While most of my stories end with the birth of the baby, when I was in private practice, I always enjoyed seeing my patients' children grow. Because of this, I cannot resist visits to the neonatal intensive care unit (NICU) to see the babies. Occasionally one will celebrate a 1st birthday there. Usually the stint is much shorter. After graduating to intermediate care and "rooming in" with the parents over night to allow the parents to adjust to the machines such as the apnea and bradycardia monitor which checks heart rate and breathing, these kids will go home.
This morning, however, I am thinking about Megan. This is not her real name but she is a real baby. Born in early January, she weighed slightly more than a pound. She is now almost six pounds and her mother is now 18. Megan's mother rarely visits I am told. Megan is very fussy and the non-pediatrician that I am, I thought this was due to inattention. I ask to hold Megan and I noticed she gets quiet for a few seconds but then she is fussy again. The respiratory therapist explained the fussiness is due to air hunger. That is right, even with oxygen on, Megan struggles to breath. She is off the ventalator in an effort to get her stable enough to move to intermediate care.
For those of you out there who have had the opportunity to sit with someone afflicted with emphysema, air hunger is what makes these adults so restless. Every nerve connected to respiration is firing, pushing the muscle cells that control respiration to work harder and faster. When this doesn't work, more catecholamines are released, making other nerves and muscles twitch.
Perhaps you arrived at the conclusion of this story before I did. How is a mother who was 17 when this baby was born going to deal with these health problems in her daughter? This mother did not seek medical care when she was pregnant and she did not follow medical advice when she was in premature labor. Yes, social services is involved. And yes, there are days that my prayer is one of thanks that I do not have that job.
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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?
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