I am feeling even more scattered than usual this lately! My ADHD brain is being tested with multiple demands and my attempts to work part-time seem to be thwarted again and again.
What is part-time for a family doctor these days? My three half days in the clinic seeing patients and doing clinical supervision, becomes almost three full days when you add in the paperwork, calling and chasing up consultants and results, trying to make sure that my very vulnerable patients do not fall through the cracks. Then add a delivery or two and preparation for a faculty development workshop and it starts adding up to 40 hours/week, so about half-time.
To add to that, my in-house support person, my husband Dave, got sick on the plane home from our Mexican vacation. I hate to undermine my feminist credibility but I usually do not have the onerous second shift that most female physicians carry. Nor do I usually have the mental labour that running a household requires. Having Dave out of commission plus the added duties of making him tea and chicken soup and doing the minimum housework I needed to do to avoid our flat from looking like a frat house, just brought home to me how much he usually does for us, in his quiet, effective and efficient way.
One of the little extras I did last week was attend a goodbye party for one of the nurses in Labour & Delivery. I brought blueberry muffins to the breakfast which celebrated Carole’s last shift. We took a moment to acknowledge her hard work, her dedication, her hard-headed, practical kindness to countless labouring women over the years. I found out that Carole’s plan was to retrain and work on the palliative care floor until her retirement and to then transition into a palliative care volunteer. One of the younger nurses said to me, “isn’t it a bit strange to go from the birthing unit to Palliative Care?”
In fact, the skills needed are overlapping. You want to honour and support a natural process, letting it unfold, using your empathy and skill to help it happen. You need to be ready to use medical interventions when they are needed and to be able to communicate well with all involved. I know a number of docs and a doula, who do both. Our own chief of Palliative Care was part of our Family Med Ob group for years. In many ways a delivery is a delivery.
In my professional life I have mostly hung out at the birth end of the delivery business. I have however had very deep and important experiences at the other end of the spectrum. I have felt great satisfaction delivering a stillborn baby, or attending the death bed of one of my patients dying of cancer. The knowledge that my presence and skill was helpful tempers the sadness.
I recently experienced my most challenging case ever. A pregnant patient of mine whom I know very well had her older child suffer a devastating and sudden illness. As this child hovered between life and death, I reacted differently than I ever had before.
I did my best, clinically. I went to the ICU, persuaded my patient to drink and lie down. I acted as a liaison between the team and the family. I was immensely sad and dreamt about them each night. Yet as things got worse and worse I felt so inadequate. I was caught between the expectations of the medical team and the needs of the family. At one point I felt so guilty that I asked the boy’s father, “Are you angry with me?” The moment I said it, was the moment I knew how inappropriate that question was. The dad looked at me with eyes red and swollen with tears, an expression of deep despair and incredulity on his face. It hit me, that I was making this all about me. What a jerk I’m being, I thought.
Now after the child’s death, I visited the family at religious services. Although they are suffering deeply, with his passing they can finally grieve. In a way they are delivered.
Soon I will see the mother for her prenatal care. I hope we can make this birth a healing experience for her. After all, that is where my focus should be. I take my place to help guide this new soul into the world, to prepare her for this experience which will be simultaneously joyful and filled with pain. A delivery is a delivery.