Friday, September 23, 2011

She's Complicated

A commenter from the post below states that I'll not likely elicit sympathy by stating that women can be difficult patients, who require significant amounts of communication. The question is also raised why I would "generalize" 100% of my patient population, as surely, if there were no women to treat, I could no longer be an Ob/Gyn (sic). I find it overall amusing that anyone would believe the post below was written, in any way, to garner sympathy, and I also find it a bit irksome to be told that I "shouldn't generalize." I'm not. I am speaking from my own personal experience. Perhaps I should expound upon this point.

I went into Obstetrics and Gynecology precisely because I enjoy caring for the(complicated, difficult) female patient. I would not do anything else, but I would be absolutely lying if I said it wasn't without its difficulties. For the record, I happen to find male patients, no offense guys, infinitely more simple in many ways, but less likely to follow any directed care of a physician unless there is fear of loss of life or, ahem, other *important* functions. In my interactions with male patients, there was little extraneous conversation, merely exam, diagnosis, suggestion for treatment (which they may or may not decide to take, but they certainly weren't going to ask you any questions about it). Women patients, quite simply, are different. They do require a lot more communication; not just about the reason for certain symptoms that they may be feeling, but also for the rationale behind the treatments to alleviate the symptoms.

Usually, this is not a problem for me, being a woman myself, particularly verbose ("talks too much" was a very popular comment on my report cards sent home from school), and, not to mention, I happen to like explaining physiologic changes in a way that women can understand and to which they can relate. However, sometimes something as relatively facile as communication can cross the line. At times, it can be repetitive and monotonous (likely not so different from other jobs). At other times, I feel as though I am speaking a script, word for word. Sometimes, it can be frustrating (for both the patient and myself), because no matter how I frame the explanation, I cannot communicate my point. Most of all, it can become emotionally draining. Women routinely tell me things that would feasibly make most people's ears burn, make me worried for them, and sometimes bring me to the brink of tears. I have an impeccable poker face, but over time the walls get chipped away and I find myself unable to stop bringing my work home with me.

I suppose it is a good thing to be human, but in medicine it is important to remain detached in order to stay objective and to provide good care. It is a difficult balance between being connecting with the patient without becoming emotionally *involved* with the patient. This is difficult and soul-grinding, especially for those of us who have a tendency to try to "fix" people. It is a burden I more than willingly shoulder every. single. day, but honestly connecting with patients can be good for them and harder for me. I'm not willing to stop doing it, but to say that it shouldn't affect me emotionally is far more presumption than I would have the wherewithal to make from the outside looking in. In summation, saying that women are "difficult and complicated" patients is not meant as an insult or to "generalize" women, it is simply a statement that I find to be true, not only of my patients, but of myself, as well.

Sunday, September 11, 2011

Ten Years

Ten* years ago today, I was a harried and hurried OB/GYN intern, the only intern on the OB floor. Rounds ran long because of a long patient census, and we were late getting over to Labor and Delivery to "run the board" (aka, check on the laboring patients). I had four laboring patients, three patients to see in OB triage, and a 30 week pregnant woman just involved in an MVA on the way into the ER. I was just about to check on my first labor patient when the charge nurse came out of a patient's room. "A plane just crashed into the World Trade center!" The sarcastic comments followed, ranging from jokes about air traffic control to what substance the pilot was smoking. It mildly piqued my interest, but to tell the truth, I hadn't the time to sit and ponder the significance. I was halfway through my triage and labor checks when the second plane hit. Then, we knew, this was no accident, and I, like everyone else that day, was scared about what this meant. Ever in constant motion, I caught what updates I could from the patient's TV screens, as I went about the routine business of histories and physicals on a most unusual and frightening day. My chief resident and I went together to see the MVA patient, it was merely a fender-bender, no real trauma, and we hooked her up to the labor monitor to look for contractions. She gasped, suddenly, eyes wide in disbelief, locked on the television mounted on the wall in the corner of the room. My chief and I turned, to see the mighty towers collapsing into dust and rubble. I don't know how long we sat and stared, silent.

The rest of that day is a true blur. I delivered eight babies between 9 am and 5:30 pm that day, four inductions and four natural labors. I distinctly remember one young patient, just 17, crying after the delivery, not tears of joy or even pain from labor, but of sadness and terror. I couldn't help but think that the baby boom that day was simply a surge to replace the souls so tragically lost. I think the unit had a total of 11 deliveries that day. This year, they are 10 years old, nearly ready for 5th grade. In the days that followed, I was morbidly fixed to the TV and the news. My husband couldn't tear me away. I couldn't stop watching. It lasted for about 3 months, and then the shock was not nearly so fresh, and I could watch non-news programming once again. Five years ago, my husband was attentively watching the commemorative movie on television. I have no desire to see any films about that day. I didn't understand why five years was the magical number for it to be permissible to start turning a profit on such a terrible day in our lives and the lives of the victims. I could barely sit through the previews of United 93 without bawling. I don't need a reminder of the tragedy, as it is indelibly burned into my memory. I was fortunate that I did not lose a loved one or a close friend, and for that I am grateful. But we as a nation suffered the loss of, not only the lives of the victims and the heroes of that day (in itself a staggering loss), but the loss of life as we had so complacently come to know it. We lost innocence and we lost feeling secure, and I'm not sure that we will ever feel the same way as we did ten years and one day ago. Today, I, like so many of you, will ponder in silence and return to the day when we knew things would never be the same. Today I will remember to never forget.

*Originally posted on 9/11/06