Long Beach Island part 2…

———— Contact ————
During the third day of our seven day stay I received word from another resident that one of my patients had delivered her first baby. According to this resident both the mother and the baby were doing well. During our residency we follow at least ten pregnant patients, from their first OB visit to the delivery of their baby. This could prove tough, as mothers-to-be can deliver anywhere from 37 – 41 weeks gestation; this is a 4 week window for which we’re to keep our pagers on and ready in the event the patient goes in to labor.[1] For example I’ve been called on Tuesday morning at 3am because my patient was in labor. This can prove difficult on someone’s lifestyle and it is for this reason that one of the first questions of a new Family Physician is whether or not they practice OB. Typically, the answer is no. We call these pregnant patients ‘continuity OBs’. I hate to use the cliché, ‘going through the motions’ but there are just some patients with whom this is the mindset. To us, these patients represent a number out of ten that bring us closer to our requirement. Like I said, however, this is only with a select few of the patients. For most of them, I feel honored to be a part of their journey that ultimately results in new life. This particular patient, I’ll call her Debra (in order to protect her identity), I had felt a strong connection with. I saw her for one of her first OB visits and I remember walking into the room and thinking, she’s really scared. She was only 18 and this was to be her first. When I was put out of commission by this mass I thought of her and hoped to be able to recover in time for her delivery (my time line for my recovery was and has always been overly optimistic). My speech was still significantly affected but I still had to call her to congratulate her and to see how she was doing. This was significant for me in that this was my first contact with a patient since the surgery. Because I was on electronic medical record (EMR) I looked up the progress of her stay.[2] It read (among other things),”mother and baby doing well.” I was relieved as childbirth can sometimes (luckily rarely) have bad outcomes. I found her number on the EMR (it was a cell phone number as I had called her before for another pregnancy related issue), took a deep breath, and dialed. I had to dial ‘*67’ before dialing so that the call would reveal an ‘unknown’ number on her phone, a habit I have picked up in all my contact with patients(my wife once mistakenly did not do this and unknowingly gave her cell phone number to a patient. The patient unfortunately had extreme anxiety and called her every few hours, including late at night. She eventually had to change her number. I realize that giving out your number does not necessarily have to end with a change in telephone numbers, but all it takes is one person for this to occur. It is for this reason that I have made it a habit not to give out my number).

Epic- our new EMR
Epic- our new EMR

“Hello? Who is this?” a male voice answered.

“Hi, is Debra there?”

“Who is this?” the voice again asked.

I had gathered from the defensive voice that this was probably her overprotective boyfriend. I had met him once in the clinic (he didn’t come across this way at all during the visit) and his voice was distinct. But for a first time father who was receiving a call from an unknown number this was understandable. “You can tell her this is her doctor, Dr. Chiou.”

“Oh, okay. Hold on, one second.”

I could hear in the background, “Debra? He says he’s your doctor?”

I could hear the phone being handed over, “hello?” she answered. From my visits with her in the clinic and my other encounters with her on the telephone, I knew it was her.

“Hey Debra, it’s Chris.”(I always introduce myself as ‘Chris’ to my patients to the chagrin of many of my superiors. The counter-argument against using first names is that it may lead to a crossing of some imaginary boundary, making the relationship less professional. This argument may be right, but I have always been uncomfortable with someone addressing me as either Mr. or Dr. Chiou).

“Hey Chris! I heard the news. How are you doing?” By then word has spread to my patients that my hiatus was health-related. I found this response interesting, as I had called her to inquire how she was doing, yet she was the one asking me how I was.

“I’m doing okay. “ I then quickly attempt to divert the attention back to her as I hate having any attention on me. “Listen, I’m sorry I wasn’t able to be there for your delivery. I have had some health issues. But luckily it sounds like everything went smoothly. How’re you and baby doing?”

“I’m doing well, baby’s also doing well. Her name is Athena, after the Greek Goddess.”

“Okay Debra, I just wanted to check in. I’ll be keeping tabs of you from my computer here and through the other residents. Good to hear from you. Talk to you soon. Bye.”

One of my biggest obstacles
One of my biggest obstacles

My initial reaction after that encounter was one of puzzlement. I didn’t know Debra had such a contentious boyfriend, were my first thoughts. My next thoughts had more to do with the reaction of both Debra and the initial responder to my call, more specifically my voice. I have always been a very self-conscious person, it is for this reason that I do not like to eat in front of people and the reason why I don’t haven’t had much contact with my patients. Both my sister and her husband were in the room and heard the call. “Wow Chris. I don’t think she could tell,” my sister said to me. Even though I figured that most or all of my patients had heard about my surgery I still had hoped that eventually one day I could speak without a trace of the speech delay and that my patients wouldn’t know. I was worried that my speech impediment might hamper my ability to get through to my patients. I saw it as akin to an overweight and out of shape fitness instructor. But according to both my sister and brother in law the speech difficulties were not evident in this phone call. Furthermore, the reaction to my call seemed to indicate that Debra could not tell. Maybe she could tell, I have not talked to her since that call.

————– Death —————-

The last day of my stay there involved a bottle of red wine and a conversation with both my sister and brother in law. At one point during the conversation the surgery was brought up. I told my brother in-law that one of my biggest fears during this ordeal was not recovering. “Wait a minute, wasn’t dying during the surgery your biggest fear?” he asked.

My sister and her family in LBI
My sister and her family in LBI

I had to think about this, he was an Emergency Room physician, someone who dealt with death every shift, asking me this. “No, I guess not,” I finally said, “even though I knew death was a possibility it is not what scared me most when I underwent surgery.” This was true I knew that there was a chance of death, but to me this would have been the easy way out. In fact, when I first experienced the double vision, I was convinced that it was a manifestation of a disease called Multiple Sclerosis. This a condition that can be very debilitating. It is a diagnosis that immediately arises to a clinician’s head once there are unexplained neurological symptoms. This is a disease without a cure, there is no surgery can make this ‘go away’, and medication only slows the disease process. I would have taken death over this diagnosis.

http://www.nationalmssociety.org/

A link to the National Multiple Sclerosis Society webpage.

“I was worried about him dying,” my sister chimed in, “especially when it was past midnight and the surgery was not finished yet.”

To me death from this was not my fear, the protagonist often dies in movies, however it is rarer to see the hero’s life permanently change for the worse once a movie is through and the credits roll. Don’t get me wrong, dying and the death process is something that upsets me, especially when I think about it. But it is the thought of the aftermath (my family, the funeral, financial difficulties) that upsets me, not the actual process (unless I am to die a slow and painful death). The next question naturally is,”why didn’t this ‘aftermath’ scare you then?” I have no good response to this; perhaps my lack of fear of death was an act of selfishness or complete ignorance.

 

 

 

 
[1] Pregnant patients who go in to labor before 37 weeks gestation are considered higher risk and are deferred to our OB colleagues.

[2] In December of 2012 Sparrow went from all written records to all electronic. This was a daunting undertaking for the hospital, but I feel a necessary one. Due to the change, long gone are the days of illegible consultations and missing notes. Now accessing someone’s medical record is easier.

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