Rants from the Crib

An Ob/Gyn gone mad

Come Ride The Rollercoaster

I am an OB/Gyn. For some, the first thought that comes to mind is, what is that? In this case, you are probably a single male. For those of you who are single men, the answer is, I take care of women.

I do pelvic exams. I do pap smears. I hand out birth control. I catch babies. I do c-sections. I do hysterectomies. It sounds straightforward. It almost sounds easy.

I deal with pain, physical and mental. I deal with disease, physical and mental. I deal with disasters. I deal with miracles. I deal with women. I deal with women and all their world around them. All of it.

An OB/Gyn gets to know their patients, unlike surgeons. Surgeons meet a patient because there is a sick organ, they remove the organ, they take care of the patient for the required six week recovery, and say goodbye, unless they find another broken organ to remove. We also remove sick organs. But we remove them from people we have known for thirty years.

An OB/Gyn begans their journey with a woman when she is still a girl. Girls have cramps, they bleed until they soak their clothes, they start thinking about sex, they have sex. Girls get pregnant.

We talk about sex, we talk about pregnancy, we talk about diseases. We try to prevent them and we look for them.

The girls become women. They come to you because they are getting married. They don’t want to get pregnant. They do want to get pregnant. They have never been examined before. They have been examined a million times.

The women have their babies. We deliver them. We deliver delight, we deliver pain, we deliver reality, and sometimes death comes when it shouldn’t.

The women get older. Their marriages get longer, or shorter. The sexual partners increase, or they go away altogether. Things start bleeding weirdly, and hurting. Things start growing where they don’t belong. Things start falling out.

Then things shut down entirely. Here come the hot flashes, the wrinkles, the dead sex drive, the dissolutionment, and the next generation starts making them crazy.

They lose their husbands, when they weren’t ready to. They lose their children, when they shouldn’t have. They spend a decade of their life caring for invalids. They forget who they are; who they were. If they are lucky, their children start driving them around.

Come ride the rollercoaster with me. Spend a day with me.

C-section, early morning. There is blood. You are tired, from lack of sleep. The day is just starting. You have to explain to a woman that you have to cut her open. She doesn’t want to be. Her husband doesn’t want her to be. There is no choice. There is nothing worse than explaining to someone that they don’t get a choice, that any different choice they make may result in death. The baby is born. The mom is OK. There is relief. Life is good.

Late for clinic. All doors closed, with charts in them. Lights are blinking. Phones are ringing. Your nurse is looking at her watch. You are looking at your watch. You start running. You must be terribly efficient.

There is something in humanity that abhors efficiency. The further behind you are, the more complicated the patients become. When someone bursts into tears, you just can’t rush out their door.

Here is my day.

Room 1. There is a little girl in there, a scared, skinny little girl. In the nurse’s hand is a positive pregnancy test. She knew, but she didn’t know. Her mom is in the waiting room. She doesn’t know. Skinny Girl doesn’t know what to do. She is crying, and twisting the friendship bracelets on her arm. How does she tell mom? How can she have a baby? How CAN’T she have a baby? These issues have to be discussed. NOW. You are scared for the girl. You are sad for the mom. You are sad that another kid isn’t going to finish high school.

Room 2. Elation! You have been taking care of her for almost 10 years. She just got pregnant! She has been trying so hard, so long! You can’t help it, you’re ecstatic for her. You’re ecstatic with her. You hug her and whoop.

Room 3. A lonely tiny bedraggled little lady slumps on the table. This is her first exam in 8 years, because she has been home taking care of her sick husband for that long. Now he has died. She is trying to remember how to take care of herself. She doesn’t remember, it has been so long. She hasn’t seen her friends in years. You leave the room, and feel profoundly lonely for her. You feel her loss. You see her emptiness.

Room 4. A black eye. Where did she get the black eye? She fell. You give her the shelter number, tell her to sneak it in her shoe. You document. You pray.

Room 5. One of your favorite pregnant patients. She’s brought her mom to meet you. You’re flattered, and tickled, and happy to meet her! You joke, you laugh, you enjoy each other’s company. You hate to leave this room.

15 minutes. You were alotted 15 minutes for each.

Back in room 1. Tragedy. Your patient has been going through infertility treatments for two years. She finally got pregnant. The ultrasound shows that the little heartbeat is gone today. You are the one who has to tell her. You watch her eager face go to apprehension, to dread, and watch it crumple. The sobs are gut wrenching. Her husband is sobbing too. It is so hard to watch a man so bare, so crushed. They are destroyed.

Back in room 2. She has a rash. It hurts, it hurts so so bad. It hurts to pee. Her glands are swollen. What is it? She is a sweet girl. This has been her first sexual partner since a long relationship. She gambled. She lost. She has herpes. To do the test, the swab, you have to hurt her, scrub the spot with the sore. You have to tell her, she has an incurable disease. You have to try to figure out how to help her live with it. She cries and cries.

Back in room 3. Your patient has brought in her beautiful new baby! You pass the baby around, hold the baby, hold back sentimental tears at his silly little hat. You have your picture taken. You are the hero. You feel great!

Back in room 4. You discuss birth control. Your patient wants to know options. ALL the options. Now. She wants you to help her decide. Now. You struggle not to look at your watch. She wants you to explain how the IUD works again. She might want that. She might not. She doesn’t know. You feel impatient, and rushed, and put upon. So tell me about the IUD again?

Room 5. Again. The woman there doesn’t want to have sex with her husband. She wants to know why not. Is there a pill? A magic cure? You try to explain how complicated female sexuality is, how many dozens of factors that can affect it. Is there a pill? A magic cure? You can’t fix her. There is no pill, no magic cure. Frustration. Sympathy.

15 minutes.

By the end of the day, you are wrung out. Destroyed. And you may likely be on call for the night. All those feelings; you’ve been tumbled around in them all day. You felt them. You felt them all. You couldn’t NOT feel them. You know these people. How could you not feel joy for them, fear, anger and pride? Not to feel is to die. You can die, or you can ride the rollercoaster.

Up. Down. Up. Down. Down again, just to break the pattern.

When you drive home, it is dark. There is no dinner. You don’t want any. You don’t have time to make any.

Your husband wants to know, why don’t you want to go out to dinner with friends? You need friends, you never see your friends, we don’t have any friends. You try to explain your job.

You tell him, honey, this is my job. All day, I enter rooms containing people who are scared, broken, overjoyed, sick, hurting, elated. I have 15 minutes to see them, get to know them, persuade them to take their clothes off in front of me, and tell me their darkest secrets. Small talk. You are the world’s leading expert. Small talk is what gets you through their embarassment, their discomfort, their fear. You are so good at it that sometimes they ask you when you are going to do their pap smear. It is done. You did it while you were chatting, distracting them, making them laugh.

Now he wants you to leave your house, go to a party. A party filled with people. The small talk. You just can’t handle it. You’re small talked right out. You never want to talk to anybody again. You are so tired. Your husband looks at you. He doesn’t understand. He thinks you are introverted, and disinterested, and no fun. What you are is out. Out of emotion. Out of love. Out of hate. Out of caring. Out of conversation. Out.

If you are lucky, you get to go to bed. If you are not, you get called back into work. More joy, more fear, more elation, more sadness, more blood, more babies. Now you are doing all this in the dark, all night. You mustn’t drop your guard. You must be ON for everyone, to explain, to persuade, to rescue them from ignorance and fear, and choose the right thing for them, the good thing. Sometimes there is no good thing. Forget your own issues; you are being paid to maintain their energy, keep them compliant, keep their spirits up.

If you are lucky, you get to go to bed.

The alarm goes off at 5, and you are up again. Another whole day. And another. And another.

Room 1. Room 2. Room 3. 15 minutes.

Come ride the rollercoaster. Come ride it with me. Today, and tomorrow, and tomorrow, and tomorrow…

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5 thoughts on “Come Ride The Rollercoaster

  1. I have much appreciation for what you do ! I think the area of medicine you have chosen has to be one of the most challenging medical specialties to be in. (At times, do you wonder why you didn’t choose podiatry, or some other specialty?) I can only imagine how trying it must be at times. Doctors give up so much of their personal life. I don’t think people truly realize just how much.

    You sound like a good, caring doctor–and your patients will never forget that. It can be tough out there for patients–you find a doctor you trust and like and then they move or quit taking your insurance. You are back to square one. It’s happened to me a few times. The system in and of itself can be a roller coaster.

    I appreciate that you let us in for a glimpse via your blog and thank you for being there when we need someone who can help. Those 15 minutes can mean the world to us.

    • I ask myself why I am not a dermatologist daily. 🙂

      I have cut back to working part time, and now that I am not buried under constant pressure, I am beginning to remember why I chose this profession after all.

      Delivering babies is such an honor. It’s like being invited to the most important event in someone’s life – every day!

      I love to see the look on someone’s face when they realize that I really really GET what they are saying.

      Sharing a laugh or a good cry with someone is so humanizing – and it’s a bonding experience you never forget.

      And there is certainly never a dull moment!

  2. I agree so much with everything Dia said. I had no idea it took so much of…well…EVERYTHING, to do what you do. I had wondered sometimes how an ob does it, they have their normal patients in a day, and then also (unlike other doctors) some of those patients are pregnant and can have the baby at any time, day or night, maybe during a time you have an appointment with another patient, or maybe during dinner, and I was honestly a little curious about how that worked. I like to think and wonder about things that don’t really concern me, it’s a bit of an odd habit of mine, I think and daydream too much (or so I’m told). Thank you so much for all that you do, and also a big thank you for giving us a glimpse into your life. I have had bad doctors and I have had good doctors, and even if they didn’t realize it (I hope they have), the good ones, despite our limited time together, really did help me and I appreciated that more than they knew. I am a shy person, especially at doctor’s appointments because I have a bit of Iatrophobia, so I may not always say exactly how appreciative I am, but I’m sure I’m not the only one who appreciates it so and has a hard time vocalizing it, so on behalf of shy people everywhere, thank you!

  3. Lindsay on said:

    Beautifully and perfectly written. Thank you for sharing.

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