Mount Everest was the riskiest place I had practiced medicine until I became an OB/GYN in the South

In post-Dobbs Georgia, unlike on Everest, I didn't choose the restrictions and threats I now practice under

Published April 7, 2024 9:00AM (EDT)

Everest Base Camp 5364 m, written on a big rock on Khumbu glacier, Mt. Everest behind covered by monsoon clouds. (Frank Bienewald/LightRocket via Getty Images)
Everest Base Camp 5364 m, written on a big rock on Khumbu glacier, Mt. Everest behind covered by monsoon clouds. (Frank Bienewald/LightRocket via Getty Images)

On the eastern glacier of Everest in Tibet, where avalanches boomed in the distance and icy winds blew through my nylon tent, I tucked in at night within a cocoon of uncertainty. I kept my stethoscope and blood pressure cuff nestled by my thighs to keep them warm and ready to use. Months stretched out in isolation with me on high alert — alone in my medical role — fearing I’d fail when most needed. Most nights I shivered as I donned my down layers, slept with two hats, and tucked a hot water bottle beside my feet for warmth. I envied the rest of the all-male team who slept bare.

In the middle of one night, my fears became reality. Two severely injured climbers crawled over uneven rocks to stumble into camp. They shouted our names for help, piercing the black air. Half asleep, with shoelaces untied and blades of hail stinging my face, I stumbled toward the sound of their voices, then helped them back to our tents, and began a marathon of care. At 18,000 feet, the thin air mirrored my nascent experience as a 25-year-old medical student. I worried about their conditions and the care I was delivering. Was I doing everything correctly? Remembering the protocols? What else should I be doing?  

My journey to Everest was a leap of faith. I was raised a New York City girl and felt like an unlikely candidate for a Himalayan expedition, but I couldn’t resist the call of the mountains. Once I joined the team as the Medical Officer, I dove into mountaineering medicine, sought counsel from experts, and armed myself with knowledge. Yet nothing could prepare me for how isolated we’d be. We saw no outsiders for months and knew there was no chance for rescue on the East Face of the mountain in Tibet. 

A few days later, back in Base Camp, I laid out packages of gauze, tape, scissors, antiseptic and checked the antibiotics on hand. While tending to a climber with severe frostbite injuries affecting both hands and feet, I tipped his hat over his eyes and suggested he look away. I removed the bandage I’d placed at Advanced Base Camp from his first finger. A shrunken black stub of a distal phalanx — the whole tip of his finger — stared back. He lifted his hat, saw his finger, and looked up at me with wide eyes. Then he rounded his back away from me like an animal curled up in defense. More unwrapping, more fingers, more rocking with sobs, digit after digit, dead, inch-long black fingertips. He wailed, shook his head, and his sobs pierced my heart. I wished I could protect him from this pain. His eyes were pleading, but I had no answers. I, too, was surprised at how rapidly his shredded fingers had turned to coal.

Since the Dobbs decision, I don’t have the autonomy I had on the mountain to deliver the best care possible.

“Will I ever be able to climb again?” he asked. The gauze adhered to his final two fingers. 

I didn’t have an answer.

My only motivation was to provide the best care possible while being present with compassion. We were all at the knife edge of our limits and digging deeply for strength.

Each of us on that mountain had weighed our risks and vulnerabilities and had chosen to be there. The climbers had chosen the extreme challenge of Everest and did everything in their power to remain alive. I had chosen to work in these circumstances and was delivering the best care I could under difficult conditions.

Not so in my OB/GYN practice in Georgia. Since the Dobbs decision, I don’t have the autonomy I had on the mountain to deliver the best care possible. This is a different kind of isolation, and it’s more unnerving. Despite years of medical training and a commitment to evidence-based care, physicians are hamstrung by state laws, and our patients are suffering. 

A few weeks ago, I entered an exam room to find a young woman staring at her phone, wearing a college sweatshirt and crocs decked out with charms. She had driven alone to Georgia from Tennessee seeking an abortion. Georgia law permits abortions until approximately two weeks after a missed period, whereas Tennessee bans all procedures with narrow medical emergency exceptions.

After discussing how she felt and clarifying information in her medical history, I said, “Your ultrasound doesn’t show a pregnancy in the uterus, which can happen for a few reasons, most commonly because it’s too early in pregnancy. But the level of pregnancy hormone in your blood and medical history makes me concerned you could have an ectopic pregnancy — one that grows outside the uterus, typically in the fallopian tubes.”

Here, the peaks are legal hurdles, the valleys emotional.

We discussed what might be going on and the next steps we could take, but this young woman dissolved into tears. Getting advanced care to rule out an ectopic pregnancy would require involving her health insurance, which would alert her parents, something she wanted to avoid. I left the room to give her space and time to compose herself while I went to investigate options for care. 

Sobbing patients overwhelmed by difficult decisions resulting from abortion restrictions are now part of our everyday practice as OB/GYNs. We’re not discussing plans of care based on science — we’re sorting out travel, logistics, time off work, childcare, emotional distress, and legal ramifications. Here, the peaks are legal hurdles, the valleys emotional.

This is taking a toll on us. A recent survey by EL Sabbath et al. of OB/GYNs in states with bans documents immense personal impacts “including distress at having to delay essential patient care, fears of legal ramifications, mental health effects, and planned or actual attrition.” The majority reported symptoms of anxiety or depression as a direct consequence of Dobbs. Ninety-three percent of respondents had situations where they or their colleagues could not follow standard of care. Eleven percent had already moved to another state without restrictions, and 60% considered leaving but have family and other obligations making them stay for now.

Although we’ve spent years in medical training, our expertise has been erased by politicians with no medical background. Not being able to practice in accordance with the ethical principles of respecting patient privacy and autonomy in the decision-making process is wounding us.

A May 2023 survey found that 55% of Idaho OB-GYNs were seriously or somewhat considering leaving the state due to the abortion ban, and a hospital there was forced to close its labor and delivery unit due to related staffing issues. Fewer OB/GYNS means less maternal care and yet many of the states with abortion restrictions have the highest maternal mortality rates.

Take this a step back and medical trainees are being affected. Abortion bans are affecting almost half of OB/GYN training programs. A recent survey of medical students in Indiana found 70% were less likely to pursue residency in a state with abortion bans. With decreased training — and diminishing numbers of OB/GYNs willing to practice in these states — maternal mortality will rise. Care of other gynecological conditions such as endometriosis, infertility, fibroids and cancer will suffer. This affects the most vulnerable among us, low-income and minority patients.

My patient’s insurance would only work in Tennessee. She reminded me of my youngest daughter. I couldn’t picture her processing this information on her own. I was most worried that my patient would need to drive herself back across state lines in this fraught emotional state.

Unlike my experience on Everest, I am not choosing these risks — to my patients or to myself — of practicing under untenable circumstances where I cannot deliver optimal care.

She returned to Tennessee, where her bloodwork confirmed an ectopic pregnancy. Even though treatment of ectopic pregnancies is permitted in that state, the hospital released her without immediate treatment. Delayed care could put her at risk for impaired future fertility, emergency rather than elective surgery, and even death. I can only hope none of that happened. Treating people crossing state lines, who we cannot adequately care for ourselves, is stressful. I still think of her.

I’ve also been thinking a lot about the decision I made to go to Everest with the risks involved and the potential for trauma. I’d joined the team to experience the majesty of the Himalayas. To wake up to fine blue mountain light, live within vastness, and quell the warnings from girlhood to stay small and be safe. To this end, I made peace with the risks I was taking and ultimately grew from facing my fears. When trauma beset us, each team member grew into the best version of themselves.

My family moved to Georgia almost three decades ago, a different kind of unlikely for this city-raised girl. I grew to love the rolling hills of north Georgia, the breathtaking palette of autumn, the scent of apple cider and boiled peanuts. I learned how to cook collards — without ham — their rough stems of veins running through me.

But in the South now, we are not expanding and growing; we are shrinking, boxed in by medical practice governed by legislators, lawyers and hospital administrators. 

Unlike my experience on Everest, I am not choosing these risks — to my patients or to myself — of practicing under untenable circumstances where I cannot deliver optimal care. If I were finishing my training today and choosing somewhere to practice, I would not come to this state or anywhere with these restrictions on practice. 

I would never have predicted, when I was shivering, afraid, and alone providing care on the mountain, that I would feel threatened 36 years later by simply practicing basic healthcare in America. I couldn’t have known that after studying and working hard, I would not be able to put my education, knowledge, and skills to their best use. That I would be hampered when fulfilling the essence of my dream to care for women with skill and compassion. I couldn’t have known how alone, isolated and abandoned I would feel. Right here, at home. 

By Mimi Zieman

Mimi Zieman MD is the author of "Tap Dancing on Everest" (Falcon, April 2024), and "The Post-Roe Monologues," a play that has been performed in multiple cities. A physician, she has also co-authored sixteen editions of "Managing Contraception." Her writing has appeared in Newsweek, The Sun Magazine, Ms. Magazine, The Forward, NBC News THINK, Dorothy Parker’s Ashes, and other publications.

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