I didn’t want to go in to the hospital. It was my internship year and I was tired from being on call every fourth night. It was my night off and I wanted to be home with my wife and son. 100 hour work weeks are hard on a marriage. I wasn’t in the mood for more work so I was not happy when my pager went off and I saw the number of the labor and delivery unit in the display. I called back and was told that one of my clinic patients was in labor. The resident on call was calling me to see if I wanted to come in for the delivery.
I was not obligated to respond. No one expected residents to come in on our nights off and the policy was that doing off-night deliveries was entirely optional. There was a resident physician on call in the hospital whose job it was to manage the obstetrical unit so my presence was not needed. I had every right to decline the request but in spite of my exhaustion I knew staying home it wasn’t an option. I had made myself and my patients a promise that I would attend every delivery I possibly could so I sighed the deep sigh if the sleep deprived and told my wife I was going back to the hospital. I scrounged around for a set of scrubs and headed out the door.
I sleep walked to my car, drove to the hospital and took the elevator to the 5th floor obstetrical unit. I made a right turn when the doors opened and headed down the hall towards her delivery suite. As I walked I could see that the door was open to her room with a current drawn for privacy. Curtains are a poor noise barrier and I could hear her cries of pain as I approached. Epidurals had not yet become routine and she was going through the last stages of labor medicated only with narcotics. It was clear that the narcotics were completely inadequate. I knew her well enough to know pain was not her only challenge, I detected fear and anxiety in her voice.
As I pulled the curtain back to enter I saw the on call doctor standing near her bedside. From a medical standpoint her presence rendered mine completely unnecessary. A doctor was needed for the delivery and a doctor with the skills and knowledge to care for the patient was present. I briefly wondered why I had felt the need to come and whether it mattered.
The patient’s response made my wonder disappear. She looked up at me as I entered and a look of relief come over her face. “Thank God you are here!” she said. She calmed instantly and I realized that what mattered to her in her time of need was not that some doctor was present, what mattered was that her doctor was present, the doctor she trusted.
I have never forgotten that moment. In those few seconds I realized a new career goal. It was no longer enough for me to be a good clinician, to simply get the treatment right. I decided that I wanted more. I wanted to make a difference in people’s lives, not solely because of my medical knowledge and expertise but because of who I was as a person and the relationships I built. I wanted to have an impact on patients not solely for the care I provided, I wanted to make a difference because I was a caring provider.
The goal of making a difference has proven to be a challenging one. My own fears, insecurities, and stress can make it easy to overlook a patient’s emotional needs. The mental focus required to make a challenging diagnosis can at times cause me to lose sight of the big picture. It is easy at times to be “just another doctor.” My patients deserve more, and because of that pregnant patient 25 years ago, my patients get more.
-Bart
PS: After writing this post I decided to see if I could find the patient on Facebook. I did, and I sent her a message. The baby boy I delivered that night is now a man of 25. In spite of the years the patient remembers the night well and how grateful she was when I arrived. She wrote, "The anxiety wondering if someone whom I did not build a relationship with, someone who was well qualified but unknown to me was to deliver my child scared and worried me. I was truly concerned that you would not get there and appreciated it more than you might have known. The fact that neonatology was called due to meconium and a concern of NICU, I was a small disaster of nerves and prayers. Seeing you walk in calmed me and reassured me that all would be right with the world that early morning. God placed you in my life for just that reason. Again thank you for being who you are and what you chose to do."
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