After a few months of writing this column and interviewing five wonderful individuals about their experiences as patients in the American healthcare system, I was ready to hear from those on the other end of the spectrum: the providers. The people who I had heard about from so many disillusioned patients. I had heard their stories of stubborn doctors, ones who overlooked symptoms and disregarded feelings. I learned about the numerous incorrect diagnoses, the shut doors, and the dead ends for young patients who had to fight for their right to be— well, sick. However, going into a very competitive medical school application cycle in the next few months, I needed to know why I should still do it. What made being a provider worth it? It seemed like the only way to find out was to ask one.

When I was introduced to Jess by another member of Auxocardia, I envisioned her as this brooding, professorial figure. In my mind, she was, for lack of a better term, one of those “teacher types.” She would’ve gone into medicine because she wanted to save the world and her voice would be one that would echo how far we have come as a medical community. For all that I had learned about patient trauma and suffering from my past interviews, Jess would be the calm voice of an alternate perspective: reminding us why medicine was great.  She was going to revitalize my faith in medicine.

But one glance at Jess’s Instagram the night before my conversation with her was enough to burst that bubble. She’s certainly far from “one of those teacher types.” From the moment we turned on the Zoom, she had an infectious and fiery energy. A self-proclaimed “crunchy hippie,” Jess spends her time scavenging the woods for artisanal broom parts, slow brewing her own remedies for patients, and yearning to be the kind of provider who reminds you of a 1600s witch on the edge of the woods that appears in street wear at your doorstep. Most importantly, however, she is the last person who would say that healthcare is anywhere near where we need it to be. Jess is not in medicine because it’s great. She is in it because it’s not. 

D: Tell us a bit about yourself

J: So little bit about me, I’m a mom of a two year old. I’m also a midwife, an herbalist, and I make handmade brooms. I guess that's the short version. The bigger version is that I went into healthcare because I was a doula for about six years before I went to nursing school and I absolutely hated the way that my clients were being treated in their births. I wanted to get to a position where I had more autonomy in healthcare and where I could change the way that my clients were being treated.

I started my midwifery job walking off of maternity leave, in the middle of a pandemic. My mentor who hired me at the end of my clinicals, the person who I thought I would be starting this journey of advocating and healing with, moved to Arizona two months after I started the position. And the person who purchased the practice— let’s just say we did not see eye to eye on the day-to-day praxis of interacting with clients. So last May, almost a year ago, I left and started my own midwifery practice. Right now I am only doing gynecological, women’s, and trans care. No births yet because my kid is still breastfeeding. I love what I do. I also teach. I have an herbal business, creating concoctions that I made for myself when I was pregnant, and I make these brooms that you see hanging on the back wall here. I mom a full time kid. I guess that’s all I do.

D: It sounds like you’ve got it all figured out. But before we really get into the nitty gritty healthcare stuff that we are obviously here to talk about, I have to ask about this broom business. Like, hello! You make brooms! These really cool Harry Potter-esque brooms! I mean, how fun is that? These aren’t cleaning brooms are they?

J: Well, you could totally use them to clean. But most of my people buy them to hang on the wall. Or if they are any kind of practicing pagan or witch they will use it for ceremonial purposes. But you could clean with them if you wanted.

D: And you make and distribute these as part of the larger “Herbal Folk House” brand that you have?

J: Mhm.

D: So tell me, how did you get into this entire entrepreneur space, specifically with herbalism?

J:When I was pregnant, I was trying to find really slow brewed products that I could use: a perineal balm, a baby butt balm, baby botanical powder, lip balm: things that were made with love and intention. And I just could not find a product that I was comfortable with. A lot of the bigger quote unquote organic brands have essential oils that make them smell organic and herbal, but I wanted something with the actual herbs in it. I had gone to herbal school the whole year that I was pregnant and so when I went to work as a midwife and my clients would ask me for product recommendations, I would just end up making them what they needed by hand. And it finally got to the point where I was like I should just make big batches and always have them available for people. 

D: And which influences which? Does your interest in herbalism derive from that healthcare worker aspect of your life or is it the other way around?

J: I always think about, if I were living in the 1600s or 1700s what would I want to offer to a client? The wise women of ancient villages, the ones who knew the herbs, who knew the science, the plants around them. that’s who I want to be. They would come up with all these wonderful remedies that the doctors of the time were not aware of. And similarly I think a lot of my patients come to me because they don’t want the allopathic stuff that you can get anywhere else. They come to me for the holistic aspect of care. 

D: And why are the 1600s and 1700s a source of inspiration for you in terms of how you practice healthcare? Earlier today I was reading a piece in the New Yorker by Atul Gawande where he discusses the evolution of childbirth through the years. How far we’ve come in some ways and how much we have regressed in others. For example, we have reduced our infant and maternal mortality rates over the years but we’ve medicalized and industrialized an otherwise natural process beyond reproach. So I guess in this context, my question is why that time period then? What about the 1600s and 1700s speaks to you as a provider?

J: That time period in history was an era where the knowledge that was passed down from grandmother to daughter to granddaughter was respected as a science– as truth. It was before the Church took over everything and completely wiped out families. It was before the inquisitions and the witch hunts engaged in the erasure of so many sects of people and so much knowledge. While we are trying to reclaim some of that power, you really cannot do that unless you have a relationship with the plants around you. And that is where most of my ethos stems from. It’s the thought of the witch on the ends of the woods. The person people go to when they need something that no one else is able to provide.

D: I love that imagery.

J: And when you are talking about people who write about infant or maternal mortality– right now we are literally one of the worst in the developed world! Yes, we have lowered our rates of negative outcomes by a lot, but we have also created all these other iatrogenic outcomes by harshly intervening because we think that there should be some standard format for childbirth. And honestly it's making things worse for the moms. 

Why do we have such crazy high postpartum anxiety and depression? Well, it’s because our rates of C-sections have soared dramatically and we bring humans into this world behind a curtain, where the mother has no idea she is giving birth; where she just gets this tiny little peek of what is supposed to be her child. And now you had this baby ripped out of you and you have no connection to the kid that you just grew for 10 months— of course we have anxiety and depression. Sure we've cut down on like— yeah people aren't totally dying in pregnancy and birth anymore, but we still have horrible rates and we're spending more than any other industrialized country on pregnancy care and birth. And it's still not good!

And not to toot my own horn here, but one of the biggest differences that you see between other industrialized countries that have better maternal and infant mortality rates and us is that in those well-faring nations, you have midwives that are in the system. They are integrated well. Sadly, that is just not the case here. 

D: It is really interesting that you mention that last bit, because there are two important things Gawande’s article also spoke about. The first is that scientists were noticing that even once we transitioned to people giving birth in the hospital instead of at home, midwives being involved statistically improved maternal outcomes compared to only doctors being involved in births. While the latter thought more about the medical or anatomical side of things, midwives were focused on giving mom the best experience.  The second thing that the article spoke about was the key factor that allowed us to really affect infant mortality in this country. The development of the Apgar score.  We have all of these fancy tools like fetal heart rate monitors, NICU equipment , and using Apgar score to so closely assess how well the baby is doing. A good Apgar score is considered a successful birth and yet we don't have any measure of how successful the delivery was for the woman.

J: And sometimes in order to assess the maternal outcomes you need to let the woman go back and think about what happened. Everything that goes on the day of, is so jarring. You need to give her time to reflect. I mean, as soon as you walk into the hospital, they take your clothes away. They force you to wear this thin, uncomfortable hospital gown. They tell you that you can't eat or drink anything. Now you have to get fluid by an IV because we don't trust you to put things in your mouth and drink when you're thirsty. They take blood work on you multiple times. They put you in a room with bright, harsh lights, like it's just completely the opposite of what our mammalian system calls for hormonally.  A birth experience should be quiet and private. And of course we do good things in the hospital, but you also have to kind of think about how you're completely flipping the way that mammals give birth. You never see a cat in nature birthing in this really bright loud space, where people it doesn't know are coming in and putting their fingers in its vagina without asking. So yeah, a lot of moms end up having to really sit down and like a look at what happened at their birth experience and sometimes they don't even want to do that because it was so traumatic.

D: And that leads me right to my next question. Your medical and herbal education were almost concurrent. Medical school of thought can be very overbearing and self-righteous for lack of a better term. It can cuckoo practices that are unlike its own and refer to them as hoaxes. It is very much of the belief that its way is the only way. Did that lead to any conflicts within yourself about the care that you would be providing?

J: Kickback from people who consider themselves at the top of the medical hierarchy is definitely a thing. Everyone from residents, to OBs, to gynecologists would cuckoo a lot of what I would be prescribing to my patients. But it’s almost like you have to work double hard when you are in my position. You have to do your reading. Today, I can pull papers and research studies to corroborate everything I provide my patients. I can very confidently say, well here are a list of publications that suggest that my method is effective and won’t cause anal bleeding and death like all these crazy allopathic options you have. You just have to pick the thing that you want to do and do it. No matter how hard it is. Just do it. And if you get pushback, view it as an opportunity to teach the other person something.

D: And that is not an easy thing to right? All the student NPs and PAs that come to my clinic have to train under physicians and doctors. These doctors are usually much older and they have all this experience and these fancy degrees. It can definitely put a student or someone who is just starting out in their career in the middle of a very unfair power dynamic. How are you expected to speak up? 

J: A lot of times those older providers that are teaching are so burnt out that they're skipping like the human component of the experience they are trying to teach you. Just today in clinical I had an older OB talking to one of my students, and he was saying something about how this woman came in TOLAC or trial of labor after C-section. This is, in my view, the more derogatory term for VBAC or vaginal birth after c-section. He seemed angry with this woman who was trying to give birth vaginally after having had a C-section with the previous birth. He was of the opinion that he had seen this case over a thousand times and he was so sure it was just going to end up in the C-section anyway. His argument was, “Why is she even wasting time trying?”

What I try to do in these situations is just pick the crux of the interaction and ask my students and patients to think critically about it. I'll say, "I know this is how western medicine does it, but here's how I think about this thing. Let's have a conversation about it and pick it apart."

D: That makes a lot of sense. But for a second here, I want to go back to what you said earlier about the praxis of everyday care. The things that you disagreed with your old practice on. Things that we do across clinics and hospitals to systematically take power away from mothers in the prenatal period. What are some of these things that irk you so much?

J: One thing that I do is always go to the home of the patient to see them. I think that it makes a huge difference to somebody's psyche and to their comfort level if instead of taking them out of their place of power, their home. I'm coming to them where they feel best. I'm not telling them they have to sit in this chair and wait for me for an hour. I'm melding into their energy and their space.

For me as a provider it was also super important to wear street clothes, even when I was in the office, because I wanted there to be equality between me and my clients. The guy that I worked for didn't like that and he wanted me to wear scrubs. I also always sit lower than the patient. So if somebody was sitting on the table or on the little bench that we had in the room I would push my chair down so that I was lower than them when I was doing assessments.

Even today, when I'm doing internal exams, I always start with "I'm going to do this assessment today, but if you need me to stop or pause or get out, say "stop" "pause" "out." We don't have to do this exam today."  I let people put their own specula in, as opposed to me shoving it into their vagina which is usually not so comfortable and sadly the way that most providers do it. I also have my patient do their own swabs. Most other practitioners are like "Hey undress I'm going to do this thing to you" but instead I'm saying " I trust you to collect your own sample, here's your swab, you can go to the bathroom and do it unless you want me to." It's these little things where you are reimagining the way that the provider client relationship works. It makes a huge difference to a patient, who now feels trusted in their own care, you know?

D: That makes total sense to me. I often wonder if one day when I'm a doctor, I will be a better provider for having worked with the nurse midwife like I do at my current role as a medical assistant. And it's just really surprising to me that nurse midwives and NPs/PAs have to train under doctors, but it's not always vice versa. Student doctors are largely educated by and trained under more senior doctors. Not that you shouldn't train with fellows and surgeons, but it would be so nice to also get knowledge from those that are trained in medicine and humanism. The nurses.

J: And I will say that that is changing. Some midwife practices do some of the resident training. But yeah, you do have a lot of students who are getting trained by 80-year-old doctors sometimes who've been doing things a certain way that's just not very patient facing. I read an article recently talking about how obstetrics is one of the only disciplines where if someone's in pain we don't stop the thing that is causing them pain. If you're doing a vaginal exam and somebody says that it hurts, please stop, or no I really don't want you inside, please take your fingers out, the provider just continues and is considered normal to just finish the exam despite the discomfort. Why is that just accepted? The allopathic way of doing things is very paternalistic, and we have completely shut off that women are telling us things about the way that they want their care to be. We just don't care enough it seems like.

D: And so with all of the stuff that we have spoken about, we've covered all the things that health care, as it exists today, gets wrong and yeah, there is a lot. We do have a long way to go, but for all of that stuff that we do wrong, what do we get right? There was a reason that you were drawn into this system or that you're staying in the system, apart from obviously wanting to change it from the inside out. What do we get right today about women's health?

J: That might be the hardest thing you have asked me today. Because my immediate answer is not a lot right, unfortunately. I think people like me who are trying to change the system are really the best part of it. The way that me and other providers help to give power back to women and teach them that they can learn about their bodies and make wise choices for themselves has got to be my favorite part. It's such an intimate thing, for instance, to teach somebody who is 40-years-old about their cycle. Like this person has never learned about their own body before just because of the way that school is set up in this country. A lot of people completely skip over that topic or they'll get one day in gym class where they're talking about their menstruation. Even educating people about the way that diet or drinking or stress affects their period and giving these little bits back to them to say "You have the ability to change your body and here's how to do that." That for me is the coolest thing ever! 

D: It sounds like the fact that women's health even exists is a win for you! That it is this field and this speciality that exists beyond just birth and pregnancy, and looks at women as holistic beings capable of more than just baby-making. The fact that a GYN is able to cater to women and the female body more than say, a PCP ever could—

J: Yeah. It’s being able to look at women and not just the human body plus breasts and vagina. We are not just people plus extra organs.

D: So if you had to write an open letter to female patients today or those identifying as such, who are trying desperately to navigate the healthcare system, what would you want them to know?

J: All caps. You deserve better! 

And the rest of that letter would probably go something like, there are options you don't know yet. You have to research what you want, and how to advocate for yourself even in the presence of a provider who is not supportive. You have the right to fire them! Go and find somebody that's more aligned with what you want out of your care. You don't have to stay with somebody who is abusive or is doing things against your will or is making you feel like you don't have autonomy in your choices. I just— there are so many that it would be like a 1200 page long letter.

And sometimes you are looking for someone who is not allopathically trained or an MD. There are midwives, nurse practitioners, naturopaths. Feel free to explore these as you need.

D: I think some of the best care that I have ever received, especially in the GYN side of things, the people who have made me feel the most comfortable or most safe have very often been NPs or PAs. Healthcare is such a team effort and NPs and midwives and PAs are providers who need to be respected and empowered as such. But to go back for a second to that quality improvement piece. Medical environments pose a unique situation where you as a patient are especially vulnerable. You're in X amount of pain, your cortisol is through the roof, and you're kind of in this fight or flight mode. So if you had to change something about hospital births; if somebody had to deliver in the hospital for whatever reason or they really wanted to, what do you think they could do to better their experience?

J: With me as a provider doing a birth with you, when you walk in I'm not handing you a gown and telling you to put on my clothes. Wear what you want to wear. The lights are shut off. There aren't people busting into the room to stick their fingers in your vagina who you don't know and who you haven't invited into your care. We try to keep it as quiet as possible on the unit when there's somebody birthing, and there's not people screaming outside of your room about how they went to McDonald's at 12 in the morning. You can bring your aromatherapy and you can bring those battery powered candles. I remember when I had to transfer from our home birth to the hospital, I brought my little fairy lights and I hung them up on the window. I brought my music and all of the stuff that I would have had at home. I didn't want to go to the hospital, but we had to and so now I'm making the space fit what I need it to look like and be like and sound like and smell like. I'll tell you every single person who walked into that room: their demeanor changed.

When you're a provider and you're in a hospital, you're just on this "work/shift mode" and so you don't acknowledge that you're walking into the sacred space of somebody who's doing this transformative thing that they are only probably going to do a couple times in their life. None of these changes are hard to do! We could just change the way the rooms are set up. Literally just add dimmers on the lights and make sure your rooms have tubs.

I got on the call with Jess because I hoped she would remind me why healthcare, as I viewed it conventionally and as my patient interviewees experienced it, was worth it. But as we spoke, Jess corrected my perceptions of two things. You don’t go into spaces because they’re cushy. If you’re happy with everything, you change nothing. You go nowhere. You push the needle no farther. And second, healthcare doesn’t need to look like doctors in offices and patients in waiting rooms whiling their time away. It can look like whatever you as a provider want it to look like.

So, the question remains. How do you give your life to an imperfect system? How do you justify the tens of thousands in student debt, the hundreds of hours spent away from loved ones, and the countless ounces of sweat, blood, and tears poured into a system that is not only fallible to its patients, but also to its providers? Jess’s answer to this might be bang on. You just choose to be the kind of provider that is the best part of the medicine. Although we all learn the same pathways and the same mechanisms in school, the way we choose to practice this science need not be the same. Healthcare is beautiful because you can decide how you want to give it. And maybe one day I too will have the courage, like Jess does, to confidently say, “The provider is out of the office.”