Friday, February 26, 2010


In addition to having a special vocabulary, medicine has its own set of acronyms. PERRLA stands for "pupils equal round reactive to light and accommodation." All medical students learn this when doing the first year course in physical diagnosis. Medical students also learn the importance of preforming both the reaction to light AND to accommodation. The reaction to light is when the doctor pulls that little penlight out of her pocket, darkens the room and points the light directly in first one eye and then the other. In the darkness, your pupils should get bigger. The bright light will make them smaller. Accommodation is where you are ask to focus on an object, say the physician's finger held out in front of your face, and watch it as he moves it closer to your nose. With this your pupils should also grow smaller.

As every medical students learns, neurosyphilis reduces the pupils ability to accommodate. Back when medical school classes were made up of mostly male medical students taught by male professors, the way to remember this bit of information came in a story about prostitutes who have neurosyphilis and will "accommodate but they will not respond."

As an intern long ago, I carried a spiral notebook in my pocket with just such a list of acronyms. This was in a time when husbands were confined to the waiting room while their wives were in labor unless they had gone to childbirth classes. This was carried out with such seriousness that certificates were given to the couple and the labor nurse was required to put this certificate on the patient's chart before the father was allowed in the delivery room.

I remember my first solo delivery. As the nurse anesthetist and I pushed the patient's bed to the delivery room, she kept asking me, "Is this an FID?" I had no idea what an FID was and I panicked. Did this woman have a condition which had escaped my attention? Could it affect her health or safe delivery of this baby? Looking in my notebook, I could not find FID. Finally, as we were moving her over on to the delivery table and I realized I would not have time to look through her chart again before the birth of the baby, I whispered to the nurse, "What is an FID?" "FATHER IN DELIVERY!" she shouted back. "No," the nurse replied. "He didn't go to childbirth classes, so he can't come in."

Well, now we have FOBs. FOBs are related to FIDs. Now, instead of pushing the patient down the hall to a delivery room, we have labor, delivery, and recovery rooms or LDRs so everyone gets to come in, at least for the labor and some patients choose to have several people present for the actual delivery. One obstetrician pointed out there was only one thing missing from the LDRs - the bleachers.

But back to FOBs. This is the term which is now quite common for the father of the baby. It is usually used when the patient and the FOB are not married. In private practice thirty five percent of my patients were not married at the time of their first OB visit, however, many did marry before the baby was born. In my current job, many not only don't marry but the FOB is the father of several other babies born to other girls.

In my continuing search for why this state has the highest teen repeat pregnancy rate, I believe accountability of these FOBs is an essential step to reducing our teen pregnancy rate. Accountability? Yes, the FOB's name on the birth certificate. Then they would be required to do more than swagger around the hospital room and brag to all their friends in the hallway. With the FOB's name on the birth certificate, the FOB could be made to pay child support. And if the FOBs are out working and paying child support they would have less time available for repeat preformances.
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