I sat at the labor room desk staring at the form. DOB 4/18/96. Thirteen. 13. Any way I looked at it Morgan Whitney Nabors* is thirteen years old. And this is her second pregnancy. The first ended in a miscarriage but still, she had been pregnant before. I searched the form for other clues. The responsible party was Olive May Warren, a medical assistant, and her employer was blank. Emergency notification listed Arthur Warren. All the telephone numbers and social security numbers were filled in.
I imagined this mother sitting in the emergency room filling out the form. How long had she know her daughter was pregnant? Who is the father of the baby? They have not yet applied for Medicaid. Who is the father of this baby? Why hadn't she gotten her daughter contraception after the miscarriage? Who is the father of the baby? Which baby? What is going on here? Who is the father of the baby? How does a thirteen year old begin having sex? Who is the father of the baby?
I have a headache from the swirling questions. Some of the nurses have told me I just don't understand the culture. Which culture? I have lived right here in this city for the last 27 years. I understand motherhood. I have raised children. I don't understand how a thirteen year old gets pregnant. Who is the father of the baby? Here I go. I am about to dive into this with CPS and social work right behind me. Who is the father of the baby? I am sure the first answer I will get to this questions is "her thirteen year old boyfriend."
There seems to be a sea of inertia in which we are swimming. Despite my strong strokes to stop these teen pregnancies, they are coming faster and younger, with the resources of prevention occasional life preserves usually just out of reach. And who is this baby's father? I will probably never know.
*all names are changed
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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?
3 comments:
Wow, I am stunned.
I don't really know how to respond.
I have a 12 year old daughter.
And now the news is out today that ACOG recommends women shouldn't have PAP smears until age 21. Dr. B, would you blog about this? I had my first one at 18 (in your office) even though I wasn't sexually active yet. My mom just wanted me to start a relationship with you. I worry this could become a mandate under a government subsidized plan or even in a private insurance situation where the ins. co. relies on this to deny coverage for an earlier routine exam. Would love to hear your thoughts. And love your blog. Miss your private practice. Keep hoping you'll have enough of doing the Lord's work and go back to the office.
I am not sure I am "doing the Lord's work." I do think this type of work suits me much better than private practice. Please know I do miss the patients. See the next blog for some type of answer to your question. I wrote it as you were asking. As for my status with "the office" that is a blog which is still in the distance.
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