10:30 pm
Just leaving clinic
So many highs
Lows
The in betweens
The teens
One, a mom and trying to do right without the support to do so
Another who prayed her way into a negative HIV test
And one who cried so hard that I scooped her up like the baby she is
When I said there was a baby in her belly
7:45 bright and early
Well dressed
Clearly headed to work after this
A Husband and a Wife
I assume there’s a baby that they want but no
He’s understanding but she’s furious
There’s pain that keeps them apart
Intimacy they both long for
Pain making that intolerable
And I think to myself
How many missed moments have that had
As I write a script for 16 pain pills
Just so they can be together
The woman, run down and beat up
Trying desperately to get disability
Since she can’t stand long enough to work her job any more
The tingling in her feet ever present
Her touch of sugar never controlled
Eyes that can’t quite see enough to drive at night
Her fast food job closing well after sunset
And the kids
She doesn’t know how she’ll feed
Worry consuming her
As she reads that the funding for her children’s meals at school is being cut
On the phone a congressman said she shouldn’t have anyway
Using free wifi
Font on extra large
The girl who says
It was just that one time
I always use condoms
Always
But He said he loved me
And he said just this once
And so
Tears
Tears are falling
And I want to cry too because I know this story
This is the story I hear all too often from girls
Girls I’m about to diagnose with something that will never go away
These are the moments that I pray
When I pick of the phone to call the lab saying
“Jesus”
The one word prayer that providers all around me know
Black suit
Brooks brothers dress shirt
The one with the women’s cuff links
$98 price tag
She’s here too
38 and finally ready to have a baby
a baby we’ve talked about for years
a baby we planned for back when I sent her to have her eggs harvested at 32
back when we decided to do the myomectomy
back when I started writing for her to work from home one week every month
because the endo made getting to the office impossible
But she’d fought through undergrad and law school and the bar
She wasn’t about to let Endometriosis take that from her
And we talk happily
About the new apartment
3 beds, 2 baths and an attached garage
grey argyle for the nursery
gender neutral of course
the nannies she’s already interviewing
And I write for and coordinate those prescriptions and appointments
A child so desired yet not a reality
The asthmatic living in a rundown apartment
Unable to afford the medicines to avoid using her pump every day
Never able to afford enough visits to accurately diagnose her pelvic pain
And unwilling to take a script for it because robbery is a thing in her neighborhood
The asthma pump
That’s what she’s here for
And its $4 and it’ll last a few weeks
While the controller
With no insurance is $240
A third of her rent
So I write for 8 refills at a time because she really can’t afford to see me either
Pregnant?
No it can’t be
I’m 43.
I’ve been through menopause
Or at least that’s what she said a month ago when she came in complaining of nausea and headaches.
And now as I search for the heartbeat I should be hearing at 14 weeks
Another prayer slips from my mouth
Because as I sweep the ultrasound probe across her belly
I see the baby she didn’t know she wanted
Isn’t going to be
I’ve been to 8 different docs
She says as warning bells dance in my head
And no one can fix this pain.
The GI doc, the internal med doc, the ER doc who accused me of drug seeking behavior
And even psych!
The pain is real
Its all the time
From my navel down
It wakes me from sleep
Its stolen my 20s
I’m 31
What do you know different that they didn’t know?
Her rebuttal as I say “I’d like to do an exploratory laparascopy because I think you have endometriosis.”
The girl who’s life turned around on Concerta
D student to A student
All the while wanting to be cinematographer
And finally able to focus long enough to shoot some film
This was my morning.
“I think he’s going to pop the question!!!!!!” squeals my colleague
And we laugh and look at wedding dresses
Venues
Honeymoons
Décor
And the Breitling she’s buying him
Because we’re modern women
Of course he gets an engagement gift too
And we sneak into the cocoon that shelters us from the sadness of the morning
Eating lunches packed from groceries bought at Whole Foods
Drinking coffees that cost more than some medications our patients struggle to pay for
The middle to upper middle class shell
that Protects our minds from what we know we’re going to face this afternoon
Pregnant
Yes, pregnant
For the 2nd time in as many years
And only 8 times as many years on Earth
Scared
Confused
Because they used condoms
The condoms I taught her to put on in clinic
But not every time
Not on Valentines Day
Which seems to be the day they conceived for a 2nd time
And she cries
Big fat tears
Tears that mourn her stolen childhood
The things she dreamed she’d do
Tears that choke her and me
And I’m so moved by reality that’s being visited upon her
That instead of the seat designated for a person with my degree profile
I move next to her
The seat normally occupied by a parent
For the kid I’ve watched and educated for years
And like a child
She finds her way into my lap
And we both cry
Running
Literally
Across campus to my 2 pm seminar
Thankfully, its mandatory because I remember my 2nd year of med school
Vividly
You couldn’t catch me in a class that wasn’t required attendance
They’re there
And engaged
Something about teen pregnancy resonates with some many who know
That had they become a parent as a teen
They might not be able to dedicate all their time medicine
Let alone Step 1
And I implore them
It’s so different over there
My morning was teen pregnancy, pregnancy loss, and trying to get pregnant
It was seeing patients who I knew couldn’t afford a follow-up so I wrote enough prescriptions for the next 12 months
Diabetes education
Nutrition, despite the little to no training I have in it
It’ll be pre-natals, post partums, and annuals this afternoon
And that’s what the schedule will say
While the patients will be way more complex that a chief complaint ever is
And just like a God appointed example
My pager goes off 911
My patient, my Pre-eclamptic, that I feel like I’ve carried on prayer to 32 weeks
From her diagnosis at 14 to now, always certain she wanted babies
Me just hoping to get her one
The surgeries she bore telling me all the while
“I’m doing it for my baby.”
The 2 failed cycles of in vitro
And now finally, a viable pregnancy
That patient
has had a few late decels and she’s seeing spots
Lecture cut short
I’m running again
And talk yelling at my chief resident to be ready to cut as soon as I scrub in
4 lbs 3 oz
Apgars of 6 and 9
She’s little but mighty
Her momma is grateful
Her dream, and to some degree mine too
Screaming her little heart out
And I’m relieved
And behind
Back in clinic I find exactly what I predicted
I somehow managed to only be 75 minutes behind
And I’m back in the middle of it all
Measuring bellies and talking about nurseries
Telling parents it’s a girl, it’s a boy
Its Triplets
Rejoicing because that triplet pregnancy follows two miscarriages
Because those parents are going to be awesome
Because its their hearts desire to be exactly where they are
Because this is the job
This is what I signed up to be
A bridge
Between science and people
And its what I love
And what I’m reminded of each and every day
Even when Its hard and there are tears
The mom who I diagnosed with gestational diabetes
Who logs her blood sugars meticulously
Proudly showing me her notebook of tightly controlled blood sugars
Because we have a deal
Water birth if baby is under 8 lbs
The tremendously difficult decision to be hospitalized
Because the throwing up just won’t stop
And hyperemesis gravida’s ICD-10 code is being added to her chart
And she’s got 2 kids at home
But she’s got to think of herself
Of the baby she’s still growing
The new babies
Squishy and brand new
And oh so sleepy
The pictures we take and post
Doctor and Baby and Momma
The sprinkle of Depo still protecting our new mommies from having Irish Twins
Like my sister and I
And somehow its 8:15 pm and I’m walking out of my last patient’s room
My dedicated and profoundly understanding nurse along side me
Good night girl! Go home to those God children of mine!
I say, shooing her out the door to her response of
“Don’t be here until tomorrow charting!”
And I do make it out of the office
Charting completed 2 hours later
I stop by the nursery to find my patient
Who struggles to her feet post c-section
to thank me for believing she could be a mom
For fighting for her fertility
And I tell her
You did this.
You’re the warrior.
I’m simply the armory,
making sure you could get what you needed to succeed
And fighting your insurance to cover it.
We laugh...those battles littering the calendar charting this long fought war that we’ve now won.
Obstetrics and Gynecology,
Yup,
This is the best decision I ever made.
