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They make it hard. - Nobody wears a white coat any more... — LiveJournal
...a tribute to becoming a doctor.
They make it hard.
I am at a bar, pretending with admirable (to me) intensity to be listening to the woman halfway down the long table. She is talking about Zoloft. She is, while not an employee of Pfizer inc, who are paying for the table, the food, and the drinks, at least a bed-buddy with them. I cannot hear her. I sip a Sam Adams and watch the diagonal length of the table, because I can see - also pretending to be listening - a Medicine Intern I have previously raved about in these pages. N, who plays Magic and thinks I'm a goddess for being in the World of Warcraft beta and is still working on getting together a chance to have a drug company pay for an all-night Halo 2 party. He winked at me when I came in and sat down.
K, who is the intern on OB-Gyn and who has taken me under her wing this month, stops by my seat. "Good, you're here. I was going to page you." She details tomorrow's OB schedule, stressing that I am in no way obligated to come to the 0645 lecture on forceps deliveries and then asks, "You are coming to clinic in the morning, right?" I stammer. Sure. "Good, because it's going to be busy, and we need your help. You're so independent, it really helps."
I am not independent, O Best Beloved. I am clinging and dependent and scared motherloving spitless of new situations. But I am even more afraid of being thought to be lazy, and I carry with me the memory of overhearing a group of residents talking: "You should've seen S. We were done early, short-staffed and everything." I have the fortune of being fond of S, and knowing that he is a nice guy, not a gunner, and completely devoted to his work, and I want what is said behind his back to be said behind mine. I am also my father's daughter, and when something frightens me I throw myself at it in a frantic attempt to discern why. And so I have thrown myself at OB clinic and deliveries and today I threw myself at a C-section and sure, I didn't do much but I did it by myself and K was quite impressed.
I threw myself at a circumcision Friday and I did well, according to my supervising resident. I am feeling almost comfortable doing colposcopy, and I think if someone were to suddenly deliver a baby in the middle of Marshall Fields I could probably catch it in all the right ways.

I am going to OB clinic tomorrow morning because they want me to be there. That feeling warms me so much more than the Sam Adams (which isn't a bad beer).

Today I went to the floor to meet a patient who subsequently went from 6cm to delivered in about forty-five minutes, warranted a stat page to K, and of course did it all while I was enduring a positively interminable lecture about practice management. As we were discussing her case, a call came in. "They're sending someone over from $natural_birth_center. Arrested second stage of labor." This happened last week or the week before, and that time when the woman was hooked up to the fetal monitors I studied the strip, turned to a nurse, and said "That's not a happy baby." And eventually the baby was delived in the most unnatural way possible: through a surgical incision under spinal anaesthesia. C-section. This time, the nurses were murmuring. “G8.” Eight pregnancies, including the current. “P4.” This will be her fifth live baby born. “Pushing for three hours.” What? Three hours, O Best Beloved, is far too long for the fifth baby. After two babies or so, they usually just fall out. “I bet she’s not even complete,” someone murmurs.
They checked her cervix when she came in. Six centimeters. Just like the other woman. Just over halfway dilated. And she delivered about six hours after that, after she’d finally been allowed to dilate completely.

I don’t mind natural birthing centers, O Best Beloved. If you want a doula and a midwife and a Jacuzzi to labor in; if you want to walk and stretch and have your labor induced via nipple stimulation; if you like birthing balls and not having anaesthesia and soft music playing, that’s fine. Go to a birthing center and have your baby. Women have been popping babies out for thousands of years without modern medicine.
But when your birthing center is telling you to push against a cervix that is incompletely ready for your baby to pass; when you are VBAC’ing - vaginal birth after Caesarian section - and there is a 5% or greater chance that your uterus is going to rupture, sending you and your baby into hemorrhagic shock unless you are in the OR and delivered within five to ten minutes; when your baby is premature or underweight or poorly developed and is going to need skilled neonatology care as soon as its born to make sure its lungs expand and its heart beats; when something is not completely normal, I do not like birthing centers. I do not like the way they speak of doctors as monsters who interfere with the natural process of birth. I do not like the way they insinuate that a hospital birth provides an inadequate level of personal attention. I do not like the way that medicine is maligned. And I do not like it when people put themselves and their babies in danger, knowingly or out of misinformation.

I hear the birthing center has to undergo an institutional review because of these women. Good. I want it to be a safe place to have babies.

Speaking of having babies, I did perform a delivery on Friday, and into my hands with almost no assistance from staff was delivered a 7# baby boy. No tears. He was beautiful. I love this work.

now feeling:: worried worried

14 whispers echo . o O ( ... ) O o . whisper a word
serennig From: serennig Date: November 23rd, 2004 01:44 am (UTC) (etched in stone)
ryenna From: ryenna Date: November 23rd, 2004 01:47 am (UTC) (etched in stone)
My dad is OB/Gyn, and I just want to give you a hearty virtual pat on the back for what you're doing right now and what you just wrote.

I've heard so many stories from my father about underinformed or uninformed women complaining about hospital conditions not being "homey" enough when in reality they are lucky that they and they babies are still alive. Every doctor I know in private practice pays through the nose for malpractice and it sickens me.

*hug* good on you for all your hard work.
ryenna From: ryenna Date: November 23rd, 2004 01:49 am (UTC) (etched in stone)
Oooh, correction: "malpractice insurance" yeah.
ayradyss From: ayradyss Date: November 23rd, 2004 01:52 am (UTC) (etched in stone)
Well, they pay through the nose for malpractise too, if they're unlucky. :)

But thanks. Your dad's a tough man for being an OB in today's climate.
ryenna From: ryenna Date: November 23rd, 2004 02:05 am (UTC) (etched in stone)
He is. It's a rought time to be any sort of doctor, but the OB docs get it bad.

I'm a librarian and we have this one patron who keeps coming in and telling stories about his wife's home birth and how they didn't need any fancy overeducated doctors demanding expensive and unnecessary procedures. I keep wanting to smack him and ask what the hell he would have done if his wife had started bleeding out in their bedroom, or the baby had had the cord around its neck, or some other entirely-too-possible problem. Apparently those things don't happen to good home birthers.

Sorry. Bitter. Stopping now.
ayradyss From: ayradyss Date: November 23rd, 2004 02:07 am (UTC) (etched in stone)
Yeah, it's like I said. And really, when we do a delivery, if nothing goes wrong there aren't any expensive or unnecessary procedures. People think we pull all the babies out with forceps or something.
ryenna From: ryenna Date: November 23rd, 2004 02:09 am (UTC) (etched in stone)
Or that OBs sit around in their office cackling "C-sections for ALL! BWAHAHA!"
ayradyss From: ayradyss Date: November 23rd, 2004 02:11 am (UTC) (etched in stone)
It's a right, you know. On the list just below "pursuit of happiness."
turnberryknkn From: turnberryknkn Date: November 23rd, 2004 09:16 am (UTC) (etched in stone)
Tough questions. Tough issues.

Thanks again for sharing.
waifofthenorth From: waifofthenorth Date: November 23rd, 2004 07:21 pm (UTC) (etched in stone)
I saw on a baby story on tv a home birth with the pool thing and all, and I thought it was weird. I'd definately want a doctor in a hospital...of course I kind of comfortable with hospitals anyway...I'm also uncomfortable with thinking about me being pregnant, so I'll just shut up now. :-|
From: dr_bobbie Date: November 23rd, 2004 09:17 pm (UTC) (etched in stone)
I didn't get to deliver a baby during my OB rotation, and just like you, I tend to throw myself at situations that frighten the bejesus out of me. You mirror my thoughts and feelings in so many ways, it's frightening. I don't need to keep a journal...I just read yours. ;)

I'm currently doing a rural OB rotation with the explicit intent to deliver my first baby. Next week is supposed to be busy. I'm hoping to get my hands dirty, so to speak. I'll be thinking of you tomorrow. <333
daxayl From: daxayl Date: November 24th, 2004 08:22 pm (UTC) (etched in stone)

Circumcision and birthing..

How horrible....the kid is fresh out of the womb and already doesn't live up the the expectations of the world. Thus, they feel they must trim him up a bit.

*grinz and snugglez you* On the other hand once the pain wears off and if their proves to be no infection it DOES make things easier since teaching a boy to take care of himself is harder than it looks *[thinks about having to help his 12 year old brother - they don't listen until it starts to hurt]*

In any case..loves to ya. Oh, and as far as the birthing stuff...my mom had one of my brothers at home. Her doctor recommended it saying something to the extent of, "I don't care if you live across the the hospital. If your water breaks and your not there...you won't make it." After my other brother (the third kid) I guess she was like a baby dispenser or something. Thus, they took classes and they called the midwife after she felt the first contraction. It IS cheaper than running to the hospital every time since your not sure how quick its coming. Of course the doc was also notified and on standby if needed. I know its different than the "home birthing" is better argument, but...yeah. See ya friday.
ayradyss From: ayradyss Date: November 24th, 2004 09:53 pm (UTC) (etched in stone)

Re: Circumcision and birthing..

See, in your mom's case it makes sense. She's not got any of those horrible risk factors. :)
daxayl From: daxayl Date: November 26th, 2004 01:04 am (UTC) (etched in stone)

Re: Circumcision and birthing..

*nodz* like congenital stupidity
14 whispers echo . o O ( ... ) O o . whisper a word