Thirteen

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

The future

I stand very quietly watching the tiny form wiggle his toes, the whole foot not much larger than my thumb. "No name yet," the nurse informs me as she adjusts the ventalator. She is reading my mind, "We are coming down on the ventolator settings. He is doing better."

I always go up to the NICU or neonatal intensive care unit to see the babies I have delivered. Many make it through to the step down unit, grow to be 5 or more pounds and go home. As with this baby, I always wonder what kind of home that will be.

I know this baby's mother better than most. She was in the hospital 5 weeks before he was born. Her drug screen was positive and after a few days of "drying out" she ask me to terminate the pregnancy. When I told her this was not only against hospital policy but at her stage in gestation, it was illegal as well, she refused all subsequent care and left against medical advice.

She returned via ambulance, again in a drug induced stupor, and I delivered this two pound baby boy on the stretcher just inside the doors to labor and delivery. At delivery I thought he was dead but the NICU team was there and revived him. Now we are here. He is two days old and getting stronger.

From the mother's previous hospitalization I know there are two other children. One in the custody of her mother, the other her sister. The patient asked to have her tubes tied and if it were up to me that would already be done. I have no illusions of rehabiliation. Sterilization is at least part of the solution. I am just wondering about this baby, with feet the size of my thumb. Who will care for him? What does his future hold?

How many more like him are in this city, state, country? Where does it stop? I fear we will run out of resources sooner than we will run out of babies with feet smaller than my thumb.

My office

With my change in positions several people have ask, "Where is your office?"

The short answer and probably the most truthful is, "I don't have one."

Oh, I have an eight by eleven foot call room complete with bed, desk, and chair. I have grow so tired of this space in the last 6 months that I now only go there to sleep. I share a conference room, complete with two computers, monitors for all the beds in labor and delivery, and cable TV with any other obstetrician who happens to have a patient in labor. There is a common workspace I use in labor and delivery, again with monitors and computers to scan what is happening in each room or access medical records. Similar accommodations exist for my use in the emergency department.

Yet, it dawned on me one morning last week, as I slogged around a park south of my home, that my office is there also. On my non-call days, when I am not chained to the hospital by my contract which states I will be physically present to care for any obstetrical or gynecologic emergency, I head for this park. It has a one mile dirt trail, beautiful oak and pecan trees, a creek bed, and several grassy areas. Set back from the roadway, the sounds are birds, squirrels, and the rustle of the leaves.

The peace of this place passes any understanding. I can feel very beaten down when I arrive but I leave refreshed, physically spent, and believing I can make it at least one more day. And, lest you doubt, it is my office, my beeper is strapped to my side and my cell phone is in my pocket. Some days I spend more than one of the five miles I attempt to traverse talking with a young doctor about how to care for a patient. My counterpart, the person who is now captive in the hospital, will have to be the physical presence when one is needed. I am fine with talking for a few minutes as I sweat and struggle to make it around the trail again or as I simply sit and admire what a fine piece of work the interior designer of this space has done.