Reflections of a Woman's Doctor

I am so crabby tonight I don't even want to talk to myself.

Perspective

Today was just plain hard, no way around it.  It was peopled with the usual array of folks - nurses, patients, staff (which is sometimes just ick to deal with, honestly), a laboring mom .  There was endless paperwork, pages, results to sign off and relate.  Surgeries scheduled, a surgery cancelled amid concerns for a possible heart problem.  A rush Rush RUSH day.  A no-peeing/eating/sitting day for 14 hours straight.  It started with tough conversations with my own 2 sons, and it did NOT improve until this evening, when -- can't you just see it coming??-- I got to see "Anne's play" again.  But THAT ... is not what I'm going to talk about tonight.

I am so blessed.  So privileged to help people.  And even more privileged to be taught by THEM.  The women I meet and touch and gentle (yes, it's a verb in my world).  Today I was blessed to have the opportunity to be taught again.  In my harried state, I might have missed it.  That chance to remember the deeply personal why of what I do.  But her infirmity, her absolute dependence on the mercy and kindness of others ... made me slow down and become again the doctor, and the human being, I want always to strive to be.

She appeared on my schedule as, "WWE/pap. Pt with cerebral palsy/wheelchair."  That little intro. will cause me to breathe in, breathe out, breathe IN ... anyday.  WWE = well-woman exam.  So, in this case... not exactly.  Pap = well, we all know what it = , don't we?!  And if the patient is a Well woman, she can usually cope with stirrups and dropping her knees out to the sides despite the awkwardness of an exam that so completely exposes her.  If, on the other hand, she is a middle-aged woman with severe cerebral palsy who just happens to be wheelchair bound, with limited mental capacity and a tendency toward "tantrums" (her mother's word, not mine) ... well now, that puts a little different spin on things. 

Her back is so permanently arched that her constant view is of ceilings and sky.  Her limbs have multiple contractures, which means she has NO flexibility of her joints, and her arms and legs are spokes projecting randomly from her emaciated trunk.  She weighs 80 pounds. She wears a diaper (again, her mother's word).  Her mother, by the way ... is God's own angel.  She must be in her 70's.  She was recently widowed - in 2004.  She treats her precious child with ... profound respect.  She sees her daughter as she IS, with clear eyes neither harsh nor maudlin.  This mother does not look away.  She does not seek to make excuses or apologies for the person her daughter is NOT.  By her example, this mother teaches me, again, how to treat my own children, and the children of all my patients' parents. 

What terrible sadness this mother must have felt in the moment of knowing her sweet, perfect little girl was not to be.  She would never skip rope, play hop scotch, run laughing into mommy's open arms.  Snuggle her head into mommy's neck ... sweet aphrodisiac, that.  NEVER.  Not ever.  Not once in 48 years.  So what was left to do?  Just love.  Respect.  Assist.  Nurture.  Gentle.  Accept.  And she has.

It took 4 of us move the "patient" (uck, that word so does not fit what I feel in this moment) from her wheelchair to the exam table.  We left them in privacy, mother and daughter.  I returned when the un-dressing was done, the gown and drape were in place.  I sought to be as loving as the mother, as respectful, as genuine and plain.  I hope I was.  I  think I was.  I sure hope I was.  It was an Honor. 

  

Sweet Anne

Tonight I am just a mom.  Thinking about my little girl, all grown up and all too soon.  She's 21, down to one last semester of college then - poof - gone.  Her dreams are HUGE, ribbon-candy bright and sweet .. and sharp on the tongue.  God, she is so STRONG.  How did this amazing woman I see before me start out as a tiny little fertilized egg??  It defies comprehension despite it being a cosmic magic trick I see performed over and over.  I feel these babies hot and wet and squirming.  They emerge in an instant and fill up all the space in the room, all the whole world of their parents.  I remember, each time, the moment of meeting my own first-born child -- her little four pound self emerging through the surgical incision white-knuckling it, holding on so tightly to the lifeline of her umbilical cord - literally.  The immense, almost unbearable sense of responsibility.  Gazing into the gray-brown (now GREEN!) eyes peering so intently from that miniscule face.  I could almost hear her unspoken question:  "So, NOW what are you going to do for me?  Here I am!"  I have to say, I still don't know the answer from day to day, and muddle through the best I can, always wondering if I'm doing ENOUGH.  Loving enough, cuddling enough, protecting (God, protecting!) enough.  Supporting while letting go ... enough.

Last evening I had the enormous privilege of attending a dramatic performance at her university.  It represents her senior honors thesis.  She arrived at the concept, and created this entire project out of her own incredible mind.  She gathered a group of talented students to function as grist for her mill.  Auditions, casting, lighting, set design, costume design, music, choreography, makeup, advertising; she wore many hats (one of her favorite words, but that's an inside story).  Her sleep suffered, but not her drive.  Anne doesn't do anything less than 100%.  It showed.

Anyone who knows me at all knows my love for my precious daughter is endless.  The best thing I can say about my relationship with her is that I am honored to count myself among her friends.  She is so much more than I ever could have dreamed of - loving, loyal, compassionate, hilarious, artistic, so so beautiful inside and out.  She will finish college, and she will either go back to London to study for another year; or to New York City.  She will train and study and exercise and pound the pavement for auditions.  She will be a "voice" for the deaf through sign language.  She will paint.  She will dance and sing and shout and cry.  Her heart will be broken, and it will mend.  And it will be broken again.  And her mother will miss the smell of her hair, the softness of her cheek, the complete genuine-ness that is Anne. 

We are getting tattoos, my girl and me, before she goes to live far, far away.  One of our favorite verses, linking us yet again.  She's designing them, of course.  I got to pick the placement.  No hesitation, there.  I will see her love for me written in my skin on the inside of my left forearm, just above (or below, depends how you hold your arm) the wrist.  Why?  It's so easy.  So I will see it every time I gown and glove ... to deliver a baby.

11.13.2009 ... early

It's 4:45 a.m.  I should be sleeping.  As usual, I'm not.  It's not that I'm not tired.  I just answered a page that made my brain have to wake up and work pretty hard and now it's not wanting to settle back down.  The house is so still, except for the elusive chirping of the one fire sensor somewhere.. ?upstairs? that must need a new 9 volt battery. 

There are some moments in life that are so ... profound.  For me, personally, there have been three above all others:  the moments of giving birth to my own children.  Looking back from the perspective of 50 years, that is so clear to me.  So that when I am about to help a woman through the amazing process of giving birth, the energy flows between me and her like a conduit connecting our eyes, our voices, our minds.. our hearts.  There are a few things, seemingly small in the moment, that I try to convey each time.  The last time she will hear that heartbeat through a monitor, instead of by pressing her ear to that soft, soft skin.  The absolute magic and perfection of the moment of delivering a child -- the fact that it WILL BE ONE OF THE BEST MOMENTS OF HER LIFE.  I try to make a warm, intimate space for the family.  Lights low.  TV off.  No background chatter between the nurses.  Just quiet, intense focus on the miracle at hand. 

Breathe in, breathe out.  Breathe IN.  HOLD THAT POWER IN.  USE IT.  Work with the force your body is already producing, everything aligned.  Give your body and your mind over to the process, ride the wave up, then down.  REST.  Let every single muscle lay flat, relax every finger and toe, close your eyes.  The in-between time is to rest, for you and your baby.  Rest for the work ahead.  Little bursts of work, so much work .. and then the rest.  You're moving him, you ARE!  I can see more and more of his head when you push.  PUSH, Sweetie, you are doing an AMAZING job!  Keep-going-keep-going-keep-going-keep-going .. don't let him sneak back up there.  Do you want to touch his head?  Here, you can TOUCH him!!!  He's sooooooooo close.  The next one will be THE ONE.  Rest.  Wait for it.  Work with your body.  Here it comes, it's starting.  Let it build.  Ok, now ... breathe in, breathe out.  Breath IN.  Hold that power in.  Use it.  PUSH!!  Here he comes!   

rest time

I am bone tired.  The day is (almost) done, the day that is yesterday/today, Monday/Tuesday.  The blur of 38 hours in a row.  It will soon be time to stop the keep-going-keep-going-keep-going ... my body is ready to rest.  SCREAMING for rest.  And...AND...my brain needs to catch up.  Or catch down.  To the feel-the-sheets-they're-so-soft-and-the-pillows-two-pillows-one-under-my-neck-one-between-my-knees-and-ahhh-cool-sweet-dark-quiet-and-cuddle-up-my-love-we're-both-here-how-strange-how-wonderful.  I have given what I can give for now, to them.  It's time to nourish me.  It's hard to do.  Still. 

Monday, Monday

I am in my frequent state of limbo.  What to do.  I'm at my office.  It's evening, after seven.  Dark in the way that November nights get deeply dark.  It's so ... quiet and calm after the hectic day of patients/rounds/pages/calls/prescriptions.  There's still charting to do ... always.  But I COULD go home, maybe, for a little while.  To see my husband and teenage sons.  Maybe brush Izzy, who got bathed this morning and will hopefully smell MUCH better from a people-nose point of view.  Maybe eat something, since that protein bar from 8 a.m. seems to have worn off.  But - I have a patient in labor.

How do I relate the way I feel when someone is in labor?  Remember when you were in college, waiting for your date to come by to pick you up?  It's like that.  I'm ready.  I have my usual navy blue scrubs on, with my usual comfy white sports sox.  My crocs (I know, I know, they ARE hideous, but a girl has to have shoes she can wash in the sink!  Babies are very slippery and generally fairly messy when they emerge, I'm tellin' ya!) are kicked off under my desk.  It's probably still 4 or 5 hours away.  Or it could be 30 minutes.  That's the conundrum - the lack of predictability.  Which, sadly, was also the case with my college love.  Hence, the canceled wedding a week before.  But I digress. 

There's a kind of mystic energy around me when I have a patient in labor.  It's excitement/anticipation/concern/apprehension  and I guess just plain mother hen-ness, all rolled into one.  I am not a doctor that can leave my work at the office, "turn it off," so to speak.  Sometimes I'm sure it would be healthier if I could.  I get SO attached to my "moms" throughout the pregnancy.  Even though I'm not there in the labor room every second, I have the baby's heart rate tracing up on my computer screen whether I'm in the office - or even at home.  I practically pace.  We live NEARby, only about 5 minutes away.  Yet, sure as I head home, that baby is ready and I'm headed back.  If I stay at the hospital, it practically guarantees a long labor.  Really in much the same way that taking off my makeup and getting ready for bed was always sure to produce that boyfriend, 4  hours late.  Little did I know that I was merely being prepared for my future schedule.  Learning patience before patients. 

GOTTA RUN -- THE BABY'S COMING!!

One of many little funnies . . .

I received this telephone message from a patient one day:

"I am about 38 and 1/2 weeks pregnant.  I was walking and chewing gum at the same time ... and I swallowed the gum.  Will it hurt the baby?"

This is an actual true story.  Promise.  Here's the answer I told my medical assistant to call her with:

"It will not HURT the baby, ... but she will be born with gum in her hair."

Because everything we eat comes out our vagina, right??  Now, of course, we did NOT tell the patient the baby would be born with gum in her hair.  My MA refused to do that.  :) 

Beginning

So, here I am.  7:47 pm on Friday night, November 6. 2009.  Beginning.  I'm not sure what I will say, but I do know that I have stories to tell, feelings and thoughts to share.  From what I believe is an interesting and unusual perspective.  You see, I'm a woman's doctor.  I practice Obstetrics & Gynecology in an "old-fashioned" solo practice.  I see my patients every single visit.  No nurse practitioner, no physicians's assistant, no partners.  Me.  I am with them the first time they hear their unborn baby's heart beating, and mine are the first hands to hold that precious life as it emerges into this world.  And when that little life falters and fails before it can grow and stretch inside, mine are the arms that enfold my patient in sympathy and, yes, love.  I'm not overstating that, I'm merely stating it.  It can be awe-ful work, and ... it can be awful work.  I hope to be able to relate not only what I do, and see, and hear ... but also the astonishing spectrum of emotions I experience.  The self-doubt and second-guessing I can subject myself to.  The dreams peopled by women and babies and nurses and missed med school finals.  The sheer, unadulterated joy.  The privilege of being present in some of the most cherished, as well as some of the most tragic, moments a lifetime can hold.  Let me share my life with you.  Ride along with me if you'd like.  I enjoy the company.