Mark vs Cancer

Thursday, August 07, 2008

Farewell to OB

For an unlucky 600+ babies in this world, the first thing they saw coming out of the womb was my ugly mug, which could explain all the crying.

Two of these infants were my own sons, although the first delivery I ever witnessed was that of my only daughter, who was born on the weekend before I started clinical rotations in medical school. When the doctor held up our new baby and asked me to declare her gender, my mind, which must have been stupified in wonder at witnessing the miracle of life, went blank and the answer to this most basic of medical questions eluded me. I stared at the doctor, at the baby, at my wife and finally the kind doctor relieved the palpable confusion and declared matter-of-factly, with vicarious shame, "Uh, it's a girl."

Well, I got better at identifying gender as time went by and the deliveries started to pile up. Before too long, the ins and outs and subtleties and dramas of a labor and delivery unit, which had seemed so intimidating, began to be familiar and even comfortable, though I never lost the wonder and awe of the event. Rapidly, obstetrics became my favorite aspect of residency. As the final groans and shrieks and splashes and cheers of yet another birth would crescendo down the hospital corridors at three a.m., it always seemed to bring a welling of (but not actual!) tears to my eyes.

I chose my residency in order to get extra training in OB, including the ability to do Cesarean deliveries. I felt that if I was going to be delivering babies in a rural environment, I needed to be able to handle not just the routine and uncomplicated births (which, honestly, rarely require the supervision of a physician, as women were delivering babies for a several eons prior to the advent of modern medicine--anyone could catch a baby), but also to handle the small percentage of births where the life of mom and baby hang in the balance. When things went south in a hurry, I wanted to have the training and confidence to be able to deliver via C-section, sometimes referred to in medicine as the "vaginal bypass" surgery.

I got excellent training in residency in Colorado, and was able to put that to good use for two years in my first practice in Wyoming. I also became aware that not only did I enjoy OB, but that I was (in my humble opinion) pretty good at it. I gave good care, developed a sharp clinical skill and intuition, had generally very positive feedback from patients and families, and earned the respect of my medical colleagues.

So considering all of that, how can I now walk away from OB?

I have a number of relevant excuses: the demanding call schedule, the emotional fatigue, the high risk of litigation, the difficult patients. The most accurate and understandable excuse is that, in order to accept the many lifestyle benefits of my new job in Colorado, sacrificing my OB practice would become a necessity. It would be essentially impossible, both politically and geographically, for me to practice full-spectrum obstetrics at a major metropolitan hospital: family doctors just don't deliver babies or do C-sections in that setting anymore, not to mention the fact that my new practice would be located at least twenty minutes from the hospital, which would be prohibitive.

The bigger and more poignant truth is that, having practiced OB for five years (including residency), I no longer feel willing to make the personal sacrifices required to continue it. Been there, done that, had some good times and bad times, now ready to move on. That sounds a bit crass, but it is probably the most concise summary.

I admit to very mixed feelings about this. I have invested a great portion of my time, youth, money and well-being to learn a rarified skill that will now turn fallow, likely never to be utilized again.

But there you have it. Who knows what the future will bring? Who, a mere three years ago, could have guessed that we would move to Wyoming, practice and move again in such a short time frame. Maybe in the future I will provide obstetrical missionary services in foreign countries, or moonlight in rural hospitals. Maybe I'll get to be the hero on the local news when by chance I happen upon a woman delivering in her car alongside the highway. Or maybe I'll miss OB so much that in another three years we'll move back to an environment where I can practice it again. (Unlikely.)

But for all of the endless memories, the triumphs and terrors of the labor deck, the privilege of participating directly in the miracle of life, I bid obstetrics a most fond farewell. I will miss it dearly . . . as I sleep uninterrupted through the night.


princess jen said...

Wow. You make some good points. It would be fun to hear some horror stories about the difficult patients you allude to. It's so hard to find a good OB anymore because so many of them are leaving. My SIL had to "lie" to get one down in Vegas. No one she called was taking new patients, so she had to make an appointment and pretend not to know she was pregnant. I have a great relationship with my doctor and it makes such a big difference in how I felt during my pregnancies and deliveries, both of which had complications. It's so comforting to know that I had a doctor who cared about me as a person foremost and not just as another invoice to bill (I had that experience with my first 2 doctors). Good luck in your new endeavors! I can't wait to hear more about it.

Danalin said...

I've always said that I would love to have an OB like you. Actually, I feel sad for all of your official patients, but I am grateful that you are not retiring from being my brother-in-law and so I will still be able to call on you with my multitude of questions and concerns in future pregnancies. So really, this is semi-retirement for you. :)

Lisa said...

Wow--lots of big changes for you guys. I hope the move went well and that you are getting settled. Please email us and give us your new address and such (and new job info). Say hi to Liz for me!