Missing Grandma

Recently my grandmother was sick. I got news of a stomach bug, and didn't think much of it. Then, she was sicker. She went to the OR for a bowel resection after an obstruction was diagnosed, and had subsequent kidney failure. I anxiously pressed my parents for what the surgeon said, for a consent to send me the operative report, for information on previous kidney function, and prognosis. I asked, and asked, and they just couldn't tell me much. I desperately wanted to see her, wanted to talk to her physicians doc-to-doc, to really understand what was going on and evaluate her with my own eyes and hands, to tell her I love her. Because after all my time working in the ER, the ICU, with patients that are very sick, I know that there are no guarantees at eighty-five, that sometimes there are things we just can't fix.

And I was here. Working. Taking care of other people's families, while I just wanted to take care of my own. I would get little bits of information, and tell my parents what I knew about her illnessess, that this was a normal course for bowel obstruction, that often times kidneys can recover if it is an acute failure. I talked to my sister before she went to visit, warning her that Grandma would look sick, and have a tube coming from her stomach to her nose draining vile looking green liquid, and that this was normal and she shouldn't be alarmed by it. I was angry about being here, knowing the only time I would get off for this illness was if she died from it, and by then, what would my being there matter?

I thought about Grandma as I touched my patients, caring for them, praying that somewhere, some other doctor was taking good care of her. That some other doctor was away from his own family because he was taking care of mine.

And she got better. Not all the way yet, but better. The kidneys recovered, as I thought they would, and she was able to eat again. But this experience stuck with me, because someday, someone I love will be sick, and I won't be able to be there. I won't be there to care for my loved one, to explain to my family what is really going on, what these medical words mean, and I'll be making guesses over the phone, just like I did this time, waiting for an operative report to be faxed and feeling helpless. This is an unspoken sacrifice of becoming a physician, and one that I underestimated. Somewhere in the greater universe, it makes sense to me that this is the sacrifice of all physicians, and that we take good care of our patients because these patients could be our own loved ones, and sometimes they are.

But I still wanted to be there.

ToMAYto, ToMAHto

I work with with thirty-three different attendings. Who want patients managed, needles held, stitches thrown, lacerations repaired, knots tied thirty-three different ways. It was part of the learning curve, at first, learning which attending liked what, remembering who to call about different problems and learning to not be upset when I didn't remember who preferred what. And now, I'm starting to develop what I like. Many attendings have offered me pearls, on patient management and surgical skills, and I'm starting to develop a framework of what I want to do, what I think works well. And this is even more frustrating, because then I end up with someone new, who doesn't like the way I am doing something, and makes me do it a way that doesn't feel natural, or right. And really, no one is very wrong, but it means I am never right. It's like how some people say "toMAYto" and some say "toMAHto." No one is actually right, and everyone insists that they are.

Here are some examples:

Yesterday in the OR, an attending showed me a way to reload my needle without touching it with my fingers. Use the pickups, inch it out, and regrasp it in a way that it was ready to throw the next stitch. Better technique, he explained, it would allow me to avoid needlesticks and was a more sophisticated surgical technique. I practice, and look forward to my next c-section, where I can practice it again on a real patient. I start, expecting the attending to be impressed or at least not say anything, but she yanks the needle out of my hand and shows me how to do it....exactly like I used to. I pick up the needle, reload it using my fingers, and silently curse this frustration.

An attending that puts me on the stool in front of the mother. She does this under the assumption that this is a good position for me to deliver the baby, but I have figured out the real reason. She puts me on the stool, then waits for the crucial moment when the baby is about the deliver, then rolls me out of the way and delivers the baby herself.

Antibiotics. Some give antibiotics for GBS+ mothers at the beginning of inductions, and some only when they are actively laboring. The downside to the first option is a mother can receive fifteen doses of a medication that burns their veins and is unnecessary for that long. Alternatively, a mother can labor quickly and not get enough of a dose in and end up with a baby in observation in the NICU for 48 hours. So, I started to ask each attending, when would you like the pencillin started? They couldn't believe I was asking this, like I didn't know. Then, I would ask with one option offered, would you like this when they are in active labor? Some people then thought I was correct, and some thought I was an idiot. So, no matter what I think or what I would do, I look stupid at least half of the time, just trying to please everyone.

I am fairly ambidextrous, and can operate either right or left-handed. Some think this makes me versatile, and encourage maintaining both. Others yell at me to pick a side and stick with it. Now I don't know which side to stand on. Likewise, I can clamp and cut cords after delivery lefthanded. Usually I hold the baby in my right arm, tucking baby's feet under the crook of my elbow, and clamp and cut lefthanded. I don't know why I do this. It just feels right, to hold the baby securely in my more dominant arm, and use my left hand for the instruments. But, attendings sometimes ask me if I'm right or left handed, and when I tell them right-handed but better with fine motor skills with my left (due to violin training, I think), they frustratedly instruct me that I should only be managing scissors around a newborn with my dominant hand. Again, I'm not sure which that is.

There are probably infinite variations on how to do one surgery, one delivery, and that's what I'm learning. Even though I've never had a bad surgical outcome, somehow I am always wrong with how I do it. I'm trying to take the best of everyone's suggestions (ie yelled orders), and compile it into my own technique, but starting to realize that it will be awhile before I can really employ what I think is best. And I can't say I wouldn't be the same later, after a career's worth of doing what I decided is best...I'd probably want to hand my hard-earned knowledge along too. But it's frustrating now.

I think I'll go sit down on the roll-ey stool and practice reloading my needle.

Lessons In Cultural Competency

I'm white.

I mean, really white. Scandinavian mostly, a little Irish and Scottish, and part Sicilian. Not Sicilian enough to give me the gorgeous olive skin of my relatives, rather, just enough to turn my eyes brown and leave me with the fair and freckled skin of generations of peoples who have never seen the sun. When it comes to those "race" boxes on standardized forms, I only get to check "White" or "Caucasian." There's really nothing else there.

But, I can switch fairly fluently between English and Spanish in the exam room. I've begrudgingly completed the "cultural competency" courses of medical school and as required by my employer. I tell myself that I'm open to other cultures, I enjoy experiencing things different than what I'm used to. I really did consider myself culturally competent, at least for a white chick.

But this month, I've had a few situations that were new to me, and showed me far more culture and much less competency than I had ever seen with any of the informational videos provided by the HR department. It turns out that understanding, and respecting, another culture that is much different than your own is very difficult, especially when a pregnancy and child is involved. And sometimes that a new culture is a lot of fun, and it's a privilege to join it, at least for a little while.

Lesson #1: Las Mujeres

I come into the room to say hello to a new patient. She is ready to push, but I can't see her. There is not a word of English, and at least twenty people in the room, all female.

"Excuse me, excuse me." I jostle through the crowd. I say hello, and introduce myself, and ask, in Spanish, if she wants everyone in the room for delivery? I'm expecting most to leave, but instead, they all circle the bed, and are ready to help her push.

Who are all these people? I start to get a little irritated as they touch my delivery instruments "No, please, those are sterile", and bump me as they crowd around the bed (hello, please give the doctor some space!). But I come to find out that in this patient's culture, all of the females she loves are here for delivery. The dad is nowhere to be found, but this patient's mother, grandmother, great-grandmother, multiple tias (aunts), sisters, nieces, and even her own young daughter are here, ready for her delivery. In this culture, birthing is women's work, and all the women are here to work.

The mother cries "No, no puedo" when told to push. The tias respond with a chorus of "Si! Se puedes!" And so it goes on, until this baby- a girl- delivers, and all the women crowd over to the warmer to see the new nina, the new addition to their family.

I smile, for the small reason that they are now in the pediatrician's way instead of mine, but for the bigger reason that this is an enviable culture. I'm not even sure if I have close relationships with half as many women as this girl had at her bedside supporting her for delivery. They all were there, and knew what to do, how to support her and love her during this significant event in all of their lives. Se puedes, indeed.

Lesson #2: A Native American Preemie

There was a patient who came to our clinic from the Indian Reservation, with the complaint of bleeding. She bled off and on, and eventually went into labor, and delivered a twenty week-old nonviable baby. These are very sad situations, and we have people and programs at the hospital set up to help families cope with this. However, this family wasn't interested in the bonding time offered, or even seeing their baby. That baby needed to be out of the room as soon as possible, as it is bad luck to be around anyone who is dying, and particularly the spirit of a dying child that could affect future fertility. I came around the nurses station a few minutes later and looked suspiciously at a mound of blankets in a metal bassinette. Was that...? One of the nurses picked up the blankets, and gave them to me to hold. It was the baby, the smallest one I had ever held, with an irregular, slow heartbeart visibly fluttering under tiny ribs, with small hands and wispy eyelashes. I touched his forehead gently and pulled my hand back, startled, as I felt how cold it was. The longer that baby was cold, the more slowed-down his metabolic processes would be, and the longer he would hover somewhere in between a heartbeat and inevitable death. I wrapped him up in a swaddle and tucked him under my sweater, holding him close to my chest, sitting at the nurses station for about forty five minutes, until I couldn't see a heartbeat any longer.

And here is the cultural difference that I struggled with: His parents weren't wrong. To me it seemed wrong, to let their baby die cold and alone, but that's only because of my own learned customs of love, grief, and healing. It seemed like the right thing to do to me to bridge the gap for this baby between this earth and wherever these little ones go to, but just because I felt that was right doesn't mean his parents were wrong.

Lesson #3: An African-American Queen

It's three in the morning. At this point, I'm wondering why I went into obstetrics. There are floors above me filled with sleeping patients, sleeping residents, and yet I am running around the third floor, awake with another laboring patient. This girl is sweet, a 16 year old here with her mother, who is earnestly coaching her daughter's labor. She's ready to push and have a baby girl, so I put my gown and gloves on, and get ready to help her to push.

She doesn't need it. She pushes well, and her mom shouts "That's it! Push hard, baby! Soon we'll hear that queen holler!" And I smile. Not the absent, tired smile I feel like I usually have, but a genuine smile. For a minute, my shoulders relax away from my ears, and I remember why I loved obstetrics. I'm excited for this family. I'm ready to meet this queen, too.

Aftwerards, I congratulate mom, and grandma. As I'm leaving, I can hear grandma on the phone talking to someone, saying "Listen to that baby holler! Speaking of, you should have seen this young woman that delivered her. Not but a baby herself."

Lesson #4: A Somali Refugee

There is a fairly significant Somalian population in Phoenix, a community of refugees. Most tend to be difficult patients- mistrustful of the hospital system and Western medicine, along with a significant language barrier and cultural gap. The roles between men and women are so much different than I could have imagined based on my own experiences. In our house, my mother had a career. My husband changed careers and moved to support mine. I go to work, and he does the dishes. In their house, the husband is the decision-maker. The patients will not answer me, not acknowledge my presence or information, until their husbands are there to communicate directly with me. The mechanics of birth are challenging because of scar tissue left behind from genital mutilation. It's hard to do an exam under the many layers of robes that the patients insist on wearing. They tend to refuse medications, and epidurals, and any procedure outside of the normal vaginal delivery.

Because of all these things, when my Somali patient's baby's heart rate went down, and then came back up, I thought it was a good idea to talk to her about a c-section. She didn't need one now, I explained, it was only that I wanted to talk to her and answer her questions while everything was calm and her baby's heart rate was fine, while I had time to use the translator phone and could explain everything about the consents.

Three hours later, I'm bleary-eyed. I've tried to be sympathetic, and explain things differently. I've tried to sit back and enjoy the melodic rhythm of a language that I don't understand. But I can't. I've spent my night sitting here, instead of in bed, and I have no consent. What it came down to was the patient understood why I was talking to her about it, but said she didn't want surgery. She wanted to be healthy, and babies die every day, so if something happened, she wanted to remain healthy and not intervene for the baby.

No!! I want to scream. This is America! I can almost certainly make BOTH you and your baby healthy, even if you needed an emergency section. But, she didn't believe me. She wouldn't sign the consent, and ultimately, I can't make her. She is deemed mentally competent, and able to make decisions for herself and her unborn child.

In the end, after my shift had ended and my friend had taken over for the day, the baby's heart rate went down, and she watched them stay down- for ten minutes- as she and an attending tried to cut through genital scar tissue to deliver the baby as fast as possible vaginally, since the patient was still refusing the operating room. My hours of trying to consent her were wasted, she had more of a wound that she would have with a simple cesarean, and her baby was in the NICU.

Did it make sense to me? No. Was I angry, and worried for her and her baby? Yes. But I had to leave this situation with these frustrating conclusions, and realize that maybe that was what she wanted, because she was a culture so different than mine.

These are the real stories of cultural competence. I watched the required videos from human resources, but I didn't learn what these situations taught me- that cultures are so different. Sometimes it's fun, and sometimes its horrifying, but the "competence" isn't learning to manipulate situations to fit your own culture. It is learning to recognize other cultures and try to accept them, to try to bridge a gap for yourself in between your beliefs and these new ones, where you understand a little bit more than you did before the interaction.

As I sit here with my afternoon coffee, reflecting on these interactions, I reach for a butter spritz cookie- my grandmother's recipe- to have with my coffee. No reason other than it's 3 pm, and that's what Swedes do.

As I head for the cookie jar, I smile. At least I am competent in one culture.

A Month on Labor and Delivery

Day 1: I feel great. Excited for labor and delivery, have my lunch packed and my latte in hand. Hair is brushed, lipstick-ed mouth is smiling. Bring on the month.

Day 4: Kinda tired. Thirty-two people are now in the world that were not only a few days ago, and since it was my hands that guided them out, I am now responsible for seeing their mothers every day starting at 4:30 am.

Day 5: Hair brushing now seems like superfluous vanity. Give up in favor of extra thirty seconds of sleep.

Day 5, later: Am primary surgeon on a cesearean section for the first time. Realize that nurses do a "count" of all surgical instruments/sponges before I close the patient, to make sure nothing is left inside. Nurse reports to me "Counts are correct, Doctor." I smile. Thank you.

Day 6: How did my fridge get empty? I seriously don't remember eating all that.

Days 7&8: Don't have time to go to the grocery store.

Day 9: I am now grocery shopping in the hospital cafeteria. What do we need? Milk? Cereal? Fruit? Dinner? A recent trip to the cafeteria yielded 6 milk pints, 5 pieces of loose fruit, a box full of salad, three tins of cheerios, and a takeout box filled with cooked chicken breasts and potatoes. The cafeteria worker laughed at me, then realized I was serious and rang it all up. Swipe...and done.

Day 10: Baby count continues to climb, as does the length of my postpartum rounding list.

Day 11: Find time to go to Fresh and Easy. Please bear in mind that F&E is about 500 feet from my house. Someone with a good arm could throw a ball into their window from my front yard. Nevertheless, I feel a great sense of accomplishment and provision for my home as I drive over. Get there and realize that the coupon I have been carrying around in my scrub pocket for five days has expired yesterday. Frick. My smugness evaporates, and deflated, I buy the groceries anyways.

Day 11, later that evening: Realize I have forgotten to buy dog food. Rather than make the journey across the street again, opt to serve the dog a chicken breast mashed with potatoes, left over from aforementioned cafeteria shopping. He loves it.

Day 13: Thinking of the raw pork loin waiting for me in the fridge (it seemed like a good idea sitting there all pretty and healthy in the grocery store case), I opt to bring home dinner from the cafeteria. Chicken enchiladas- a favorite of my husband's- were being served, and I bought a plate and took it home. I slid it onto my own china, reheated it, and served it. About halfway through, he squints at me, and asked if asked if I had made these? I just laughed and asked...what do you think? He laughed too.

Day 15: I didn't have time to do my laundry, and ran out of underwear. Opted to buy a new pack from Target instead of devote time to mountain of dirty clothes. Must remember to maintain efficiency and get all other shopping done as well while I am there. Cat sand? Check. New mop? Check. Dog food! Yes! What else? I just cant remember.

Morning of Day 16: What is that smell? I turn my head. It's stronger now. I surreptitiously sniff my armpit. Oh God. That's what I forgot at Target. Deodorant.

Day 18: Deodorant still not purchased. Just when I'm about to give up and start changing my scrub tops thrice daily, I pick up a prescription for the hospital pharmacy and notice they carry deodorant. Hallelujah.

Days 20 and 21: Working both weekend days. Miss husband. He comes to hospital for lunch. I feel bad that he's driven 45 minutes each way to see me, but he insists that the Banner Bistro makes the best chicken sandwich in town, and he was hungry for a good chicken sandwich, so it's really not my fault. He also brings me and my fellow intern our favorite frozen yogurt treats, which I know is an additional 20 minutes out of his way.

Day 23: So, so tired. Realize that between the drive home and needing to come back at 4, I will spend only eight hours at home. Decide to sleep at the hospital, which allows me to sleep in until 5:30, and roll out of bed and into my patients room. Don't care that my hair isn't brushed, but realize the deodorant I've worked so hard to procure is at home. Dammit.

Day 23, later that morning: Purchase another deodorant from pharmacy. Pharmacist grins at me. "Didn't you just buy one of these?" I glare at him, and add a toothpaste to my purchase. He laughs at me.

Day 24: Baby count: 97. How is it possible that there is anyone still pregnant left in Phoenix? I must have delivered everyone by now.

Day 25: My first needlestick, while suturing a difficult vaginal laceration. Must figure out how to get to occupational health.

Day 26: Buy second pack of underwear and larger laundry basket.

Day 28: Mother, upon hearing laundry plight, mails me five pairs of Victoria's Secret panties. I'm sure the postage cost more than what I spent on Fruit of the Loom pack from Target. Gratitude for supportive family eases my tiredness and makes me smile.

Day 30: Had a slow day today. Only delivered one baby. Is it true? Did I really deliver everyone? I was kinda joking before. Hmmm...

Day 31: Never mind. Pregnancies, if not in Phoenix, have now appeared from surrounding areas, including, but not limited to: Camp Verde, Strawberry, Show Low, the Grand Canyon, Colorado City, Buckeye, Salt Lake City, and California. None of these places are within two hours drive of the hospital. Appreciate, really for the first time, that this is a true tertiary care center. Humbled by the fact that I am part of a program/medical center that people travel hundreds of miles to get to, because of what we can provide in terms of high-level care. I don't work with these patients right now- they go to the more experienced residents- but wonder how it happened, and will happen, that in a few months I will be helping to provide care that people drive hours to receive.

Final Count: Babies: 106. Husbands: 1. Supportive family members: more than I deserve. Lost hours of sleep: countless. Pairs of scrubs: 44. Hospital Meals: 61. New pairs of underwear: 17. Exhausted and humbled residents: 1.

Counts are correct, Doctor.

Pretty (Tired)

I used to be pretty.

Theoretically, I still could be. I have some decent raw material. Taller than average. Slender, athletic frame, if a little pear-shaped. Hair that is straight without intervention, light brown with natural strawberry highlights. Brown eyes, dark eyelashes, full lips. Clear skin with a few freckles. Maybe not beautiful, but okay. More than some people have to start out with, and I feel like I should make the most of it.

I'm working in the clinic right now. I adore office work. Things that most people take for granted- sleeping at night, wearing your own clothes to work, eating lunch- are joys that I get to experience in clinic that I don't usually get while working on the wards. I can put on pants that fit, a purple shirt that looks good with my skin tone, and put on thirty seconds worth of makeup. Undereye concealer, powder, a little blush, a lipstick that has been in my white coat for months. Four people stop me this morning to tell me how great I look. "Wow, are you wearing makeup?" "You look great!" "I like you in your clothes" (side note: does this sound inappropriate to you? Would you also like me out of my clothes?) "You are really pretty." They always sound a little surprised when they say that.

I smile and laugh a little. I tell them thank you, that this is how I used to look in my other life. This is how I looked before I went to medical school, became a doctor, and worked harder/got less sleep than a mother of perpetually newborn twins.

When I'm at the hospital, I wear the required men's scrubs. They are too short, hug my hips too tight, and gap in the chest. My hair is always up and never combed. Sometimes I wear my surgical hat even when I'm not going to the OR, just because I feel like it's cuter than my head. My skin is dull, I have pimples from my surgical mask, and I look bruised on the thin skin under my eyes. My joints ache with tiredness. I look weary. I feel old.

I always sort of wondered when I would start looking older. I look young for my age, and always have. Indeed, the "little doc" came out of people's surprise that I was old enough and accomplished enough to be wearing a white coat. When would I stop looking like the "little doc" and just a doctor? Now I know.

I think this process will age me. Like the presidents. Those guys always start out looking okay, and gradually their wrinkles form and deepen, the skin looks sallow, their hair goes gray. By the end of the term, they have aged much more than four years. And I think this four years of residency will do the same to me.

However, hopefully then I will have a stable practice that I love, a little more sleep at night, and more working hours during the daytime. I can wear comfortable scrubs that are made for women. I'll feel better, even though I'll be older.

And hopefully I'll make enough money to buy more expensive cosmetics, and afford a few units of Botox. I think I'll probably need them. :)

Like A Surgeon...Cutting For the Very First Time

Ok. I know that is a Weird Al song, parodying Madonna's "Like A Virgin." Nevertheless, this melody is what plays through my head as I learn to be a surgeon.

At first, it was little things. A "gateway" surgeon, if you will. I could sew up fascia, and close skin. Then, I got to come around to the surgeon's side of the table, and do a little more. A skin incision here, a fascial incision there. I'd retreat back to the assistant's side for the important things, like opening the uterus, delivering the baby, sewing the uterus closed

Today I stayed the whole time on the surgeon's side. And suddenly, all these little pieces of things that I had learned to do on their own added up to me being the primary surgeon, me being able to do an entire cesarean section on my own. I could ask for the knife, and retractors, and scissors, and all the things I needed and actually be able to use them. I could smile as my chief resident handed me the suture to close the uterus, instructing me to "sew like the wind" as blood poured out of the gaping incision. I could reach my hand into a person's abdomen, and feel their aorta pulsating under my touch, hold their uterus and feel the baby kick my hands, feel their pointy vertabrae from the inside instead of the outside.

It's kind of like working in the cadaver lab, but this person is alive! It always startles me how warm everything is to my touch, how their is so much movement in vessels, muscles, enclosed babies...how much life I can feel resting in my hands. And I think this is part of the draw of surgery...to be able to do this to another person, to have your hands deep inside them and not only have them live through it, but have a desired outcome from it.

Even routine surgeries are scary for me at this point. I am more focused then I ever have been, with time slipping away from me as if it was only seconds. I leave warm and sweaty, more tired than if I had run a race. It's scary, but exhilirating.

Like a surgeon...cutting for the very first time...

A Few Stories

Once in awhile, the residents get together and just laugh. We have to, with some of these patients. Here are a few stories from this past month's work:

A kind resident goes to evaluate a woman that has presented for multiple times for drug seeking behavior, on the premise of chronic pain. She probably does have pain, at least from being so addicted to narcotics, but we don't want to prescribe anything because it's not good for her, and not good for the baby. As I'm leaving triage, I hear her shouting at my (male) colleague: "Bitch, you don't know my pain!"

I enter the delivery room and greet a woman who is fully dilated and ready to push. I begin to give her my earnest speech about how to push with an epidural, how to pull your legs back and take a deep breath and curl up around the baby. This speech is complete with a demonstration that I think (hope) is helpful and I'm sure makes me look like a giant fool. As I talk, the woman sneezes and delivers her baby.

In clinic, my friend was performing a well-woman exam, and asking about any changes to the patient's breasts. The patient says, "Well, they've gotten bigger..." and asks the doctor to measure her breasts to fit her for a different sized bra! My friend, being a kindhearted woman who used to work in a department store and thus is qualified to do this task, considers it but ultimately decides this is a doctor's office and refers the woman (in all seriousness) to Victoria's Secret. Do you document that referral on the chart?

Meanwhile, on the antepartum ward, another resident is called urgently to evaluate a patient. She has had a cerclage, meaning her cervix has been tied shut in order to help her avoid premature delivery. It is much akin to the string tied at the base of a balloon. It appears that the cerclage has come out, as the nurse reports finding a long black string with a knot in it. The resident comes right away, and the nurse presents him with a paper towel spread between her hands. On the paper towel is a lone long black pubic hair, with a knot tied in it. He explains to the patient, Ma'am, the cerclage is fine. And no, I don't know how that hair had a knot in it.

Over on labor and delivery, I am working with the most anxious patient in the world to push. I'm trying to distract her, to calm her, so we are talking about her horses at home, and shooting animals in the wild, and her latest hunting trip. (Let me say here that I do not have much to add to this conversation, as I am a liberal almost-vegetarian.) Nevertheless, I act interested as she says she'll just die if this baby is a city boy instead of a country boy. She pushes a little more, and I tell her I can see the top of the baby's head, and he has some hair! She asks me if by looking at the top of the baby's head, if I can tell if he is a Republican?

The next delivery I have is normal, and uneventful, and to very nice parents. I hold the baby up and announce the arrival of their baby boy! Both parents start crying; the dad in joy, the mother in horror. What? I glance at their pink carseat, the baby's name written on the board. Oh. Yeah...this wasn't the Liliana they were expecting. The dad is ecastatic, and has already named the baby Jr. whatever his own name was. The mom asks me if I'm sure I got the right baby? I am sympathetic, even though this question is obviously answered as the baby is still attached to her via the umbilical cord. It's not often in this day and age that parents don't know what they are having, and even fewer times that it is not what they expected. On the postpartum visit the next day, she asked me if she could go home. Was she feeling okay? "Yes, and I need to get to BabiesRUs. I have a lot of exchanging to do."

A Different Life?

I've recently had a little more time for reflections on my life, my chosen path. I'm working nights, and when it's not too busy, I'm able to lay down in between patients. I don't sleep because I am always waiting for my pager to jolt me out of bed, but I can enjoy the quiet. It's getting cool again, and I'm able to run outside, putting one foot in front of the other as my mind untwists whatever is subconsciously present, much like a dream. In these moments of quiet, I wonder about what my life would have been like, had I not gone to medical school. I don't doubt that becoming a doctor was a good choice for me, but was it the only one that was right for me, like I had thought at the time?

Let me be clear. I don't regret becoming a doctor. But, I think about what my life might have been like, as someone else. Or at least as myself, having made different choices. I could be a yoga instructor. I would have been good at that. I could be a professor, with a doctorate in clinical nutrition- my other professional love- or maybe a dietitian, like some of my friends from college had become. I could join my friends on their travel, because I would have time and money too, without worries of massive school debt or a constrictive schedule where I celebrate two days off in a row. I could be a wife and mother, a homemaker, like so many of the women at my gym and who come to see my at the hospital.

I know I am already a wife. But I'm talking about being a different kind of wife. The kind of wife that takes care of chores, the kind of wife ever available for listening, and sex, and companionship. The kind of wife different from what my own husband has. He has the kind that spends every other night away from home and is away even more hours on top of that, who can be distracted, with a limited attention span and patience, who wants to use the bed only for sleeping and expects an equal contribution, if not more, to household chores. The kind that a "dinner out" consists of driving 45 minutes to the hospital and enjoying a cafeteria meal together in between pages.

I think in a different situation, I could have really enjoyed being a mother now. I feel separated from my peers as they have children, as their facebook pages are filled with darling photos and cute anecdotes. I look at my facebook page, and decline putting up another status, because I don't have much to say outside of my life at the hospital. I deliver babies every day, and hand them away to anxious mothers, eager fathers, most younger than I. I am a little jealous, not only for these couples starting their families but for the sole fact that the mother is in bed at 4 am while I am up making rounds.

My dad says that anyone can get pregnant, but it takes a special person to have a baby- meaning me, the obstetrician. He says that I'm special, because these choices that are difficult, and sometimes isolating, that set me apart from other twenty-somethings...they mean that I have worked hard enough to get to have this privilege of being different, of getting to do a really important and special job.

One of the very best things about my new job is the other residents. Aside from childhood friends and a few treasured college/med school friends, I haven't connected well with others as a young adult, I think because my life took such a sharp turn away from the typical twenty-something experience. I'd go to church, to small groups, gym classes, and parties, and find that I really didn't have much to offer to a conversation once the conversation turned away from medicine. Relationships shifted into a more familiar territory- ie doctor/patient- as acquaintances began asking me advice on their pregnancies, but it didn't do much for me feeling like one of the gang. Some didn't understand why I was gone so much, why I wasn't available to volunteer more or be more reliable. And now, I have seven other people that deeply understand my situation. We can never get together all at once, because at least two of us are always working at any given time. We can share these stresses and fears about being subpar spouses, worries about becoming good doctors, laughing at jokes that others wouldn't understand or find funny. They understand that a date is spending time together, regardless of whether it is at a cafe or cafeteria.

The reason I write these somewhat wistful and non-cogent thoughts down is that upon talking with other residents, I've found this to be a fairly common thought process, and not one that I think might be intuitive to someone outside of residency. A chief resident mentioned to me that she loved her job, but felt like she could be completely fulfilled with a different life as well- one as a homemaker and mother. A third-year resident who I adore has a craft closet and could stay home happily baking bread. My heart broke for another resident who came back sobbing back from maternity leave. My best friend from medical school wrote me that she was literally sitting in clinic the other day, looking at the patients piled up, wondering what she had gotten herself into, wondering if maybe she should have considered other options, like cooking school. One of my loved co-interns told me once that she thought what she did was important, and she wanted to be good at it, but at the end of the day, this was a job, and her life and family came first. The census overall is that we love what we do, but we'd love a normal life for once too, and fantasize a little about what our life would look like if we hadn't invested all this money and time, if we had made more typical choices.

Kinda makes me feel better about my half-fantasy of becoming a stay-at-home yoga instructor.

The Parking Garage

One of the perks of my new job is that I get to park in the physicians' garage. This may sound minor, but is a substantial benefit during the Phoenix summer. While initially exciting, it has proven to be an interesting insight into the sociology of doctors.

It is labeled "Physicians' Garage" and "Parking: Doctors Only." At first I thought, I'm a doctor. Sweet! I have finally reaped some reward from the eons of school and debt I have undergone. However, on further examination, the first three floors are "Parking: Doctors Only" with blue tape around the pillars. If you continue up to the 4th and 5th floors, there is red tape. I notice that my parking sticker is red.

What does this mean, you ask?

The first three floors are reserved for ATTENDING physicians only. They get a blue sticker. The resident physicians have a red sticker, and have to park on the 4th and 5th floors (the 5th is uncovered). So, the reward for completing medical school is a car that is equally roasting as the CNA's in the parking lot down the road, except I have to walk up five flights of stairs to get to mine. I pull in at 5 am, and wind up the garage past floors of empty spaces, and park in the crowded upper floor. The cars on the first floor are shiny, new, and mostly expensive. Undoubtably, they do not have a gas tank that is perptually one-third full. They have dark tinted windows, rendered irrelevant by the fact that their "covered parking" is actually fully covered. Later in the morning, the bottom floors become more full, and then empty again by the time I leave.

I have drawn a few conclusions from the sociologic observation of the physicians' garage:
1. I am not a doctor
2. I will become a doctor after residency
3. At this time I will
a) have more money
b) sleep more
c) be able to touch the steering wheel with my entire hand instead of two fingertips
d) said steering wheel will be attached to a choice car that will not be running on fumes
e) and generally have a better quality of life overall

I look forward to parking on the bottom floor of the doctors garage.

Just for Laughs

They say to smile instead of frown, since smiling takes 15 facial muscles and frowning requires 35. It's a simple matter of efficiency.

Some women take this advice a step further, and laugh instead of push. Every now and then I'll have a woman that is ready to deliver, and instead of pushing, something will make her laugh and she'll just pop that baby out. Instead of screwing up the face and pushing as hard as she can, the woman will give a laugh (creating some abdominal pressure) and the head will come out.

What a fun way to deliver. I love it.