Sunday, June 14, 2009

The loco MD

Today I am considering a change in the title of this blog. Loco MD seems more fitting. Recently I left the security of a well respected group to practice as an obstetrical hospitalist. Every day I have at least one second thought. This morning it came as I was delivering a 17 year old patient. The "baby daddy" was there very curious about all that was taking place. I was equally curious about how he was keeping his pants from falling down. The pants were riding about 4 inches below his waist to allow more than adequate exposer of his underwear.

Two days ago my second thought occurred as I dealt with a patient laboring after she had taken PCP. I had forgotten about the vertical nistagmus. The patients eyes oscillate up and down very rapidly. I know of no other instance when this happens. Patients on PCP can also be quite agitated which is understandable if your eyes are jerking up and down about a hundred times per minute. Have you have seen that commercial with the fried egg - "your brain on drugs"? Believe it!

I also spend way too much time thinking about who is taking care of those toddlers left at home. One of my standard questions after I find out the ages of previously delivered children is "who is taking care of them." "My mom" is a common response. In a short time I have concluded there is a large group of children being raised by their grandmothers. I am hoping the grandmothers do a better job the second time around.

I have also become way too familiar with filling out and signing death certificates. These dead certificates are for babies who died before their mothers came to the hospital. Many times the delivery of their dead baby is all the care these women get for their pregnancy. Drugs are frequently involved.

I came to this job through a series of events that have happened over the past two years. I could be seeing patients in a high profile wellness clinic in the wealthiest part of the city. That job was my second choice. At the time I believed it was too tame. I still do.

I write these things to say that I was not as well prepare for this job as I thought. Still it is what I wanted. And still it is work worth doing.
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reverendmother said...


Thank you for writing and for the work you do.

Anonymous said...

In response to the comment about the grandmothers - I know they're trying. I have taught so many students who are being raised by grandparents - and I think they just don't know how to get out of the cycle of what they've done before.

local MD said...

Yes, I believe you are correct. The grandparents do not know how to break the cycle. I often think of Hull House in Chicago in the late 19th century, where progressive women helped immigrants learn better care for their children. I see some of this at the free clinics in the area. There are many resources if we could just get people to access them.