My dad gave me his fetal stethoscope as a gift at the start of residency. It’s a slender, wooden stick with a cup on either end, one for the doctor’s ear, the other for the pregnant woman’s abdomen. During his career, he had used it hundreds of thousands of times to listen for fetal heartbeats. I can tell from the well-worn nicks and scratches, and the smoothness of the stem, that the tool has served a meaningful purpose in my dad’s hands.
During my third year of OB/GYN residency, I became determined to subspecialize in gynecologic oncology. I realized that I enjoyed taking care of cancer patients the most. Despite being overworked and perpetually exhausted, I always had the energy for the long surgeries and involved patient-family conversations. I reveled in the challenges and the teamwork. I knew I wanted to do this for the rest of my life.
The first surgical case of the day was Margaret, an adorable, delightful lady with advanced cancer. Her husband of 60 years, Charlie, stuck close to her side. They hobbled down the hallway, arms around each other, free hands holding matching canes. Charlie asked us to take good care of her; she was all he had. I assured them that her attending surgeon was someone I would trust to operate on my own family members. Charlie and Margaret shared an extraordinary, palpable connection. Their hearts and souls were so clearly intertwined I knew they couldn’t survive without each other.
The Supreme Court has stepped into the health care fray and will hear a challenge to the individual mandate in the Affordable Care Act early next year. The main questions under debate are whether the federal government has the authority to require that people obtain health insurance and if they can impose a penalty for those who don’t comply.
Indeed, no one likes the government telling them what to do, especially when it comes to our bodies. It doesn’t matter that the bill grants exemptions for financial difficulty, religious reasons, low income, and temporary loss of coverage; or that the penalty is as low as $95 in 2014; or even that law enforcement would miss most offenders, just like the IRS only tracks down a tiny percentage of tax evaders. The very idea that anyone’s autonomy is compromised is repulsive to most Americans. National polls show that a clear majority views the controversial mandate unfavorably.
My first job out of college was as an entry-level research associate at a health care consulting firm. I wrote glossy briefs for CEOs and COOs of hospitals, pharmaceutical companies, and insurance firms, answering their questions on wide-ranging issues from how to alleviate emergency department overcrowding to how to cut costs with disease management programs. Usually, I had two days to scour the Internet and interview sources before producing a memo of highlights that could be skimmed by a busy executive between meetings.
At my first performance review, my manager told me that my analysis and writing were excellent; but I “wasted” too much time looking for references. I would be more productive if I filled out the templates without trying so hard to validate new data. Time is money, she emphasized.
Hinna’s husband escorted her into the emergency room. He looked suspiciously at the young women purporting to be doctors. A pool of fluid was collecting at Hinna’s feet, staining her modest, ankle-length dress. The husband said in broken English that Hinna was having a baby. At that moment, my co-resident yelled from the exam room: “Cord prolapse!” I looked in and saw the umbilical cord hanging out between Hinna’s legs, which meant the fetus was getting little to no blood flow. I put Hinna in a wheelchair and ran for the operating room. There was no time to get an Urdu translator to explain to the stunned couple that Hinna needed an emergency Cesarean section. In the next minutes, antiseptic was splashed over Hinna’s abdomen, she was put under general anesthesia, and a baby boy was born. When I shared the good news with the husband, he looked me in the eye for the first time and thanked the staff for saving his wife’s and baby’s lives. He doubted that they would have survived if he were still in his village.
Dr. Jones had excellent bedside manner. She listened empathetically to patients and exuded a comforting energy. The staff liked her. Her patients were devoted to her. The residents enjoyed her easygoing style.
The first time my chief resident assigned me to be Dr. Jones’ surgical assistant, I was relieved. As an intern fresh out of medical school, you always breathe easier operating with a laid-back attending. My chief resident reminded me that I should call her for help at any time. She didn’t expect any trouble though. It was a routine minor procedure.
The first time I met Nikki she lied to me, omitting key aspects of her medical history and denying substance abuse. When I confronted her with lab results, she demanded that I repeat every blood and urine collection because the hospital must have mixed up her specimens with someone else’s. She had a ‘don’t-mess-with-me’ attitude from the start. I was up for the challenge.
The first time I met Ms. B, I found a turkey sandwich hidden under her right breast.
“I left it there for safekeeping,” she explained, chuckling. Ms. B had to sweet-talk an eager nursing student into getting it from the cafeteria. “Shhhh,” she gestured with her index finger up to her lips.
Ms. B had just come out of the ICU, having been admitted for heart failure, blood clots in her lungs, and uncontrolled diabetes. Weighing almost 450 pounds, she needed help to turn over in bed, so she rarely moved. It wasn’t until her transfer to a cardiac unit that her new nurse noticed something she didn’t recognize between Ms. B’s thighs. An in-hospital OB/GYN consult was promptly ordered, and there I was.
Mike was a towering man with army tattoos who clearly felt out of place on a labor and delivery floor. He carried a pink bag filled with baby supplies, a bulky car seat, and an overstuffed leather purse. His wife, Kerry, clung to him, cursing and digging her manicured nails into his arm with every labor contraction. He was relieved when the anesthesiologist came to place Kerry’s epidural.
I liked the two of them right away. Mike was good-natured and cheerful. He called me “Doc,” and bragged that he once helped deliver a baby in a cab. Mike and Kerry’s first child was delivered by c-section because “the baby was sunny side up.” The couple wanted to try for a vaginal delivery this time.
Home for the holidays, Elisa was a college student, who arrived in the ER with severe abdominal pain. After blood draws, radiological tests, specialist consults, and an invasive diagnostic procedure, we finally learned the source of her pain: cancer.
A determined young lady, Elisa was going to be the first in her family to finish college. Her parents had made significant sacrifices to help her achieve this dream. In fact, they stopped paying for health insurance to save for tuition. I offered our social work services to assist with coverage issues. Elisa declined, saying she could not put her family further into debt.
My patient was veiled in layers of heavy black cloth from head to toe. I could see blood staining her white socks as I waited impatiently for a female Arabic translator. Slowly, I told the patient and her sister that I was worried about her pregnancy, and would need to do a pelvic exam. As feared, I soon saw that she had a miscarriage. “Can I see the baby?” she said, gesturing to the container I discreetly covered with a clean towel. “We need to take him home for burial,” the sister added. I hesitated. A 12-week fetus wasn’t an easy image to prepare someone for. I laid it on clean gauze and explained, “It’s very early. It won’t look like a baby.” My patient nodded and held out her hand. At the sight of it, she shrieked, then clutched the fetus to her chest and began to pray.
Cheryl was a cancer survivor, recovered drug addict, HIV carrier, and devoted mother of 3 kids. At age 35, she had been cured from cervical cancer after surgery and radiation therapy. However, due to treatment-related fistulas, she had been in and out of the hospital for most of the year. I was taking call for the gynecology service the last time her family brought her in, delirious and with black, sticky stool oozing from an opening in her unhealed abdominal incision. She needed wound care and close monitoring in the intensive care unit (ICU). I called my attending and paged the ICU team simultaneously.