The chronicle of a lonely do-gooder family doctor who survived.

Sunday, November 15, 2009

I love my job part two.

Last night, as many of my high school friends whom I hadn't seen in years gathered to celebrate Kevin's 40th birthday, I was stuck in the hospital, sitting at the foot of the bed of one of my favorite patients. I was on call, attending for the residency, and trying to figure out how to deliver this patient's baby who'd arrested at 8 centimeters dilation. Her temperature was rising and the fetal heart rate was showing signs of distress.

For 40 weeks, this patient had greeted me with a huge smile at each prenatal visit. She was so excited to be pregnant again, having miscarried her last pregnancy at 13 weeks the year before. She had no insurance, and most of her family was in Mexico, so for her the care and support she received from the clinic each week was literally a lifeline. Each visit, I'd work so hard to reassure her that things looked normal, diffusing her anxiety with humor. I knew she and her husband had wanted a boy and so early on, long before her ultrasound, I laid my hands on her belly and told her "Yes, definitely a boy, you can tell just by feel." When she came in with her ultrasound results two weeks later, she and I had a huge laugh at the report of a single, healthy male fetus, despite the fact that I had a 50% chance of guessing right.

At her last visit the week prior, realizing I was going to be on call this weekend, I told her, "I want you to come in and have the baby on Sunday, this is what works best for my schedule," as if she had any control over the situation. When I received the page from OB triage announcing her arrival in active labor, I wasn't the least bit surprised.

Yet, I had really been hoping to make it to Kevin's party. All night I watched the clock. At 6, I thought, if we could get her membranes ruptured, maybe we'll deliver by 7 and I could get there by 8. At 8 I thought, if we could rotate the baby I'd get her delivered by 10 and I could still get there by 11 to say hello. Now it was midnight, the Sunday morning she promised me had arrived, I had abandoned hope of making it to see my old friends, and things were looking hairy.

We started oxygen, we tried position changes, I rotated the baby's head, I called an obstetrician, the first step in a process that usually results in C-section. But she was strong, focused, and determined and despite my plans to be elsewhere I was right there with her. At 130 am on November 15 she delivered on her own a beautiful healthy boy.

I finished my paperwork and drove past Kevin's house on my way home, surprised to discover everyone still up. Despite my exhaustion I still got to visit with my old buddies and share pictures of our kids. I told Kevin all about the delivery earlier and we both laughed at the fact that the parents decided to name this child that shared a birthday with my friend, "Kevin."

But the thing that blew me away the most, just as I left the hospital, was the look in my patient's exhausted, blissful, and grateful eyes as she told me, "Thank you for the work you do."

I swear I don't make this stuff up.

Friday, November 13, 2009

Oh no.

Matt Haughey, founder of Metafilter and user #1, is in the hospital and twitter is probably going to crash with the flood of well wishing. -->: #mathowielove

Guy tweeted his own seizure. That's hardcore geekery.

Get well soon, Matt. Metafilter is the only website that matters.

Sunday, November 8, 2009

House passes health care reform

I love Wonkette's headline this morning: "House Votes to Kill Your Grandmother & All Christians, 220-215."

The House bill, which has to go through further watering down in the Senate and is a *long* way from becoming law , is a step in the right direction. Problem is, I think we are *far* past the point where "steps in the right direction" are going to take us where we want to be: quality, accessible, evidence based health care. I honestly think that, with the exception of health care providers and people with serious medical problems, very few Americans understand how far we are from that goal and how entrenched the institutions are that are trying to keep us from this goal.

I am all for market based approaches that improve quality and drive down costs. The problem is that quality and cost aren't where insurance companies are competing. They compete with strong arm negotiations with hospitals, denials of coverage, and lobbying money. This bill, while setting up some standards for fair competition, is also requiring the American People to give more money to the insurance industry. I personally am just skeptical that they won't find other clever ways to screw us; their primary allegiance is to shareholders, not patients. Yes, this bill does currently include a limited public plan (which I highly doubt will make into the Senate bill) but (as I understand it) it is a self-funding plan for individuals without employer sponsored insurance who are going to be forced to buy something, and it will compete against similar plans offered by private insurers. Pretty weak tea. Anything that doesn't allow a person with employer provided insurance to opt into a public plan, you know, in case they're curious about what consumer-driven health care would really look like, falls short.

If our legislative branch wasn't totally corrupted by lobbyists, the negotiations should have started with "Socialize all medicine now!" and settled for the optional public plan. I am not a communist, I just want a better health care system that's in-line with the rest of the civilized world.