Confessions of an Intern

Week Forty-eight

Week Forty-eight. Aaaahhhhhhhhhhhh. (Read deep sigh)

While I have made great bonds with the nurses on OB and humbled beyond words to be a provider who can put their minds at ease when I walk onto the unit, I am relieved to be done with OB for my intern year. I have learned a great deal, realized I have some very strong viewpoints on certain aspects of "healthcare for all" and it's pitfalls, and handled my fears by facing them. This month has seen me showing more irritation for some of the things I am asked to do that I disagree with, and speaking up. While that may not be popular with some, I feel it is also the only way to get my opinion across.

Surprisingly, I feel comfortable now putting on the booties, blue gown, and sterile gloves when the nurses say we are ready to have a baby. Many times, I feel I could handle the delivery on my own without an attending. Of course they are there when they are asked in time. And I am comfortable with my instincts when they say to go ahead and have the woman start pushing and I don't like the way things feel. I will always trust my gut instinct, as when I go against that inner voice, I always regret it. We've had a few close calls, but so far all good outcomes this month. There are some sad stories with babies who have been born, but none of it because of their birth event.

I shared my secret of being a closet writer with the night nurses while I worked with them. I was shocked when one of them said they had come across my book Finding Grace. It is fun to hear what she thought of it. And how once you start talking about it, many people love to write and are bashful about talking about it. It seems writing is a very personal thing to most people. It is also very evident I need to be in the mood to write and be creative. Last week, a reader asked me why chapters were getting shorter. It is not because I've lost the love of medicine. I was pulling 75-82 hour work weeks and I was exhausted. And something about OB takes away my excitement for medicine. I still love it, I do a very good job at it, but I recognize in myself why I did not even entertain OB as a specialty.

I love the miracle of childbirth. It is an honor to be there when a family welcomes a child into their family. I used to have a tear in my eye at every delivery I watched. Then I came to my hospital and worked with a different population. I have watched a woman give birth, and still be texting on her phone, barely glancing at the baby. I've watched a woman nearly die from her birth, and not even be able to look at her baby. The father, thank God, cherished that beautiful little girl. I've gone in to take care of a post-partum mom and baby pair and watched as the mother did not even have the slightest interest in the baby, she did not want him. Fortunately for him, he had and uncle who wanted to adopt him. Our system is so messed up we could not just send the baby home with family who wanted him, we had to get social services and legal involved. I've delivered babies to women who have been pregnant 7 or 8 times, had multiple abortions or do not have custody of their other children. I've worked with women with mental illness and watch as they are sent home with a baby who I know will be neglected, because they cannot even remember where they are. The injustices we submit our future generation to is nowhere more glaring than at an inner city maternity ward. It is so uncommon for us to deliver a baby to a married couple, we almost make it a party when there is one. I'm not saying only married people make good parents, but our norm is a woman who has no interaction with the father of the baby, or who has multiple fathers for her children. Often, we see a pregnant woman, and her grandmother or aunt as her support system. And that is not race specific, more inner city culture specific.

I must say, my education is more complete for the setting under which I am completing it. My attendings are all so different in the way they do things, I have no choice but to learn different ways of doing things. I am so relieved my comfort level has increased with the normal way things are supposed to go that I am able to think more critically when something is going wrong. Someday, I will have developed "my way" of doing things. A few people have described to me how my competency will develop: after 20-40 deliveries, I will feel capable/comfortable; after 100, I will competent and proficient, after 1000 I will be an expert. I would hope it would not take the full 1000, but I understand where it comes from. Odds are after 1000 you will have been exposed to almost everything that can go wrong. We'll see, I seem to be a magnet for "once-in-a-lifetime" experiences.