Global Day for Safe and Legal Abortions

4e1359d8e206b850346e738d142216cdThe young woman left my consulting room after protracted counselling, with a completed J88 (a medical report of assault), a prescription for anxiolytics and pain medication, and a referral to a therapist. She was six weeks pregnant, but would not be for long. Her husband had inserted misoprostol tablets in her vagina, without her knowledge or consent. She was already in the throes of uterine cramps.


07cc7967ffd26d872fce5dafe4e3bd86The smell of blood permeated the ward I walked into that morning. Twelve beds with twelve women, who would be discharged that day and replaced by twelve more. And again. And again. Some women did not meet my eyes. Some looked angry. Some resolute. But the teenagers implored me with their big doe-eyes, waiting for me to pull back their sheets and discover the expelled products between their legs.

The night staff regularly refused to help the patients admitted for pregnancy termination. “It’s your mess. You clean it.” Many women would lie helplessly at night, groaning in unrelieved pain, with no assistance from the nurses sworn to care for them.

I was just an intern. I did my best. But maybe I should have done more.


4457445e1daf992adfbc37a6aa68a7e0An unidentified woman stumbled into the labour ward. Her long skirt was sticky with blood. She was diaphoretic, and breathing fast. She was weak with low blood pressure. She would not – could not? – speak.

“I think… I feel… bone shards?” the registrar reported on the vaginal examination.

An informal abortion gone awry. We will never know who did it, and the woman will never find justice. Abortion deaths were common in the days before legalisation. Our elders in medicine remember them well. These days, we are not meant to see women die from septic abortions. But that night, we did.


Today is the Global Day for Safe and Legal abortions. I feel like this protestor: I can’t believe we still have to protest this shit. How hard is it to leave women’s bodies alone? How hard is it to back off, and respect our autonomy?


I am tired. Tired of hearing how women must run from pillar to post to find a facility that will help them, because so many healthcare workers choose to “conscientiously” object. Conscientious my foot.

A very important report; worth reading. Click the image.

And I think that instead of suggesting a list of things readers can do, I’ll name just one:

Talk about it. 

Even just with your closest friends. If you can, talk to your colleagues. To family. Say the word out loud: abortion. Break the silence. You don’t have to have had an abortion to believe in choice and safety. Your voice is just as loud.

Say it.

I believe in the bodily autonomy, safety, and right to choose of all womxn. 

I believe that legal abortions are integral to the health of communities. 

Statistically, abortion is an everyday part of life. The sooner we start treating it that way, the better.




Stop telling your depressed friend to go for a run

Gratuitous selfie at the top of Chapman’s Peak. This was a good day, and I DID feel pretty high.

“Go for a run, you’ll feel better.”

If you’ve ever been sad, you’ll have heard this. If you’ve been depressed, you’ll have heard it ad nauseum.

What depressed person has the energy, let alone the motivation, to go for a run? Realise that “going for a run” is a multiplex of tasks. First, you must get out of bed. Then, you must get dressed. You must put on shoes. You must (preferably) eat something. You must unlock the door. You must step into the sun. You may have to greet the neighbour. You must put one foot in front of the other. Then you must do it faster, and remember to breathe.

Some days the only thing a depressed person can do is get out of bed. Some days, that will be there achievement.

Image via Odyssey

I’m a runner (sort of). I’ve had the elusive runner’s high. But I’ve always known that running does not and cannot cure my depression. Until recently, I could never substantiate it.

Earlier the year, I attended an Essential Pain Management course, by Professor Romy Parker of UCT*. A large part of the course looks at chronic pain, and naturally there were a lot of parallels with major depression – one such parallel being the endogenous opioid system.

Endogenous opioids are those little chemicals that make you feel good. Endorphins – the ones you get from chocolate and (good) sex? Those are endogenous opioids. The runner’s high involves endogenous opioids (it’s probably a bit more complicated than just that).


As any student of biology will know, for any enzyme/peptide to have an effect on the human body, it must have a receptor. Serotonin has receptors, and that is why we have SSRIs. So do norepinephrine and dopamine. And so do endogenous opioids. If the receptors become damaged, or desensitised, or up- or down-regulated, the effect of that peptide changes. And that is when we get pathology, like depression.

Many people know the monoamine theory of major depression (and much of mental illness, actually). Serotonin, norepinephrine, and dopamine are all monoamines; and the idea is that changes in the levels of these peptides, be it by production or absorption, will bring about changes in mood.

What is less well-known is that many other compounds are involved in the regulation of mood. We know it, but we don’t know it. We talk about endorphins, but we don’t recognise that we are essentially referring to endogenous opioids, and that these therefore play a role.

Much recent research illustrates that opioid receptors in the brains of those with major depression are somehow dysfunctional, compared to the brains of neurotypical individuals. In other words: people with depression (and chronic pain, and some other illnesses) do not get the same effect from endogenous opioids as do healthy people.

So, when you drag your depressed friend out of the door and make them run, you are not helping. They won’t feel better. They started the day off depressed, and after their run they will be out of breath, sweaty, in pain, and still depressed.

There are other ways to help, but this is not one of them.

For more information:

  1. Dysregulation of endogenous opioid emotion regulation circuitry in major depression in women; Kennedy, Koepe, Young et al.
  2. Major Depressive Disorder: Looking Beyond Monoamines (pdf); Gus Alva
  3. Endogenous opioids: The downsides of opposing stress; Valentino, Van Bockstaele

* I highly recommend attending this course if you find one near you. Check out the EPM SA website.

Read This Book: An Unquiet Mind

11552857I love that more healthcare workers are talking about depression these days. It’s something I did not see while I was studying, and that meant that I felt very alone. You might even have seen (or participated in) #crazysocks4docs, which was meant to highlight the high rates of depression in the medical profession. (Some took exception to the term “crazy” – but I’m not going to discuss that right now.)

Anyway, more and more HCWs are doing their part to delegitimise stigma by sharing stories of their own depression. But some mental illnesses are still “off limits” – bipolar mood disorder and schizophrenia, for example; and it’s not hard to know why. For a doctor to get sad and burnt out? Most people can wrap their heads around that. But few are comfortable with the idea of an “unstable” doctor. Society hasn’t become comfortable talking about those disorders that may lead to losing touch with reality. Continue reading “Read This Book: An Unquiet Mind”

General Practice is not exciting, but it is fulfilling

By Lauren Squires, with permission. Click image for her Instagram.

As I enter into my third month of General Practitioner work, I find myself reflecting. I started with private GP locums to fill the gap til I got the job I wanted. But now I’m signing a contract and I’m here to stay – for at least another five months.

One evening, my housemate asked, “So, did anything interesting happen at work today?” When I responded in the negative, we laughed about how my work had become almost mundane compared to working in hospital and coming home with fascinating stories of grotesque injuries and life-saving surgeries practically every day. Continue reading “General Practice is not exciting, but it is fulfilling”

GP Work is Hard

One week of some GP locums and I am exhausted.

7b609ee5184afeee3a442d25e5549028I can spend 10 minutes per consultation if people have straight-forward tonsillitis or gastroenteritis.

But what about the parents who are hesitant about vaccinating? I need more than ten minutes to make an impact.

What about the woman whose pregnancy test was unexpectedly positive, and needs to discuss options? She might not have anyone else to discuss options with.

What about the myriad people with psychiatric illness? I need more than ten minutes to figure out if it’s depression, or if there is a history of hypomanic spells. Is it substance induced? Is there another general medical condition? Who can start someone on antidepressants after a ten minute consult? Continue reading “GP Work is Hard”

Can I Be A Depressed Doctor?

Ever since I wrote about how going for therapy was my biggest gift to myself*, I’ve met with a few medical students to talk about the topic of mental health. Many of them were worried about their ability to make it through med school with their illness. Many were worried about the viability of a career in medicine with depression.


When I was a student, there was a rumour that students with mental illness would be excluded from the course. We were informed by our senior students, and they by theirs, and thus the rumour was propagated. Continue reading “Can I Be A Depressed Doctor?”

Mental Health Begins With Medical Students

Every few months, the mental health of doctors/medical students makes it to popular media. It seems like these spikes in attention occur, and everyone shouts YOU SHOULD CARE FOR YOUR DOCTORS! and then we write blogs and we tweet and we make youtube videos and eventually we go back to work, and nothing has changed.

I think we are the missing link. And by “we”, I mean qualified doctors. And also, you, the older doctors. Continue reading “Mental Health Begins With Medical Students”