I first met MW when she presented to labor and delivery for contractions. Her cervix was not dilating but her blood pressure was elevated. She still had five weeks until her due date, set by the residents at the country hospital. Looking at her records she had not been seen by a doctor for at least two months.
Admitting her to the hospital for her elevated blood pressures, known as gestational hypertension, I tried on two occasions to get a twenty four hour urine collection to determine whether she had preeclampsia. This was the medical situation, the social situation was another story.
First she told me "my child's father is not paying me enough attention." Then I found him in bed with her on early morning rounds. Though she did not go into labor, her blood pressures became so high, her labor had to be induced. She quickly tired of labor and begged for a C-section. Despite epidural anesthesia, labor "hurts too much." She told me. I tried to explain that incisional pain after a C-section was also a problem.
After a long induction her labor did stall and she was on the operating room table when she asked me, "I get to eat after this, right." My reply of "No, not exactly..." and an explanation of the need for a clear liquid diet until her bowel function returned was met with cursing and crying. I understand frustration. My oldest was the product of a Cesarean section after 27 hours of labor, but this seemed a bit much. The entire OR staff allowed her to ventilate before bringing "the father of [her] child" to the delivery room.
I pulled screaming baby boy out of the incision in her abdomen about 15 minutes later. Being cleaned and dried, weighed and measured by the nursing staff, I exchanged several glances first with the circulating nurse and then "the father of [her] child." The baby's skin color did not match his.
Despite bracelets placed on baby, mother, and daddy in the delivery room, the next day this young woman was claiming those of us in the delivery room had some how drugged her and exchanged babies. She got no support from the boyfriend in this and finally gave it up.
On the day she left the hospital, I discharged her with an appointment in two weeks to see her clinic doctors. She complained about this but in a much more subdued way than all the issues of the past 8 days. As I removed the staples from her incision, she said, "But I want to come to the clinic and see you." When I explained to her that it didn't work that way, that she only had me for the days she was in the hospital due to the fact that I was on call, it began to dawn on her that our relationship was ending.
The reward for my eight days of patience came with the very last words she spoke as I turned to walk out the door. Sitting in the bed holding her son, she meet my eyes and quietly said, "Thank you."
skip to main |
skip to sidebar
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.
Posts
Followers
About Me
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?
No comments:
Post a Comment