Tuesday, October 05, 2010

Crazy Life

October has a special place in my heart. The fall weather is my favorite, football is in full swing, and the school year is settling into a routine. This year, however, it is also my favorite because September is finally freaking over! In the past 4 weeks of call I have cared for, delivered, operated on, or diagnosed the following:

- A twin IUFD @ 18 weeks, followed by a retained placenta requiring a D&C.

- 3 post-partum hemorrhages, transfused a total of 9 units of blood between them, one of whom almost lost her uterus, but was saved by a B-Lynch stitch.

- An 11 pound shoulder dystocia (baby and mom were fine).

- A 30 week severe IUGR IUFD, barely able to be delivered vaginally due to a contracted pelvis.

- A multiparous unmedicated, "I'm physically here, but mentally I'm not," precipitous delivery followed by a shoulder dystocia, complete with tight nuchal cord x 2, baby with a very purple face, but no other sequelae.

- A newly diagnosed placenta previa, possible accreta at 28 weeks gestation.

- An 8 cm ectopic pregnancy.

- A cervical ectopic pregnancy.

- More preeclampsia than I have ever seen or care to see again.

- A full labor and delivery unit, laboring patients in triage, delivering in the ORs due to lack of beds.

- A 360 pound, 28 year old patient who had never seen a gynecologist with excessive bleeding and a 10 cm complex right ovarian mass.

It's been a rough month to say the least! Not to mention the day-to-day office grind, allergies, a sinus infection that won't go away, and a poor prognosis for a family member, recently diagnosed with recurrent, advanced malignancy. Every day I see something that makes me aware of how fragile our lives really are, and I am so thankful for all with which I have been blessed. So I am taking all that I've learned from the above experiences, gray hairs, angina, and all and pressing forward into October. It can only get better....right??

Friday, September 03, 2010

Little Wonders

I sat with my patient, a new mother, in the examination room. She was there for her first post-partum visit and we were discussing the events of the last few weeks. We chatted about breast feeding, birth control, lack of sleep, how annoying it is that men can sleep through *anything*, and then, I asked, as I always do, about how she was handling things emotionally. I always make it a point to screen for post-partum depression, many times, if you don't ask, they will not tell you how they are really feeling. This time, though she passed the screening for depression, she gave a laugh and said, "For the first time, I know why my mother is the way that she is." She went on to elaborate how she always made fun of how emotional her mother is, and now how she couldn't watch Kleenex commercials any more without bawling like a baby. It is so true. When we become parents we are forever changed, not only do we understand our parents better, but the way that we look at the whole world is different.

For me, it was the same. Before I became a mother, I loved to watch scary movies. The scarier the better. Imagine my surprise when, not long after Cindy Lou was born, and Mr. Whoo and I settled in to watch a horror flick when I realized that I had changed. I could not watch it, couldn't even get past the first 30 minutes. Why? Because there was a little girl child in it who was missing, and I couldn't handle thinking of a child (my child) being lost, scared, and alone. I never realized how many horror films use disturbing images of children before having a child of my own. It changed how I watch movies even now, far removed from the emotional lability of the immediate post-partum days. The same holds true for news stories involving children, footage of the 2004 tsunami devastated me, same for Katrina the summer after. The tears flow more freely now, happy, sad, and wistful. Most of all, music speaks to me, and often moves me to tears. There are certain songs I associate with different stages of my children's lives, and find myself tearing up just thinking of the lyrics. For Cindy Lou, it is "Baby Mine" and "Return to Pooh Corner." For Bean it is "Sweet Baby James" and "Little Wonders." Especially these lyrics:

"Our lives are made, in these small hours, these little wonders, these twists and turns of fate.
Time falls away, but these small hours, these small hours still remain."

So now I know how my mother felt when I was younger, when Cindy Lou turns to find me wiping away a happy tear or two and says, "Mommy, if you are happy, then why are you crying?" Perhaps it is because the transformative joy and wonder of having a part in creating these precious lives fills up our hearts until they break, just a little, from the magic of it all. How have your children changed the way you see the world?

***Cross Posted at Mothers in Medicine***

Tuesday, July 13, 2010

Aw, yeah!

Hi! Don't you love how I swear that I'm back to blogging and then don't post for two weeks? Time keeps slip-sliding away, but the main reason is that I was on *vacation.* Woo hoo, right? There were good, bad, and ugly parts, just like any old fashioned family vacation. The good: time with family, spending time in, near, and on the water, reading books (for fun!), eating good food, and having absolutely no responsibilities, pagers, emails, or Internet access. The bad: family overkill, NO AC in our rental (and 90 degree temps, if you know me, you know how disastrous this was), mosquitoes the size of my pinky finger (and a blue million mosquito bites), not really having anything to *do*, eating way too much good food, and no Internet access. The ugly: 23 hours in the car (each way!), with a 6 and almost 3 year-old. Yes, you read correctly, a total of 4 of my vacation days were spent driving in the car, with my whiny, don't- know-how-great-they-have-it children, slowly going insane. I believe that the first "Are we there yet?" came about 17 minutes into the trip, so yeah. Fun times.

The hilarious thing is, Mr. Whoo and I were crazy enough to make this trip about 5 years ago, with our just over one year old, and swore we would never do it again. HAHAHA! See how time dulls the sense of abject horror? Well, time, and over $400 per person for plane tickets. The first time around, CindyLou was just a little over one year old, and, while we had a DVD player (the makeshift kind that would hang in between the front seats and plugged into the cigarette lighter), CindyLou had the attention span of a gnat, and would only watch *one* of the many DVDs we had brought for her pacification, er, viewing pleasure. Any other of the videos made her bored, or scream, so we lucky people in the front seat got to listen to Ses.ame Stre.et "Sing Along" approximately 4872 times. The first couple of times, it was cute. We sang along with the songs and giggled at CindyLou's response. The next few times, we grinned and bore it. The next 100 times after that we started making up rude lyrics to the songs and commenting the actors "Mystery Science Theater 3000"-style. Any time after that, we just became hysterical and delirious. Seriously, this 30 minute video was the funniest sh*t we had ever heard. To this day we have quotations from that show (both real and altered) that we use in every day life, including a very enthusiastic "Aw, Yeah!" which came from an owl-type character in one of the songs. At the end of that trip, we (for some reason) kept the DVD, but did not watch it again for 5 whole years (mostly because we could recite it by rote)....until this trip.

We were a good 6 hours into the first day of traveling in the car, the novelty had worn off, and the kids were no longer interested in the snacks, our conversations, or the scenery. We were each "taking turns" choosing movies or music, when CindyLou and Bean just could not agree on a form of entertainment. The situation was devolving, and no amount of Capr.i S.un or Gold.fish could keep our offspring from complaining about one another when Mr. Whoo suddenly got this evil smile on his face, looked at me, and mouthed "Sing Along." My response? "Aw, YEAH!" So we played it. Bean was enthralled, CindyLou was still enthralled, and Mr. Whoo and I were laughing so hard we cried. The rest of the trip, we tried to engage the kids in the old standards such as the "Billboard Alphabet" game, the "License Plate" game, and "I Spy." We tried to give them a little taste of what it was like to travel back in the dark ages before DVD players, iPods, and Ninten.do DS. I'm not sure how much they appreciate it now, but hopefully, in time, they will. It is funny how the things that drive you the most insane are sometimes the best memories that you have. So family vacations, gotta love them. Now I am back in the fray, and just waiting for the next extraordinary happening in an ordinary day. Aw, yeah!

Monday, June 21, 2010


...and the living is, well, kinda crazy. Isn't that always the way? The more free time we seem to have, the more we fill it up with visits to the pool, spending time with grandparents, and trying to keep our kids from growing up so darn fast. I had to take a bit of a break from the blogosphere. I had gotten into a very bad habit of reading too many doctor-bashing blogs, and it was making me incredibly bitter and angry. Partially because of the blatant misinformation being bandied about, and partially because I know so many great, caring, and self-sacrificing people that are physicians, and to hear us all painted with such an ugly brush really p*sses me off. Not to mention how reading about how much people hate us out there was making me wonder why I was busting my *ss going above and beyond for people who didn't appreciate a d*mn thing that I did. So, I stepped away from the screen for a bit, and took the time to look around me.

In that time, life brought several patients my way that helped me to remember why my job is so important and yes, even still, appreciated. I did a 2 am emergency c-section on a woman who was actively abrupting at 35 weeks and helped save her life and her baby's life, as well. I helped two women, one with an early demise due to a fatal fetal anomaly, and one with a heartbreaking term demise to deliver and make it through the absolute worst days of their lives. I attended several "routine" deliveries and got to be a part of the happiest day in many women's lives (dreaded hospital setting and all). And I waited out a prolonged labor, complete with three hours of pushing and a pretty scary shoulder dystocia, and helped a first-time mother to deliver her healthy, 9 pound 15 ounce baby.

In the spaces in between, I got to celebrate CindyLou's 6th (!) birthday and her "graduation" from Kindergarten, enjoy some time with family and friends on the weekends that I have off, and I even successfully completed 2 weeks without eating any carbohydrates at all (and lost 6 more pounds, yay!) I think of this time last year, as we were preparing to make this move, and I was dreading July (as I always did, with OtherDoc's mega vacation looming in the foreground). This year we have vacations planned in July and Bean's 3rd (can you believe *that*?) birthday, and only 1 full weekend of call. I am finding my life again, and still getting to work in a field about which I am just as passionate, now with less burn-out! Whee! I also want to thank the sweet anon poster who asked that I not give up on the blog...don't worry! I may lose chunks of time in between posts, but I won't forget about you guys. I just have to find a way to make this blog funny again, and not so depressing and whiny! I will continue to fight the good fight for Ob/Gyns out there, and do my best to stop the rampant fear mongering by providing the example which contradicts the general blogosphere "rule." Good doctors do exist, we by far outnumber the "bad" ones, and we prove it every. single. day. Happy 1st day of summer, all! I am going to the pool. :)

Monday, May 03, 2010

Far from Fine

I am blessed. I have a great family, healthy children, a loving marriage, a career that I (mostly) love, and many good friends. But I still have things that I worry about, there are still things that are far from fine with me. Despite a 22 pound weight loss on my previously mentioned program (woo!), I am still obese and now that I am "graduated" from the program, I find the bad habits slipping back in and pounds creeping slowly back on. I eat when I am stressed. I am stressed a lot. Therefore (logic 101) I eat a lot. I wish I ate a lot of vegetables, or even a lot of fruit, but mostly I eat a lot of pasta. It must release some kind of serotonin, because it calms me like nothing else can (except wine, and I *really* don't want to go down that slippery slope, you know?)

I'm worried about our country's path, our future, my children's future. What the hell is going on with our politicians...all of them? Our government is so perverted from what our founding fathers originally envisioned. It is almost laughable, but worse, it is scary. I am scared to death about freedoms and rights that are being stolen from us right beneath our noses in the interest of some kind of unrealistic, Utopian "greater good." Many of my friends "get it," but there are also many that don't understand what I am saying or seeing, and it drives a wedge in these friendships.

I am worried about the future of my profession. I can see what is coming down the pike in the coming years. It is ugly and is going to get uglier, and I'm pretty sure that physicians had a hand in sealing the demise of our profession as we know it by being the types of people that physicians are...altruistic to a fault. While I'm doing what I can on a local level, I feel helpless to change the runaway freight train that is the bureaucracy surrounding what should be built on a case by case (patient to physician) basis.

So, I fret, and rage against the machine, and beat my head against the wall trying to get people to understand what they refuse to try to understand in both my personal and professional life, and I eat. I recognize that I am self-medicating...but what? Frustration? I'm not clinically depressed. I do have some anxiety and OCD tendencies, but nothing that has been interfering with my daily life. I am just using food as a crutch, instead of healthy sublimation like exercise, I am raising fork to mouth to push down my feelings, my fears. It isn't working for me. So today, after having pasta for breakfast after a particularly harrowing weekend call, I got off of my arse and went for a walk. The hardest step is the first step out the door. Right?

Tuesday, April 27, 2010

Things I Say Every Day (Home Edition)**

1. Good morning, sunshines!

2. I love you.

3. No.

4. What do you say?

5. Hmmmmm?

6. Put your clothes in the hamper.

7. Stop teasing your brother.

8. Stop torturing your sister.

9. Sorry, you cannot have mac and cheese for breakfast.

10. Sooooo, whatcha want to do for dinner tonight?

11. Thank you for (doing laundry, the dishes, going shopping) honey!

12. Are you ready for a bath time? A bath time party? This is old CindyLou (and Bean) ready to get that bath time started....

13. So, tell me about what you learned today...

14. I need some snuggles (or, the abbreviated, "snugs")!

15. I missed you today.

16. Did you set the DVR?

17. No, no, it is (CindyLou's/Bean's) turn to sit in the front of the tub.

18. Pick out the book you want to read tonight.

19. What was your very favorite part of today?

20. Good night, sleep tight, sweet dreams...see you in the morning.

21. Ahhhh, adult time!

22. We need to go to bed earlier.

23. I am going to bed early tomorrow.

24. I love this show!

25. Maybe we can work out....tomorrow.

Things I Say Almost Every Day**

One thing that I love about my job is that it is ever-changing, and there are no two days that are exactly the same. That being said, I have my own daily script that I find myself reciting as I move through the more routine parts of my days in the office and on labor and delivery. My nurse could probably come up with a million more things (since she gets to listen to my spiel 30+ times a day), but these were the first off of the top of my head:

1. That's normal.

2. You're going to feel a little pressure.

3. Are you feeling any pressure?

4. Do you have any questions?

5. In a normal cycle, you have a rise of estrogen, then ovulation, then a rise of progesterone. If you don't become pregnant, then your progesterone level will fall and *then* you will have a period.

6. That's normal.

7. Take a deep breath.

8. Now, wiggle your toes.

9. No one will know your breasts better than you.

10. Tell me about what has been bothering you.

11. Is that interfering in your daily life? How?

12. The definition of menopause is no periods for one year.

13. It takes two 16 oz packages of cottage cheese to equal the Calcium in one 8 oz glass of milk.

14. You can do this.

15. Congratulations!

16. There are risks, benefits, side effects, and alternatives...

17. I'm sorry for your loss.

18. That can be normal.

19. I know it is counter intuitive to "relax" but try to make your muscles as loose as possible.

20. Do you understand?

21. Tell me what you know about birth control, then tell me what you would like to know.

22. That is a normal physiologic change of pregnancy.

23. I promise that you won't be pregnant forever (usually after discussing our elective induction policy of no earlier than 41 weeks gestation.)

24. How can I help you today?

25. I know this is scary, but I am going to talk you through it.

**Cross Posted at Mothers in Medicine**

Tuesday, April 13, 2010

"Why is my OB always running so *late*?"

Recently one of my friends posed the question as to why her Ob/Gyn physician would routinely run at least 45 minutes late, with the caveat that she would be fired for doing the same to one of her clients. In typical fashion, I posted a long, rambly, and overly detailed answer in her comments section, after (thankfully) seeing a lot of other friends chime in on their personal experiences with their particular physicians. I realized that this is most likely a very universal wonder/complaint, so I am re-posting my response for you, my dear readers. I am sure you have pondered this at least once whilst sitting on an exam table, shivering in a paper gown.

Allow me to describe my day, in order to better explain why we may routinely run late. Today I am on call, and so, while I am responsible for all that happens on labor and delivery, in the office, I do have patients scheduled. The majority of patients are OB visits, most of which rarely take more than 5-10 minutes tops for routine appointments. We also will see check problem patients (early pregnancy bleeding, labor checks, blood pressure issues, hangnail, etc.) So, our scheduling staff (none of whom are medically inclined or have any clue what we do on a day-to-day basis) has most "on call" schedules looking something like this:

8:30 OB patient 1:15 OB patient
8:45 OB patient 1:30 OB patient
8:45 OB patient 1:45 OB patient
9:00 OB patient 1:45 OB patient
9:15 OB patient 2:00 OB patient
9:15 Problem 2:15 OB patient
9:30 OB patient 2:30 Problem
9:45 OB patient 2:45 OB patient
9:45 OB patient 2:45 OB patient
10:00 OB patient 3:00 Problem
10:15 OB patient 3:15 OB patient
10:30 Problem 3:15 OB patient
10:45 OB patient 3:30 OB patient
10:45 OB patient 3:45 OB patient
11:00 Problem 4:00 Problem

So, we have anywhere from 5 to 7 patients scheduled in an hour, and if everything is hunky-dory, there are no issues, long litanies of questions, no problems, or complications, I can generally run on time for these appointments (and by, "on time" I mean that once the patient checks in (usually running at least 5 minutes late, themselves) the nurse talks to them, does any necessary screening labs, checks their weight, urine and BP, listens to fetal heart tones, brings me the chart, which I then review, I am seeing them at *best* 15 to 20 minutes past their original appointment time).

Then, add in the inability to predict labors (I had a couple of laboring patients today) and scheduled procedures (I had 2 cervical ripenings and a C-section scheduled-not by me-at 7:30 am and then another scheduled C-section at noon. Unfortunately, one of my laboring patients delivered at 12:15, smack in the middle of when I was supposed to do my noon C-section, so the section was put on hold until after the delivery. So, by the time I finished the (complicated) scheduled C-section, did all the necessary charting and orders for both deliveries (mind you, not having any time for lunch) I was able to get back into the office by 3 pm. If I am lucky (today I was), my colleagues will have mercy on both the patients and me and pick up a few charts to see patient or two in between their already over-packed schedules. If I am not, then all of the patients scheduled from 1:15 are still waiting to be seen at 3 pm.

So, (whew) does this make it a little more clear why we are not running on the spot of time? It is completely different than making one appointment (that you probably schedule yourself, when it is convenient for you, allowing for travel time, and keeping in mind how long you expect most meetings to go) with one client for the span of 30 minutes or an hour, so the two are really just not comparable...at all. Hope that this helps the next time you are waiting for your physician. P.S. If you grow to expect the long waits, start bringing entertainment (iPo.d, magazines, books, cell phone bejeweled or solitaire) or little projects you can do (bills, checkbook, cleaning out your purse), and know, it really could be worse. Back in Whoo-ville, OtherDoc's patients would wait for him for upwards of 3 hours...now *that* is ridiculous. ;)

Monday, March 29, 2010

Answers for A

I recently received a comment on the blog posing the following questions. At first, I was going to just correspond via email, but I thought perhaps my readership could also jump in on answering these questions from "A," a 3rd year medical student considering Ob/Gyn. So, thank you in advance for your help!

Hi Dr. Whoo,

I have thoroughly enjoyed reading your blog and appreciate the time and effort you put into your posts to provide us readers with a glimpse of your life. I am currently an MS III with only 6 months left to decide on what to do with my medical career. My top 3 choices are OBGYN, Anesthesiology and Psychiatry. I loved my OB rotation and feel that the field is a perfect blend of medicine, surgery, procedures and primary care.

Hello, A! Thank you for the nice words about the blog, I am glad to be able to provide a glimpse of life in the world of Ob/Gyn. I agree that Ob/Gyn is a perfect blend of medicine, surgery, procedures, and primary care. It is a really great field, but it does have its limitations.

However, I am afraid to commit to the field for the following reasons:

-Work hours. I cannot get a straight answer from the academic faculty on what to expect after residency. Most of them have flat out discouraged me from choosing OB, telling me that I should just do one of my other 2 choices. Is it possible to find a job working 60-65 hours/week and still come out with a salary of $250-$300k in smaller cities in midwest or the south? I just want to be well-informed of what to expect before I take the plunge to ensure that I don't end up hating my career .

HAHAHAHAHAHAHA! Ahem, I mean, ah, not likely right off the bat, at any rate. I think you can get the salary you want with more work hours, or the work hours you want for a lower salary, but it would be rare to find the above combination just out of residency. My average work week (5 person group practice) is right about 60 hours with weekday call, 110 hours for weeks where I have weekend call. As an employed physician, I make less than $200,000. My pay will increase with each employed year until I am able to "buy-in" to the practice. After that, my income will increase (but a large portion of it will go back into buying into the practice). After about 5 years of "paying my dues," I will be able to set my ticket for income. It just takes some time.

At my previous job, I made over $250,000, worked in a rural, under served area with high Med.icaid, and only had 4 days off per month, so 168 hours the weeks that I worked weekends, 120 hour weeks the weeks when I had the weekend off. Trust me, it is far better to make less money and work less hours, especially now when O.b.ama.care looms on the horizon. (Plus, think of the taxes you will be paying on a higher salary, you may get to keep more of your money working for a lower income.) So, while I am sure you can find some places where low work hours and higher income combines, that would certainly not be the norm until you establish a practice.

-Liability. How stressful is this aspect of OB if I choose to move to a state with Tort Reform or low liability?

Liability, Tort Reform or not, is always stressful in OB. It will loom over your shoulder with every decision you make, especially with respect to managing labor and delivery. Even when you uphold the standard of care, you can still be sued for bad outcomes, and all it takes is one case to destroy you financially, personally, and professionally. Malpractice premiums are fairly exorbitant in the field, as well. You may not be able to cover your malpractice costs if you have a poor payer mix, meaning more volume, which leads to more chances of things going wrong. Vicious cycle. Most of the time, it is just like static noise in the background, other times you hear the alarm bells clanging. You get used to it, but it is always there.

-I am a male (a minority in the pool of OB applicants). I have been told that being a male would make it difficult for me to find a decent job because practices tend to prefer women OB's (hence males have to settle for worse locations, work hours and call schedules). How true is this?

Well, to be honest, I am not sure, since I am not a male. (Any male Ob/Gyns out there want to field this question?) I know that in many of the positions for which I interviewed, they were very interested in procuring a female physician. One field that you may consider, if you are so inclined, is the field of Urogynecology. I think it is a 3 year specialty after residency. It is a more surgery-heavy specialty, and, in my experience, still fairly male-dominated. You still get some procedures, good primary care and a lot of good surgeries, no babies, so less liability, and likely better hours and compensation overall. I hope that these answers helped somewhat, and I hope my readers are able to clarify further some points I am not able to elaborate upon. I truly wish you the best of luck with the rest of your training, and in whichever specialty you choose to pursue.

Thursday, March 11, 2010

Dropping In and Frustration

Since my move from Whooville to Newville, I've had to make some adjustments to the new patient population. Perhaps the most frustrating of all, however, are the "drop-in" patients on Labor and Delivery. My previous hospital was a rural, community hospital. It was certainly off the beaten track, and the building? Was old. Really old. The L & D suites were certainly sufficient and functional, but luxurious? Not so much. You had to know where you were going to find the hospital, and it was quite the rare occasion to have patients just "drop-in" for care.

Not so for the new digs. This hospital is new. Pretty much Brand Spanking New, and posh, and beautiful, and, oh yes, right off of a major highway, visible for all the world to see. Which makes for the fascinating phenomenon that is the OB "drop-in" patient. "Drop-in" patients come to this hospital "because it is close," or "because it is nice," or "because it was on the way." So, what is so bad about working in a hospital in which everyone wants to deliver? Well, what is so frustrating is the women who *know* that they want to deliver at our hospital, but do not seek pre-natal care from physicians that cover our hospital. Therefore, any pre-natal labs or records, or history of complications are virtually inaccessible at the time that they come in for delivery. Often patients from the large, downtown academic center (who don't have insurance or have insurance not accepted by our practice) receive all of their pre-natal care "for free" at the downtown center clinics and the purposefully come to our hospital to deliver. The patients are often not troubled by this, and often seem mildly surprised that we "aren't all the same" and have no way to access their records. After all, they are getting exactly what they want. It is much harder for us, as physicians, however, to help these patients. Especially when it comes to their expectations for delivery. It is difficult to develop a proper rapport in the few hours that we have with them. I think that trust is so important in the delivery room.

Even more difficult are the transient patients who stop in on their way through town, like one patient who had absolutely no pre-natal care, and was on her way to deliver her baby somewhere "non-medical" when her water broke, and she decided to stop-in at our hospital. She had, indeed, broken her water, but she refused an ultrasound to assist with proper fetal dating because she was concerned that the "x-ray waves" would damage the baby. She then proceeded to refuse any medical assistance from the hospital at all for over 24 hours, tying the medical staff's hands, and putting them at risk for liability at the same time. Eventually, she agreed to augmentation of labor, and even requested epidural analgesia after a prolonged labor. With medical assistance, she eventually was able to deliver, but the baby boy had definite signs of septicemia (likely due to prolonged rupture of membranes) and ended up in the NICU for over a week. When all was said and done, the mother, upon release from the hospital, said that she and her infant would never step foot in another hospital again, despite the fact that it was with the hospital's help that her child was born and made well when he was sick. To this day I will never understand why she "stepped foot" in the hospital from the start, if she did not want any intervention that the hospital could offer. This case brought a lot of issues that plague the medical profession in this day and age to the forefront.

Thankfully, her baby, despite some health issues at birth (that likely could have been avoided with faster intervention) did well...but what if he did not do well? What if the infant did not survive? Then who is at fault? The hospital? The physician? The mother? These are the questions the haunt physicians' sleep at night. Obstetrical interventions are not only done to avoid lawsuits, they are done to protect the safety and health of both the mother and her baby. However, one bad outcome, one wrong decision, can result in catastrophic professional, financial, and personal losses for the physician. Is it any wonder that we are hyper-vigilant? Is it any wonder that we would jump at any opportunity to prevent a bad fetal outcome, even it it means surgical intervention risks for the mother? It is thanks to Jon Edwards and others like him that the cesarean rates are rising, VBACs are being refused, that patients are being over-monitored, and that interventions are becoming the exception rather than the rule. Without tort reform, without the ability of the physician to operate from another position than that of fear of a poor outcome, then I am afraid that obstetrical care will remain the same in this country for years to come. Please consider that your rage just may be misdirected.

Sunday, February 21, 2010

Ob/Gyns are *not* evil

Just because I'm an OB/GYN physician...

~ don't assume that I don't care about you as an individual.

~ don't assume that I'm out to cut your baby out of your womb in favor of getting home for dinner.

~ don't assume that I go home and roll around naked in piles of money.

~ don't assume that I view pregnancy or birth as an "illness."

~ don't assume that I don't know anything about "natural " (unmedicated) labor, transition, or alternate pushing positions.

~ don't assume that any inductions of labor that I schedule are done for *my* convenience.

~ don't assume that I will roll my eyes at your birth plan.

~ don't assume that my attempts to educate you about your pregnancy are "scare tactics."

~ don't assume that I am "what is wrong" with the way women give birth.

~ don't assume that the only way I know how to facilitate labor and delivery is through "unnecessary interventions."

~ don't assume that I am an unfeeling automaton who wants to "put you on the assembly line."

~ don't assume that I am "too busy" to take proper care of you.

~ don't blindly believe everything you see and read about my profession.

I've been doing some browsing through different labor/nursing/birth blogs, and, as it is wont to do, it depresses the living hell out of me. Partially because I know that I am not close to 90% of the descriptions I see from women out there, and partially because I'm starting to worry that maybe I am an exception and not the rule. In my current practice, I can see a definite split between the younger generation of physicians and the older generation. I certainly believe that through medical school and residency that I was taught a much more "collaborative" model of care than earlier generations. However, no one in my practice comes close to the urban legends out there perpetuated by the anti-medical world. I know I've ranted about this before, but it bothers me! So many physicians with whom I work have sacrificed *so much* for their training, for their ability to help people, just to be mistrusted and maligned by the population at large. Perhaps the most disheartening thing, is that there can be no real dialogue between the two philosophies, so jaded are our particular perspectives. Nothing I can say on this blog can convince you that I'm not a knife-wielding harpy, but if you were my patient, you would know.

P.S. I have been playing around, trying to start a facebook page for this blog. Any tips on how to make it better? I am poor at social networking!

Saturday, January 30, 2010

New Sensation

In my previous job, I essentially functioned as a solo practitioner, so I could be fairly certain that (like it or not) I would deliver nearly all of my OB patients. Not that I didn't wish sometimes that a few of them would happen to deliver on one of the 4 days that I was freed from the hospital. In many ways, knowing all my patients from beginning to end was really wonderful. I knew who was stoic and who was, er, well....not stoic. I knew who was a worry-wart, who never had a single complaint, who had a birth plan, and who wanted an epidural when they hit the front door. I knew who was having complications, how far along (ball park) they were, and sometimes could even remember how dilated they were at their previous checks (should they arrive in triage thinking they were in labor).

The very best part, however, was the relationships I developed with the patients during the span of their pregnancies. We got to know one another, build trust, and when the time finally came for delivery, the rapport was usually strong enough for us to communicate well during the process, and to celebrate together when the delivery was complete. Sometimes this could actually be somewhat detrimental, as getting "emotionally attached" to patients can be a hindrance to good medical care, but mostly, while I cared for women on a personal level, I was still able to objectively direct their care. Of course, I didn't "click" with every single patient (that is impossible) but I did feel like a level of trust and mutual respect was able to be fostered with many.

Now, in a much larger practice where there can be anywhere from 60-80 patients due in a single month, it is much harder to develop the same rapport. There are times when I haven't even had a chance to *meet* a patient before attending her delivery. We try to have the patients see every physician at least once, but sometimes it just doesn't happen. This makes it much harder to develop trust in one another, during a very crucial time. So far I have overcome this by taking some time when admitting the patient to review all the records (sometimes helpful, sometimes not, depending on who was doing the documentation) and to discuss the plan of care with the patient and their family members. It is strange to deliver someone that you don't know well, and though I did experience this with some of OtherDoc's patients back in Whooville, it was not on the same scale.

Another adjustment I have had to make, and I think I may have mentioned this before, is adjusting to the "way of the group." Before, the medical decisions I made about patient care were mine alone, now I have 4 other physicians that have to be somewhat on board with a plan of care. Not to mention the way that they handle gestational diabetics and inductions is very different than to what I had become accustomed in the prior four years. Plus, when I order certain tests, sometimes another physician is the one that gets the results and then makes the decision on how to proceed. Scheduling inductions is also tricky, sometimes I can't schedule them for myself, and worry that I may tick someone off by scheduling someone on their call day.

Through all of this, I have noticed a strange new phenomenon. It isn't consistent, but I am starting to be able to "feel" who I am going to deliver. I know, it sounds completely bat shit crazy, but it is the strangest sensation. I just get this little gut feeling with certain patients that I am going to be the one that does their delivery. It matters not if I happen to personally like the patient or if the patient is one with whom there is not a strong connection. There is no basis in anything concrete, and it sounds so new-agey and non-scientific when I write it out like that, but, so far, each time I have "gotten that feeling" it has been correct. Verrrrry interesting. I will continue to observe as time goes on. Has anyone else, patient or physician, experienced anything like that before?

The really nice thing about getting my bearings and settling in to the new job is how well I am clicking overall with the patients and the nursing staff at the hospital. It is so great to hear the nurses tell me that they like the way I manage patients, or to have a patient tell me "You were my favorite, I hoped it would be you delivering my baby!" Very satisfying, indeed. Happy weekend, all!

Saturday, January 23, 2010

Workin' on the Weekend

Ah, weekend call. When I was in residency, the nurses would refer to it as the "3-day hostage crisis." I find this hilarious. And, in many aspects, true. In my former job, weekend call just seemed like a continuation of a long parade of call days that flowed seamlessly, one into another. I resented being held from my life on the weekends just as much as I resented the weekdays. Now, weekend call is a distinct, and separate being.

Weekend call for me consists of Friday, Saturday, and Sunday, starting at 7 am on Friday morning and ending at 7 am on Monday morning. Definitely a long, lonely stretch. Blissfully, the Monday after weekend call is mine, all mine. So there is always a break on the horizon, which, sometimes, is the only thing that keeps me going! Hospitals have a different overall feeling on the weekends. The pace is slower (usually) and generally, not a lot gets done. This even extends to Labor and Delivery. While it is true, babies have no concept of weekends or evenings and tend to come whenever they damn well please, but there are no elective inductions, no scheduled C-sections, and most patients are eager to leave the hospital.

The best thing about weekend call, for me, is the ability to spend as much time as I need to on Labor and Delivery, without feeling rushed. Weekdays usually will have scheduled C-sections at 7 am or 12 noon (sometimes both) and inductions can range from 1 to 3 for our group, there are circumcisions to be done, patients to be rounded on, not to mention a full slate of office patients for the day. Getting it all done can feel impossible, even when there are other partners there to divide the work. Splitting work can also be stressful, wondering if all the patients were seen, or if someone got missed in the shuffle. On the weekends, there is something peaceful (or is it merely resignation?) about knowing that, come what may, *you* are the one responsible. Sometimes it makes me wonder if I would prefer being a "laborist," because I really love the ability to stay on L & D, close to the action.

Some mornings there are just a few patients to see, and I can sleep a little later, and spend a lot of time with each person. Other mornings, there are many patients to see, but the pace doesn't necessarily have to change. Following the cardinal rules of deference to the call gods, I never make a single plan for my call weekends. If it happens to be slow, we spend some lazy time as a family together at the house. If it is busy, then I can take up residence in one of the (really, way too nice) call rooms where I can read, flip channels, and watch laboring patients simultaneously, or I can hang out at the nurses' station, chatting and getting to know my co-workers (and usually get access to some really great food, the staff definitely eats well on the weekends!)

So, while I still get a little wistful when I hear of others' fun weekend plans on the weekend that I have to work, I am bolstered by the knowledge that my "day off" lies just on the other side of the weekend. I am further heartened to know that weekend call is only once a month, leaving 3 other weekends wide open for fun plans of my very own, without fear of the dreaded page from L&D. WTF is wrong with me? I never thought I'd see the day when I appreciated weekend call; I must be getting mellow in my old age! Working or not, I hope you all have a wonderful weekend.

Saturday, January 09, 2010

New Year, New Me

Year after year, I have seen resolution after resolution fall by the wayside. We always start the new year with the best of intentions, but, more often than not, our perfectionism gets the best of us. We inevitably fall off the wagon, then, once off, tend to wallow in the mud. I will say that I have not been perfect, but instead of wallowing, I have picked myself up and tried to be better. Since starting my new regimen, I have lost 15 pounds, 6 inches from my waist, and 4 inches from my hips. I also ran in my very first 5K (boy, is my body pissed off about that one!) So my resolution for 2010, is much the same as every other year. To be a better mother, doctor, friend, and person. But this time, when I inevitably fail, I won't give up on myself as a lost cause. I will dust off and persevere. I know I can do this, and so can you. 2010 is going to be a great year, and I hope to be able to share more stories with all of you.

I am six months into my new position, and I cannot believe the difference. I am still working very hard when I am at work, but when I come home, I am home! I see my kids, we do normal family-type things. We have *plans* each weekend! The days that I am on call, I expect to stay in the hospital, but luckily, those days only come one week day per week and one weekend per month. The past four years are becoming more of a dim and distant memory. I have no idea how I did it, besides sheer adrenaline. I remembered that when I thought that I might die in the last mile of the 5K that Mr. Whoo and I ran together. If I can survive those 4 years of stress, I can survive a measly 3.1 miles.

Recently, I discovered that a woman that I know from college is a patient of our Ob/Gyn practice. This is a bit of a sticky-wicket for me ethically. We weren't the closest of friends in college, but we knew one another well, she is my face.boo.k friend, etc. I find myself worried to death that something will go wrong with her pregnancy, and that she will feel like it is my fault. So far all is going well, and she is excited that I am part of the group taking care of her. I, however, am petrified. The closest thing I have come to before was being a physician for the nurses with whom I worked in the hospital. At least they knew me as a professional *before* becoming my patient! Anyone else out there with advice on how to handle being a physician for someone who knew you before you became a doctor?

P.S. Whoever keeps commenting with Asian characters/links/advertisments, would you please CUT IT OUT? I will not publish these comments, and they are cluttering up my message feed. Ugh.