As I closed my eyes after the last twenty-four hour shift as an OB hospitalist the realization hit me concerning my new patient population. My final delivery of the night was one of a 16 year old having her first baby with her mother and her older sister in attendance. If she had delivered yesterday she would have been 15 when her first baby was born.
The baby weighed 4 pounds and 11 ounces. Small in size due to the fact that she was six weeks early, the early arrival was due to the fact that her mother and her aunt, her mother's older sister were smoking pot and doing lines of cocaine last night just before the bag of waters broke. The patient unabashedly told me this story which was confirmed by the urine drug screen.
This is the new norm for me. Teenage moms, positive drug screens, no fathers in the picture. No one employed, no insurance, the government attempting to pick up the tab.
Today social services have been notified. The patient and I have discussed and she has agreed to injectable contraception that will last for three months following discharge. Still I have the feeling that this entire screen will repeat itself in her life all too soon.
And what will happen to this baby. Born six weeks early, withdrawing from drugs to a single teenage mother living with her single grandmother. How will she ever have a chance?
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Musings of a physician in private practice for 24 years, now teaching in a residency program and working as an ob-gyn hospitalist in a large metropolitan hospital.
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The Local MD
Having now been a physician in private practice for twenty-one years, twenty-six days and about an hour and twenty minutes, it occurs to me that I have become what in medical school was often a derogatory term, the local MD.The presentation on rounds often went something like: "This 45 year old Caucasian male was seen last week by his LMD, and diagnosed with a viral upper respiratory infection..." At that point everyone knew that the LMD had missed the diagnosis. Otherwise the poor patient would not have ended up in a tertiary medical center with three consulting specialist, a fellow, a resident and four medical students at his bedside.What we, the medical students, the resident, the fellow and even the attending hospital physicians did not realize is that we would never know John Smith as well as the LMD. We would never speak to his wife using her first name. We would never be able to recall the names of all his children and know where they were in the world. We would never remember his favorite hobby let alone joke with him about it. Nor would we shed a heart felt tear when we gave him the diagnosis of the aggressive small cell carcinoma of the lung that had landed him in our midst and would kill him in less than three months despite our aggressive treatment that was the best medical science has to offer.At that point in my life I was very proud to be even the lowest ranking person on the team that was on the cutting edge of the diagnosis and the treatment of the gravest of conditions that plagued mankind. I felt so very lucky that I was being initiated in to this sacred fraternity. That I would soon be able to write "MD" after my name. I am still proud of my vocation yet I believe there is a wisdom that has only come with those twenty-years of practice.Today I realize what people want most of their physician is that he or she is someone who cares.Yes, we all want "everything medical science has to offer." Yet, what most of patients need is someone who will listen with their heart as well as with their head. Physician eyes are important, not only for seeing signs of disease in the body but for making contact with the patient's eyes where we are often allowed to see into their soul. All of the technology in the world will not replace a warm clasp of the hand or sitting at the bedside to share a few moments of the day along with the test results.So, I have created this blog. In large part it is a place for me to put my feelings. My hope is that at least some of these posts will resonate with others out there. Not just physicians, but others in caregiving vocations and even those for whom we care. If we are not here for each other then why are we here?
1 comment:
Welcome back to a different world. It's one that's all too common. Thank you for doing your part to change it.
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