Humanity Is An Ocean

Oh, Yeah, Baby!

2006-03-17T12:25:00.000-08:00

So, here's the followup to my story from yesterday. I called to give her some test results (negative) and asked how she was doing.

"Great!" she said. "And guess what? I'm in shock! I told my boyfriend that I wouldn't have sex anymore and told him why - and he just said, 'Oh, ok, that's no problem. I still want to see you, though.' Cool, huh?"

Yeah, cool alright - and amazing - kinda makes me feel all warm and tingly inside, like maybe I'm doing what I'm supposed to be doing...

Just Say No

2006-03-16T12:24:00.000-08:00

It's remarkable, sometimes, what patients will talk about. Sex, for instance, comes up often enough in my practice that it is neither surprising nor uncomfortable for me to ask about it or to respond to questions about it. The details, though, sometimes are surprising - sometimes for me, sometimes for the patient.

A thirty-something recently divorced (or divorcing) woman came in the other day to be tested for sexually transmitted infections (STIs). Not an uncommon request, especially among singles but also even among married women. The conversation that ensued, though, was what set this visit apart from many others.

This particular woman, very attractive by anyone's standards - a statuesque, very pretty blonde - related the problems of the single life and what a drag it was. She said, "Oh, how I want to be married again!" It turns out the single life is not all it's shown to be on tv - and, in fact, carries with it significant risk (pregnancy or infection) and significant heartache (breakups and the games people play). So as we talked about her dissatisfaction with being single, and talked about the risks, she asked a not-so-uncommon question: "So, what am I supposed to do? How do I avoid this hassle of worry about STIs?"

We talked about condoms and other barrier methods - but really nothing protects as well as you'd like - so I also said, as I always do, "The only sure fire method to protect yourself is abstinence." She laughed and just about choked on hearing that come out of my mouth. She was just absolutely incredulous, and said, "Yeah, right! By the third date the guy is wondering what's wrong if there's no sex. And you think I can say no? I'd have nobody!"

Then, seeing that I was serious, she asked, with a now puzzled look, "Are you saying that some people do that - they date without sex?" I affirmed that there are such people, and that they decide together to be abstinent, and that they even purposefully set out to do so right from the beginning of their dating relationship.

It was like I was from Mars - she had no idea that such could be the case in this day and age in America! I could see a spark of interest, though, so I added, "And also, you know how you said you want to be married some day? Well, guess what? By saying yes to sex you've removed one of the strongest motivators to the guy wanting to move forward with marriage. You're giving away one of the privileges that comes with the committment!" She smiled, "You mean, like why buy a cow if you get the milk for free?"

Yeah, something like that! We finished the conversation by her asking, "Well, how would I tell someone that now I'm not going to do it?" That gave me hope that a light bulb had really gone off in her head! "Well, some people that I've seen have told their partner, after a bad scare, 'You know, this just isn't worth it. I was so freaked out by what happened last week that I just can't continue putting myself in that position anymore.' If he really loves you, he'll accept that statement and stay with you. If he really just loves the sex, he'll be gone."

Surprising ending to an STI visit? To me, no. To her, my guess is: a resounding yes!

Sunday Morning Surprise

2006-03-03T19:32:00.000-08:00

Sometimes over-40 couples having their first baby are a bit on the nervous side - understandably so, don't you think? - but it can make things kind of interesting.

One couple I cared for were a great example of that. They always came in together, always had lots of questions, and were always appreciative of the time I spent with them. They had lots of extra visits and in a strange way endeared themselves to us with their nervousness and questions (rather than be an annoyance like you might think with someone who was always "bugging" you). Anyway, they finally, at nine months, right on schedule, delivered a nice healthy baby.

Then the post-partum questions began. Calls began coming in with questions about nursing, bleeding, cramps, etc. One Sunday morning while I was at the hospital making rounds I fielded a question from them. I could tell that the wife had gotten herself into a real tailspin with the combination of sleeplessness, cramping, and nursing problems all at once. I also knew that if I could actually see her and examine her I could reassure her better than just dealing with this over the phone, but I didn't want to add to their woes and make them bundle up the baby and get everything together to come to the hospital.

So, knowing that they lived fairly close to the hospital I suggested that I would make a home visit. They were shocked! "Really? You'd come here?" they asked. "Well, yes, it makes more sense than you coming in here," I found myself saying -after all they only lived a few minutes from the hospital.

Or so I thought! When I asked directions, I found out they lived about 30 minutes away, in another county! But now I was committed. So off I went. Sure enough, seeing her and spending time with her and her husband there at their house was very rewarding - to them for sure, but also for me.

Going the extra mile - well, in this case thirty! - blessed me that Sunday morn!

A Chance Encounter

2006-02-22T16:10:00.000-08:00

My chance encounter with this sad young woman - 27 years old - and her parents was brief but notable, raising many questions in my mind - which will, as you'll see, remain unanswered - but also stirring an emotional response that was, at once, surprising yet understandable. I was seeing her for a colleague on his off day - thus the brief encounter with someone with whom I'll no doubt never have additional contact - following a surgery that had been performed for cancer.

Her story was significant in one important respect: Two years earlier she had received the news of her cancer - a cancer that is generally easily cured with surgery - but she had refused the life giving hysterectomy surgery. The only non-surgical option, medical therapy of the cancer, is usually not successful, and in her case, was not. Now she had been readmitted because of extensive spread of this same cancer throughout her abdomen and pelvis; now she had undergone the surgery previously declined; now she was dying of a cancer that should have been easily cured.

So my visit with her, "rounds" as we say, was to assess her condition on that post-operative day and to see that her medical needs were attended to until the next day when my colleague would return. My visit with her coincided with a visit by her parents: She, gaunt and pale, in bed, answering questions with a weak thin voice; they, worried, with pleading looks, asking with their eyes, "Will this new doctor be the one to bring healing?" Sadly, no.

Heartache filled the room, evident for all to see - parents watching a daughter terminally ill, she wanting more than anything for a miracle, them all wondering how they had arrived at this point in time in this condition, silently ignoring the question that rose above all else - "Why didn't I ... ?"

My heart broke particularly for the parents - the pain of seeing one loved as dearly as a daughter can be loved, slowly yet inexorably slipping away from them. This quiet, unimaginable torment - powerlessness in the face of this great impending loss - was almost more than one could endure, and I found myself pained as I looked into their eyes: I averted my gaze. I couldn't help, though, but to imagine for them to a pain greater still that awaited.

The unhelpful questions will remain unanswered: What could have possibly seemed so important two years earlier that would have led to the improbable decision to forego surgery in favor of a doomed medical regimen? Fear of surgery? Distrust of the doctor's diagnosis and prognosis? Unyielding desire to hold onto her future fertility?

This brief, chance encounter: for me a personal reminder of a parent's painful love journey with their children, with relentlessly haunting questions of what could have been...

True Beauty

2006-02-19T08:14:00.000-08:00

The anesthesiologist was ready to give the patient the medicine to make her go asleep when the patient asked, "Do you mind if I pray before you put me to sleep?" We were all gathered there, ready to begin - the anesthesiologist, the surgeon (me), the assistant surgeon, the scrub nurse, the circulating nurse - and one sensed a feeling of "Well, if you must" among those present, but of course I said, "Yes, please, go ahead."

I expected - I think we all did - a prayer asking God's protection during the surgery. Instead, we were treated to her beautiful intercession for each of us there in the room. She asked God's blessing on each of us at our homes, for the rest of the day ahead of us, and in our marriages. She praised God for His care over each of us. She never once asked anything for herself - just for us. When she finished, she said simply, "In Jesus' name, amen," and we each also humbly added our amens to hers.

The anesthesiologist then said, for all of us, "That was beautiful. Thank you" and gave her the medicine to have her go asleep. There was silence in the room for a minute as we all considered what we had just witnessed.

This woman, who was herself in such a vulnerable and frightening situation - about to undergo surgery - had on her heart not herself and her concerns, but us - selflessly intervening with God on our behalf, on behalf of people who (except for me) she would likely never see again.

What a testimony to the relationship she obviously felt with God and Christ; a testimony to the confidence she obviously had in Him. Beauty - pure and simple!

He Is

2006-02-12T07:20:00.000-08:00

Mom and daughter - she about ten years old - were there for the ultrasound, a chance to share the joy of seeing the baby at this early stage of development, the mom being less than three months along. Little did they know - either one of them - the real lesson that awaited them.

Bright smiles of anticipation turned inexorably to horror as we searched in vain for the baby's heart beat - and this little girl, in as poignant a moment as one can imagine, with the realization that this baby sister or brother was not going to be, and with the most gut-wrenching anguished expression on her little angelic face, ran to her mom and buried her head on her breast, with great sobs and tears. Mom, overcome with sadness, held her daughter close while I, with a gentle touch of support, watched - the silence broken only by their tearful sobs.

Yes, there was a lesson to be learned that sad morning - a lesson that touches on the very fragility and mystery of life to be sure, but also something more, something deeper - deeper for me at least, perhaps because this is a lesson I am in the midst of learning myself.

There was, in that little girl's immediate response - going to her mom, allowing herself to be swallowed up in those loving arms, reaching for someone bigger than life itself, someone able to take the pain away, to make things right - a demonstration of a universal principle of this life we live as humans.

Don't we all need someone or something bigger than life itself to make it through and over the bumps in life? Sudden shocking pain forces us to examine - in a hurry - where we find our true strength. For this little girl it was her mom. For us adults - and this is the lesson I am learning - it has to be something grand, rock solid, unyielding and never-changing. For me this strength and solace is found in only one place - my faith in a God who is, who can, and who always will.

Justice or mercy

2006-02-09T11:26:00.000-08:00

So I wondered some more about this sad display of humanity (read yesterday's post if you haven't already done so) - and these are the thoughts that pressed in:

1. This immediately disproves for me the post-modern notion that there are no absolutes - that right and wrong are somehow situational and defy absolute definition - for this event, the murder of an innocent baby, is wrong, wrong, wrong. Always, from the beginning of time to the end of time, in any and all cultural settings, this cannot ever be right in a moral sense.

2. This also challenges me to think of justice and mercy in a new way, or maybe to restate - with this stunning example in mind - my thinking about the interplay of justice and mercy.

Pure justice would say this woman should be condemned - period. She should accept - and we as a society of human beings needing to live together should demand - consequences for her abhorrent actions. But then pure mercy would say, as the previous Biblical quote implies, "Who among us has no sin?" and would ask for compassion and grace.

Does our reaction depend on her remorse? Maybe - but also we can at once hate the sin (and require justice - societally) and love the sinner (and offer compassion, mercy and grace - personally).

And then I wondered, and wondered again, whether I - me in my own humanity - would actually be capable of that personal response...

Hint: Not in my own power (Higher Power needed!)

Stone Throwers

2006-02-08T21:20:00.000-08:00

Today I learned that a patient I delivered murdered her baby - the baby I helped her deliver just a few short months ago. How very tragic, senseless, and sad! A short news account related the story of this woman, arrested for the beating murder of her infant - other details absent - like the understanding (as if there could be any understanding??) of how a person could ever - even in their wildest fantasy or deepest, darkest hour - bring harm to an infant, helpless and innocent. What depths of depravity - or more likely psychopathic craziness - could yield this murderous result?

And then I thought some more, and Jesus' words came to me, "If any one of you is without sin, let him be the first to throw a stone at her."

I pondered the applicability here - certainly the civil authorities should throw the book at her - yes, that is their responsibility! - but I wondered, and wondered again, what my own personal response should be...

A Delightful Treat

2006-02-04T07:59:00.000-08:00

Well, I surely did not expect to see 1) a man in bed with the patient, and 2) the patient wearing a blue elbow-length glove when I visited my partner's post-partum patient a few days ago. But that is exactly what I encountered!

This 7 am visit, on the second day after she delivered her baby, was surprising on a number of levels. Turns out, despite my initial slightly skeptical and slightly negative knee jerk reaction upon entering the room, that my conversation with this cute young married couple was a delightful highlight of my day.

The glove was a medical covering for a severe burn she had received to her hand and arm - at six months of pregnancy - from an oil fire accident in her kitchen. She had been an inpatient in the burn unit for three weeks initially and now was continuing outpatient therapy - which included the blue latex glove.

As we talked - they were both interestingly talkative, charismatic, and had beautifully expressive faces - I discovered that they were from an Eastern European country which I had actually visited a few years ago. Now imagine their surprise when I was able to say "good morning" in their native language! This revelation set off a whole new round of conversation topics!

I'm so thankful that I was not rushed that morning! I would have missed out on a real treat!

Our Cozy Group

2006-01-30T12:59:00.000-08:00

This ER visit was unique - no doubt about that! As the ob-gyn consultant I was called to see a 20-year-old woman who was about 20 weeks pregnant who had come to the ER because she was exposed via her 5-year-old to Fifth Disease (slapped cheek disease; Parvovirus). This exposure always worries pregnant women because of the possible effect on the developing baby, so the visit was ok - well, maybe it wasn't an emergency, and maybe it could have waited until the daytime, and maybe it could have been to her outpatient doctor rather than to the expensive ER, but given all the warnings about Fifth Disease in pregnancy it was certainly understandable. Plus it gave me a chance to meet this inquisitive, worried young woman.

She was there with her boyfriend - well, her ex-boyfriend actually - who was there with his new girlfriend. Which presence was convenient in that she was also pregnant! Also about 20 weeks pregnant, to be exact! And with the same young man reported to be the father of her baby as the fellow for the patient!

What a chummy cozy group they made! We all got along famously as we talked about Parvovirus, the level of exposure, the potential problems, the testing to be done, and the followup.

Very entertaining visit, very rewarding, and - as always - containing an interesting commentary on the diversity of life choices being made and lived out by us human beings on this planet earth! One can only hope and pray that the past choices made by this cozy little group will not have the unintended consequence of bringing emotional damage to these babies - that the group will still be as friendly in another 20 weeks - when these two pregnant women are ready to deliver - and that this young man will maintain some meaningful involvement in the lives of these innocent little babes.

Choice is one thing; responsibility is another...

A Nephew's Education

2006-01-29T08:00:00.000-08:00

One afternoon a pregnant woman and her sister came in for a prenatal visit that would include an ultrasound. The patient - about 28 or so - and the slightly older sister had the sister's eight year old son in tow. They were excited for him to see the baby on the ultrasound - what an educational opportunity this was going to be! Indeed! He ended up getting more of an education than they anticipated!

Naturally to perform the ultrasound the tummy needs to be exposed - so the shirt gets carefully rolled up and the top edge of the pants gets pushed down. To protect the pants from the gel that is used for the ultrasound, I take a small towel and tuck it under the top edge of the pants and undies. This almost always exposes the top of the pubic hair line which is then visible a wee bit.

Well, this very observant young boy noticed this and with the cutest little shocked expression on his face exclaimed, "You have hair down there!" All the adults were speechless for a second, the patient (his Aunt) turned red, and his mom, after a few seconds, opened her mouth but nothing came out. I then said, "Well, all adults do. That's a normal thing when you get older." Without missing a beat, he turned to his own mom and asked, still with shocked disbelief in his voice, "Do you have hair there?" I don't think I've ever seen anyone turn so many shades of red as that poor mom!

Peace and Joy

2006-01-28T13:19:00.000-08:00

I asked Mrs P today whether she had thought about the fact that she came very very close to losing her life. She looked down and nodded, "Yes." I followed with the natural question, "What did you think?" to which she replied with quivering voice, "My three month old still needs me."

She had had a baby just three months ago, and then unbelievably had gotten pregnant again - unfortunately, though, pregnant in the tube rather than the uterus. A tubal pregnancy - an ectopic as they say. She was well one minute, not even knowing she was pregnant, and then in the next there was suddenly a severe pain in her left lower quadrant. Then she collapsed. Her tube had ruptured in the exact place of a crossing blood vessel and as the minutes ticked by she began bleeding to death.

As "luck" would have it, her husband was home and had the good sense to call an ambulance, which brought her with sirens blaring to the hospital, to the operating room where our team could open her belly to find the bleeding vessel and stanch the flow of blood. She received the operation and much needed blood replacement in the nick of time. A decision to ignore the pain and the fainting would have been fatal.

Yes, her three month old does need her - as do we all in this interconnected world in which we live. May Mrs. P live out her days in peace and joy, knowing now the value of life in a new and different way.

Will he??

2006-01-26T21:55:00.000-08:00

The morning call came to see a young woman - maybe 20 - who had presented to L&D - to have her first baby! She and her equally young boyfriend were there together, she confident and ready for anything, he looking like a deer in headlights.

Her labor proceeded uneventfully, epidural in place, baby looking good, her cervix behaving itself and following all the rules.

As the hours passed he (the boyfriend) gained in his own confidence and strength and became a useful helper and mate in the process of this "baby-having-thing" - frankly, I'd had my doubts earlier - but he really rose to the occasion! They actually made a great team, despite (maybe because of??) their youth - and in the end she pushed out a healthy, squirming, pink-in-all-the-right-places girl! Oh, the smiles and delight that little girl brought to both of their faces!

Later, after the young man had gone out for pizza, he returned and walked past the nurses station with a Little Caesar's box in his hand. I went over to ask how his "girls" were doing. He smiled and said, "Great!" Then he said, "Want some pizza?" That was an offer I couldn't turn down! He opened the box to reveal thin-crust pepperoni pizza - and I found a small piece to take, sharing it with pleasure with this young man who now was embarking - whether he wanted to or not - on what hopefully - prayerfully - will be a journey of true manhood - staying with his woman, staying with his little girl, loving them both as only a real man can.

Oh, to look into the future...

Holy indeed!

2006-01-25T19:55:00.000-08:00

I attended a funeral recently. It was a sad reminder of our limitations in medicine, yet also - and more importantly – it was an uplifting tribute to the love expressed within an extended family, to the courage and strength one finds in the midst of grief, and to the expression of a faith in something larger than ourselves that carries one forward in times of despair.

Young Ana had endeared herself to us all in her first pregnancy - at age 17 - with her always bright smile, uncontrollable shyness, and her infectious little laugh. She spoke only Spanish, so her visits were often marked by gestures and sign language when words failed. When needed we'd use a translator by phone and all went well with the eventual delivery of a healthy little girl.

We had been seeing Ana off and on for checkups - although in her extreme shyness she really hated them - or to dispense pills, when one day - now age 21 - she came in because she felt pregnant. Sure enough, she was. Although not planned, she and her husband would never dream of termination even though circumstances might have dictated otherwise. She was here illegally, they had very little money, they cared for a disabled cousin, lived in a crowded little place all together, etc.

We embarked on another round of pregnancy care together. This time I hired a translator - one of the hospital housekeepers - so the visits would be smooth. She became more animated and excited each time she saw the baby on ultrasound, and we were having lots of fun together through the first few months - my staff and I so looked forward to her visits! - that is, until the 22nd week. At that visit she disclosed that she'd leaked a little fluid and an exam revealed that her membranes had indeed ruptured - there was almost no fluid around her baby! In this tragic circumstance we have nothing to offer medically and there is less than a 1% chance of a healthy baby - but she wanted to go for it! She started a program of bedrest and prayer - until about 2 weeks later when she went into labor and delivered a little baby boy that lived less than a day.

It was his funeral I attended - the only anglo among a large gathering of her family and extended neighbors. I waited in the room for the service, not knowing the family was all outside. Eventually they all came in, one by one looking at me standing there in the back. Finally toward the end of this family procession, Ana appeared. When she saw me she burst into tears and buried her head in my chest. We hugged in that universal language of mutual sadness and caring. The Spanish priest delivered an encouraging talk about life and death, faith and courage after which we proceeded to the gravesite. There we gathered around and each one, starting with the youngest kids, tossed a white carnation onto that beautiful little white coffin there in the ground. This holy moment, acknowledging that little life and Ana's love for him, also was a testimony to the love felt for Ana and her husband by so many.

Holy indeed! How grateful and privileged to be witness to this holy event.

¿Me entiendes?

2006-01-24T22:20:00.000-08:00

The nurse summoned me to Labor and Delivery to see a young pregnant woman who had presented with severe pain. I arrived a few minutes later to find an Hispanic woman and her husband, both looking frightened and scared.

The nurse had already told me that they spoke no English - which meant I had an opportunity to use my (limited) Spanish - so in my best and friendliest accent possible I addressed them both. "Buenas tardes! Como estan ustedes? Me llamo Dr. x." They smiled. Then I proceeded to ask a few questions about the pain, its location, when it happened, when it didn't, and its quality. I was so-o-o lucky that her problem involved very simple vocabulary!!

As we talked, they both warmed to the idea that I could help them, that their baby - their fifth, by the way! - would be ok, and that all would be well. We laughed about my Spanish - definitely bonding us in some strange way - and we did a few tests which confirmed that the pain was from a kidney stone and then they left an hour or so later - to take pain medicine, to strain the urine, and to wait for the stone to pass.

Oh, the transformation from frightened strangers to smiling friends in the space of a few minutes!

One Day At A Time

2006-01-24T22:18:00.000-08:00

Well, I've been given a unique opportunity in life - an opportunity to observe people in what are often special circumstances that reflect back to me the divine human-ness of our existence in special ways through the poignant, exhilarating, sad, humorous, perplexing, and inspiring stories which are shared with me.

I am an obstetrician-gynecologist and I care for women and their families - in the good times and the bad, at the youngest of ages or near the end of life. What a privilege! This blog will be used by me to record observations of some of those encounters - some having brought a smile, some a tear, all having revealed something of our humanity, our interconnectedness in this life, our interdependence on one another. We may not always share a race, creed, color, gender, or place of origin - but we always do share our humanity and those human emotions that separate us from the beasts of the field. For that I am thankful!