« recognizing childhood diseases, part 3 | Home | how should doctors be paid? part 1 »
“they don’t care how much you know…”
By | May 12, 2010
i know someone who could have died in childbirth.
of course i know lots of ladies who had births that were medically “abnormal” (my daughter’s 48-hour labor last week, or my own three postpartum hemorrhages, for example), yet who bounced away whole and hearty, who’ll testify they had a righteous, flamboyantly amazing, “wild-good” experience. but i also know someone whose labor, birth, and postpartum were dangerously mismanaged, practically from start to finish. i wasn’t there and am not an eyewitness. however, from her accounts, i have to wonder whether the primary problem wasn’t the egocentrism of her caregivers, both alternative and orthodox – who didn’t want to acknowledge that something was going wrong under their care; who blamed her for it; who handled her callously; who made her pain worse not better; who lied to her about her baby’s health; who frightened her in ways i believe were manipulative; who denied accountability, abandoned her, and stuck her with the bill.
fortunately, she’s not much the self-blaming type. my anger and outrage don’t hold a tiny birthday candle to her own. on top of all that rage, i sense a deep betrayal, not least because she hesitates to tell her story, what with all these happy birthers around. it reminds me of the burning silence of a rape survivor at a wedding shower. sometimes we can’t speak because we know we won’t be able to stop.
don’t worry, i’m not going to bring you down! today, she’s the strong, healthy, creative, kick-ass, go-to gal she was before it all started, older and wiser, but still a beauty, with a cute funny awesome firecracker of a preschooler, who has a thing for the number 5. (or used to – i may be behind the times!)
it’s humbling and frightening to me to meditate upon her journey, because i’m strongly aware of my own pernicious egocentrism, plus the defensiveness that haunts the awareness that you don’t know all the medicine you should; you don’t know so many things; you weren’t taught so many more; you haven’t seen so much that’s so important… dreadful things could go wrong under your nose, because you’re not all-seeing, all-knowing. worse than that – many of the things you do know, that you were taught, may be menacing and indeed harmful in uncertain situations. the authority of the caregiver – be they surgeon, physician, psychotherapist, or midwife – is like plutonium! toxic when handled carelessly, difficult to control, creating a false illusion of magical powers.
my friend might not tell her story much, but i do (just not on the internets). i began using my friend’s birth story as an object lesson when training other future caregivers. as i told her, the story provides “ten things NOT to do.” i am annoyed by the cautionary yarns spun around birth by most doctors, which often betray a great deal of suspicion of the female body; mine betrays my own suspicion of the medical establishment, which is reciprocally annoying to them, no doubt. you can read her story in detail, yourself, elsewhere.
a wise and gentle neurologist once gave me the rule, “do what you know – know what you do – and don’t lie a lot.” i sure can’t top that! yet here are my…
TEN THINGS NOT TO DO for doctors, nurses, and midwives:
1. do not neglect pelvimetry, even though you know there is no “evidence base” for this old-fashioned, hands-on technique.
2. do not ignore it, if her cervix reverses dilation during labor. and do not pretend it doesn’t happen, even though your old professor assured you that it doesn’t.
3. do not omit careful palpation of the uterus when a woman’s in labor, and do not ignore it if you find something strange, like a bandl’s ring (look it up!) or an unexpected fetal part (dehiscence).
4. do not cast aspersions on the sincerity of a woman’s desire for normal/ natural birth, as a putative reason for her labor slowing or stalling – neither aloud, nor by facial expression/ tone of voice – even though your clinical intuition is like a finely honed steel.
5. do not give substandard, less comprehensive, or more interventive care to a woman of whose birth plan you disapprove. do not voice or otherwise indicate your disapproval, in the room, the hallway, or the chart.
6. do not administer “wound care” that is painful. do not omit pain prophylaxis.
7. do not dismiss a sick baby’s NORMAL vital signs, clinical signs, labs or images, as unremarkable at best, or temporary/ illusory (“the damage just hasn’t shown up yet”) at worst – even though doing so would allow you to greatly consolidate your authority.
8. do not counsel a newly-delivered mother to abandon hope for her sick baby’s life or health, or ask her to focus on some other imaginary (better?) future baby – even though it may you a chance to demonstrate how very, very smart and/or “realistic” you are.
9. do not try to convince a mother, who is (perhaps invisibly) grieving the catastrophic end of her birth plans, that “saving the baby” is what “really” matters. this would only demonstrate that you are an asshole.
10. do not indulge in immature defense mechanisms – denial, passive-aggression, projection, etc. – that may be provoked by clinical situations that threaten you, such as, oh, say, ANYTHING INVOLVING CARE OF PEOPLE IN CRISIS. i use the word “indulge” advisedly. do not be self-indulgent, when others need your compassion, in addition to your incredibly big and fancy diploma.
i could go on and on and on. i’ll round it out to a baker’s dozen:
11. do not get me started on “evidence-based obstetrics”!!!
12. do not allow a sick baby to develop and maintain oral aversion caused by multiple intubations!!!
13. do not ignore the oversized impact that further medical “help” – screening, imaging, snipping, sampling, trying one, then another, medication on for size – will have, on the woman (the child, the family) who has been medically traumatized.
the gentle neurologist who was my teacher also told me, “they don’t care how much you know, til they know how much you care.” i hope it’s true! i don’t know EVERY SINGLE WAY TO SAVE A PERSON’S LIFE, but i do care about a person’s life, including how they feel when they leave my office and go home.
plus, i know at least ten things NOT to do.
Topics: Uncategorized | No Comments »
