A story

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."

Least favorite

This month called January is my least favorite of the year. One reason maybe the weather. Even though I am located in the south where it is often sunny, January is usually cold and cloudy. Winter has just set in and spring is far enough away, I rarely think about it.

Another reason for my discomfort during this season is the resident training cycle is half over. Often, I think I am the only one who realizes the true meaning of "half." Interns are now much more comfortable presenting patients they have evaluated. Good skills have been developed, things begin to move a bit more quickly, and yet, it is a common time for them to begin missing things, too. There will usually be a few cases which make us all pause, reflect, learn the importance of being thorough once again. I find myself becoming hyper vigilant once again. As a person who makes few New Year's resolutions, I think this is a time for my favorite one: To do better.

Better can be a confusing term but in the sphere of my work, it means I will strive to be more accurate in my diagnosis, more compassionate with my patients, a better colleague to those with whom I work. I will learn at least one new thing each day and at the end of the year I hope I will be a better physician than I was at the beginning. Medicine is no place for complacency. If this year's class of interns are learning this then my enjoyment of these cold winter weeks will increase. Hopefully, so will the temperature.

Our Great Society

Don't get me wrong. I am usually as liberal as they come. I admire LBJ. I have visited his library no less than six times. Medicare, social security, civil rights, and all the other legislation from the mid-sixties are programs I believe in but...

I pause when the father of the baby I just delivered tells me this is his ninth child. How is this possible? Three babies with each of three women. Or I receive a 16 year old girl pregnant with her third child from a nearby psychiatric hospital. She was admitted there when she expressed her suicidal thoughts to another obstetrician. All three of her babies are the product of rape. The second child is dead. This child's father is 33 years old and thankfully in jail.

There is decay in this Great Society. Our cultures of greed, power, and lust* are eating away at the heart of our nation, killing our children. Not my children, you say. Think. How will your children cope with all those born in such circumstances as I have described?

*http://blog.sojo.net/2009/11/25/the-three-most-important-issues-what-the-manhattan-declaration-gets-wrong/