A (Very) Delayed Reflection

25 01 2013

Last night before I went to bed, I reflected a bit on how far I’ve come since this time last year.  Not only have I completed 3rd year and almost all of my required medical school clerkships (only EM to go), but I know what I want to do with my life, have a project for my MPH capstone, and have a solid list of places I would like to apply to residency.

I also have hundreds of patient stories tucked safely in a file folder of my brain, and I can really see now what experienced physicians are talking about when they say that you will carry some of your patients with you for the rest of your life, and those interactions and their outcomes have already begun to shape not only my professional interactions, but they often spill over into my personal ones as well.

If you’ve ever read the book The Things They Carry by Tim O’Brien, or if you knew a soldier in the Gulf, Vietnam, or Korean wars, you’ll know that soldiers could only take the personal items with them that the could bear the weight of on their backs.  As a result, some chose to carry only memories with them on the front lines.  After the past year, though, I would argue that often times the weight of your memories can impose even more strenuous a burden than any physical object could.  Those types of weight, the emotional and psychological ones, can also be the most difficult to drop.  I haven’t experienced any events whose emotional impacts could be considered traumatic; there have been some very low days, and there have been some great days, but over time any extreme emotions have fallen away.

For the most part, though, the really positive events have balanced out the negative ones.  Just as I was drifting off to sleep last night, I was reminded of one of the best experiences I’ve had in medicine, one I haven’t shared here yet.  This is either because the overall negativity of that rotation temporarily overshadowed it, or I hadn’t realized the impact until recently.

This couple came to the hospital late one afternoon when I was working on the labor and delivery floor.  It was about 5pm, and my shift ended at 6, when a woman came into triage in labor.  The resident shooed me into the room to “get the story.”  I don’t remember her name, or her husband’s name, which sounds terrible considering the impact they had on me.  She was transferred from a hospital about 30 miles south, which was odd because nothing about her labor was complicated up to that point.  She was almost completely dilated but refusing to push.

When I first went into the curtained partition, the husband startled and rushed to cover his wife.  They were Muslim, and believed steadfastly that the woman could not be seen by a male health professional at all.  They had asked for a transfer from the other hospital because she had gone into labor and no female physicians were scheduled to be on duty there that evening.  Her husband had driven her to us.

They were a very kind, good-looking Yemeni couple in their mid-20s, and I liked them.  The husband asked me with concern in his eyes whether I could make sure that only women (aside from himself) would be allowed into the delivery room, and I had to take a moment to think about it.  There was 1 female resident and 1 female attending on then, but after shift change at 6, there would be 3 female residents on night call but no female attendings.  This could pose a problem in an emergency, but they knew the risks.  I was just a 3rd year student with no power or influence at all over the physicians, but I needed to advocate for this patient and her husband.

So I found my cajones and spoke up.  The residents looked at me like I had a Venus flytrap growing out of my nose.  The immediate reply was “No, She’ll get whoever is available to deliver her baby.  This is a teaching hospital.”  I asked again, got another non-committal answer, and then changed tactics.

“What if I ask Dr. S if she is willing to stay a bit late to help with this delivery?” I said, and then the 3rd year resident shrugged.  He said there was no harm in asking, so he picked up the phone and made the call.  Not 5 minutes later, another (female) resident had interviewed and examined the woman, determined she was fully dilated, and wheeled her back into a real room.  It took her less than 2 hours to deliver a healthy baby boy, and then I went home.

The next morning when I went in to do my post-partum day 1 note, I smiled at the “Female Staff Only” sign on the door.  The new parents thanked me several times for making sure they had a safe birth experience, and at the time I graciously accepted their thanks but brushed it off in my mind, feeling that I hadn’t actually done anything.  Each time I visited, they asked me to explain and affirm the advice that the doctors, nurses, and lactation specialist had given them.  They knew I was a student, but they seemed to trust my opinion more than some of the trained professionals who were taking care of them.  It was very weird.

Because I wasn’t a health professional, they even asked my opinion of the baby’s name, which they had not even revealed to anyone in the family.  They had a strong, significant Yemeni name picked out, but both were nervous that the name would be too confusing for the baby’s American peers and were considering naming him Ameer instead.  After the difficulty they’d already encountered with keeping their faith and their heritage in a community that isn’t always enthusiastic about accommodating such concerns, I felt for these people.  My suggestion was not to waver from the great name they’d chosen, and if they were worried about social acceptance, use Ameer as his middle name and allow his schoolmates to use that name.  And you know what?  After they had thought it over, that’s exactly what they did, and they were grateful to not have to compromise their beloved name selection for the sake of assimilation.

They took their baby back home the next day, and I briefly missed having them there in the hospital to chat with.  Then the rotation reverted to business as usual, and the tiny family stayed in my mind.  It wasn’t until last week that I fully realized why they had made such an impact.

That was the first time that I had ever stepped up, advocated for a patient, and actually made a difference.  The realization was kind of intense.

So there you have it, almost a year late, but published nevertheless: one of my happiest moments in medicine, delayed only because I was slow in the realization.  The funny thing is, as bad as that rotation was, the memory of this couple makes the entire ob/gyn experience much lighter to carry.




2 responses

27 01 2013

Wow beautiful story!

15 02 2013

It was the first time in your life that you experienced “being someone’s doctor”. You will have many many more times like this one. Enjoy it. It is the very reason why I am still a practicing physician.

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