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.
Breaking Point
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.
We Do Not Stand Alone
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.
The Seduction Minefield
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.
The American Character
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.
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