"I'm pregnant? I can't be pregnant! I mean I have had a period every month." Ducking her head to avoid my gaze, she thinks. "Yes, every, agh.." The next contraction takes hold and she has to breathe and then she is overwhelmed and tries to push.
"We have to get to labor and delivery'" I declare as the ER nurse calls report on her mobile phone. Unlocking the bed, I make sure the patient is completely covered before we start the journey that is about a city block of corridors and a short elevator ride. I have never understood why anyone, even a hospital architect would allow so much distance between the two departments.
We do make it to labor and delivery. The patient is thirty-two weeks pregnant. Labor stopping drugs, tocolytics, are used to get steroids, which aide in fetal lung maturity, on board along with antibiotics to protect the baby against infection. Her urine drug screen is positive for cocaine and marijuana and the baby delivers a day later despite our best efforts. She has a rough start in life, weighing just over three and a half pounds.
Even more challenging is the fact that this mother will leave the hospital with a three month contraceptive shot. She will not get any follow up care even though it is free and she willcontinue on the same behavior which got her here in the first place, unless and probably even instead of the fact that she may be put in jail for a short period of time. This mother has a parole officer and a 20 month old son. The 20 month old son is in foster care, taken away because of her drug habit. I suspect this baby will end up in foster care also.
I have already thought about this scenario too much. How does one change this pattern? Where will it all end, for this young woman and for her children?
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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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