Posts Tagged ‘OB’

Making my day

January 19, 2014

Two patients sure made my day

With rewards much better than pay

It brought me great mirth

For I had attended the birth

And had followed them up all the way.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  I danced back from the brink of burnout in 2010, and, honoring a one-year non-compete clause, went to have adventures and work in out-of-the-way locations.  After jobs in Alaska, New Zealand, Iowa, and Nebraska, I returned home and took up a part-time position with a Community Health Center. 

On a windy day last week I took care of a patient I’ve known for more years than she has breathed air.   I promised not to write any other details about her case; she gave me permission to mention her gender and age.

When I started in at The Practice Formerly Known As Mine, I still delivered babies.  But I recognized back then that male Family Practitioners in obstetrics qualified as obsolete.  At a meeting in 1987, I said to my partners, “We’re dinosaurs.  Does anyone here really think we’ll still be doing OB in 10 years?”

We all shook our heads.  But 1997 came and went and I still did OB, and one member of that group continues to this day.

I stopped delivering babies on my 60th birthday in 2010, but only after I had done a couple of second generation deliveries.  Along the way I followed people and families, from making the diagnosis of pregnancy through the prenatal care to the delivery, then the well child checks, the sports physicals, and the college physicals.  And then I saw those people make their new families.

I had seen that person grow past infancy to childhood to adolescence, past callow youth to young adulthood.  And then I attended to her needs again, now 23 and a responsible adult accompanied by her child.

Those moments bring rewards that cannot be measured and often lack description.

Without a better term, I’ll use the words depth of joy to describe my feelings during the visit.  It suffused the minutes I spent with her, and at the end, I told how good she looked.

My day continued, the glow from the Family Practitioner’s moment stayed with me, while outside the snow fell and dusted the streets, then the sun melted the snow.  I took care of baby boomers paying the piper, well two-year-olds, refugees struggling with English and Hispanics becoming Americans.

After 4:00 I took care of another patient whom I had delivered, decades ago, and followed through well child checks.  Just to tell me things had gotten better and the medication wasn’t needed any more.  Having figured out the stressor and gotten rid of the toxic person, the migraines had disappeared.

A phone call could have accomplished the same purpose, but it wouldn’t have made my day.

Ending obstetrics

May 2, 2010

I sing and I dance like a bunny

I laugh and I think that it’s funny

     I caught my last baby

    I don’t mean maybe

And I’ll take a great trip with my honey.

Thirty years ago, on a fine spring day in Casper, Wyoming, I talked with one of the Family Practitioners in town while making hospital rounds.

“You sure look happy,” I said.

“I stopped obstetrics,” he said.  “They say you retire twice, once when you stop OB and once when you retire for good.  I feel like I retired.”

At the time I thought he was copping out or caving in.

In the ensuing years FP’s presence in the delivery suite has steadily eroded.  Most don’t do OB any more.  In 1987, I said at a partners’ meeting, “If we’re in OB we’re dinosaurs. There’s no way we’re going to be delivering babies in ten years.”  They all agreed with me. 

Time proved me wrong.

In our practice, the doctor who does the prenatal care is the one called for the delivery.  Exceptions include vacations, weekends (sometimes), or the doctor’s day off.  The continuity of care gives a competitive advantage against those practices which do deliveries by rotation.  For the last twenty-three years, I’ve carried a beeper because I’m the only doc in town who delivers babies and speaks Spanish.  The Labor and Delivery units have been under instructions to call me first if the patient doesn’t speak English, even on weekends and my days off.

My patient’s due date was April 24, and we haven’t seen her since March.  When she missed an appointment at 37 weeks, we called her and she scheduled her 38 week appointment but she didn’t show for it.  I’ve had the most capable staffers trying to find her, but the cell phone number we have for her doesn’t work and we kept getting an answering machine at her home phone number.

A normal pregnancy lasts more or less 40 weeks.  First pregnancies go an average of 5 days longer than the other pregnancies.  Women who have sex throughout their pregnancy generally deliver, on average, 5 days before women who don’t.  Smokers have shorter pregnancies on average because they have so many preterm births.  Races vary by one or two days.

The placenta, which nourishes the baby, starts to degrade at 40 weeks.  A few quit working before 40 weeks; after that the decay function has a steep drop off at 41 ½ weeks.  If the placenta wears out before the baby is born the baby dies.

Most babies are ready to be born at 37 weeks, a few aren’t. 

Thus there is a tradeoff; does one wait for one’s patient to go into labor and risk a still birth, or does one induce labor and risk having to put the child in the Neonatal Intensive Care Unit for several days?

National research suggests that induction of labor before 39 weeks causes more problems than it solves, and both hospitals have protocols; we have to arrange for a consultation with a specialist if we want to induce labor.

Most of the patients I’ve delivered in the last six months have had their labors electively induced after 39 weeks.  One patient, who very much enjoyed being pregnant, refused induction till I insisted at 41 weeks (everything came out fine). 

I have been worrying about my last OB patient for the last three weeks, and the worry has grown with every day, borne not only from scientific research but from the first hand emotional trauma of being involved in OB cases that did not go well.  I fretted so much that I stopped delegating the calls to try to reach the patient and I started doing them myself last week.

Friday afternoon I finally reached a live person.  With sick relatives in another state, I was told, the patient left town weeks ago, and has since had the baby.

I set the phone receiver in its cradle and I looked out my office window, saw the fine green grass and the clear blue sky with billowing white cumulus clouds. Waves of endorphins washed over me.  I danced down the hallway even though people were watching and announced the news to a med student and two of my partners, one of whom stopped OB a month ago.

Then I danced down the hallway again.  I didn’t care who saw me.

It was the same kind of feeling that I had when I bicycled into San Diego from Colorado, but more so.  It was an accomplishment twenty three years in the making.  I’ve been riding a roller coaster without a grab bar for more than two decades and I just got off.

I’m not done with OB yet!

February 19, 2010

FEb 19 2010
 
The morning is off to a bad start.
In the wee hours, I received a call about a patient of mine going into labor.  I commented to the nurse that a patient delivering on her due date was bound to happen sooner or later(it would have only been the third time in 31 years).  I tossed and turned till about 530, when I called to find out how the patient was doing, only to find out my partner was in the process of attending the delivery.
In a multisystem series of errors, it seems a nurse assumed I had stopped OB a few months ahead of my official stop date and called my partner.  Yes, there’s more to it than that but the explanations I get from Labor and Delivery have certain logical flaws.
I get apologies but no real indication that things are going to change.
I have had all the disadvantages of doing OB (the vigilance, the constant presence of the beeper, the sleeplesss night) and none of the advantages of doing the delivery (the joy and the continuity of care, the euphoria of being there when new hope and light come into the world).  Sort of having a hangover without getting drunk.
Even though I’ve only three months left in this position, I will be addressing the problems at multi levels today.