision. But we can only offer the truth (the whole truth), and allow our patients and our superiors to make their own decisions.

Wikimedia. The contributor writes:
"This is an image of my child, he died
and this is how I remember him."
You may visit and learn in IVF clinics. REIs are very intelligent and know a lot about physiology. If you are taken on a tour and see freezers and incubators, use it as an opportunity to pray for the little souls trapped there, and the adults who are trapped in confusion.

Pray every day. 30 minutes of mental prayer keeps you moving towards sanctity. (St. Theresa said that if we meditate, we will either become saints or stop meditating.) If I'm an OB intern and I can do it, so can you.

Talk it out with a friend. If the attendings are making you feel unwelcome, if you're stressed, if the culture is asphyxiating...get it off your chest! Get coffee with a friend and vent! If you don't have anyone sympathetic, email me. (That address is permanent, so even if you're reading this ten years after I wrote the post, I'll get it.)

Contact Alliance Defending Freedom if you're truly discriminated against. 

Be patient with yourself. You can't solve all the patients' problems or correct all your own inabilities all at once! Christ has the power to make up for your defects. Ask Him to do so, go to confession, and move forward in peace.

The Don'ts

Don't make assumptions about sinners' intentions. (This includes patients, peers, and attendings.)

Don't proselytize. Be attractive as a good student/resident, then be unafraid when people ask about NFP or the Catholic Church's ideas on contraception.

Do not advise the use of any hormonal contraceptive (e.g. mirena) in sexually active patients. Period. This is because of their post-fertilization effects.

Do not promote barrier contraceptive use as a good in itself. As Pope Emeritus Benedict wrote, condom use can be a step towards chastity, but always hold up abstinence as an ideal for the unmarried and NFP as an ideal for the married.

(For medical students) Try not attend more than two IUD insertions, more than two nexplanon insertions, and more than two essure insertions. Frame it as sharing with the other med students, or go find something helpful to do on the floor. Make something up if you can't find anything legitimate to do ("I have to go bring this down to the radiology library," "I have to fax this paperwork"), because it's important to not overexpose yourself. You don't want to dispose yourself to think these things are okay.

Do not participate in egg harvests, male masturbation, intrauterine inseminations (IUIs) and other gamete transfers, or in-vitro fertilization. Medical students should not put themselves in this situation: do not do an REI rotation at a facility that does IVF. Residents: if you must observe, make it clear to the attending that you cannot participate, even by holding the transducer.

(For residents) Do not induce labor for inevitable abortion, i.e. when fetal death has not occurred (e.g. when there are still heart tones).

This is a miscarried baby, not an EAB victim.
Never be present at an elective abortion (EAB). This is not because your participation is any different from your participation in BTLs, essures, and LARC insertions. It is because it is much more dangerous for you to be exposed to a sin of the gravity of an EAB. Two former abortionists have told me that the first one is repulsive, the second one isn't as bad, and the third one they make a pass with the curette. Never participate. Say, "I'm choosing not to participate in abortions (or "terminations" or whatever word your resident/attending just used)." Fake syncope if you must. I'm serious! Prefer disciplinary action and a bad reputation to observing an abortion.

(Mostly for medical students) Don't disrupt a patient-doctor relationship. This means that if your attending prescribes contraceptives to a long-time private patient, don't go into the room and talk about the carcinogenicity of hormones and the irresponsibility of using them. This will scare or frustrate the patient, make your attending unhappy with you, and cast a shadow on the truth about fertility awareness. This item not is on the list is because we want to be happy and comfortable. It's because a trainee has limited abilities to help people make good family planning choices; trying to break out of those limits will likely not help you become a physician, or a saint.

Don't dump any other task on others.

Don't be frustrated when people assume you're making these choices for stupid reasons. Most will assume you're choosing unfounded cultural/personal opinions over science. Take it gracefully, and remember that when you suffer it is because Christ is bringing you close to Him in His Passion.

I hope this post is helpful. I will edit it periodically to reflect new devices and laws as the need arises. I want to fill in some of the numbers and am working on finding the literature behind them so that I don't put unfounded figures in your mouth. Please leave a comment below if you've run into a situation I haven't covered.