I just checked on a lady who started being induced last night. Dr. A, her primary OB, is not happy with her. This is her fifth pregnancy; the others occurred in a different state. She presented to Dr. A, at first planning to deliver in the midwives’ unit, because she’s never used an epidural. Lately, however, it developed that she thinks pregnancies should conclude at 37 weeks, because somehow she’s always gotten induced at that point in the past. And she demanded that Dr. A induce her now. After a scene at the office (so I hear, I wasn’t there), Dr. A finally conceded to get an amnio to check for fetal lung maturity, and induce her. Dr. A thinks she’s a horrible patient, and tells everyone so when she signs this patient off for the night. The office staff is in turmoil because of her.

So I said hello this morning, and she looked calm and cheerful. Just now, I found her and her husband sitting together, him holding her and rubbing her through contractions. They’re young, but they seem very committed to each other, a strong family unit, unlike so many black couples. In fact, in my limited experience, this is the first time I’ve seen a black man really supporting his partner through her labor, rather than sitting in the corner, or simply completely absent. I don’t see a sign of the obnoxious nuisance that Dr. A is describing. So did she disappear, now that she got what she wanted, or does she not exist except in Dr. A’s perception?

My father was trying to tell me not to do surgery because it has some nasty procedures. “You don’t know what you’re getting into. You haven’t seen an amputation yet.”
“Actually, I’ve seen three, and done one.”
“You’ve done an amputation? What do you mean? How can that happen?”
“Um, I cut the bone. They gave me a wire saw, and I cut it off.”
Blank silence. Sorry, daddy.

This morning when I woke up early, I knew there were no patients to write notes on, just that one who was being induced. I thought I’d call and see whether she was progressing rapidly, and I should come in without delay so as to be handy, or whether I could take my time getting started. I called the nurses’ station, gave my name, identified myself as a fourth year working with the university group, and asked for the nurse taking care of Patient X. The lady at the desk put me on hold for a minute, then announced that “we can’t give information over the phone.” I gasped, then stammered, “Look, if a doctor called, you would let them talk to the nurse, right?” She said firmly, “I can have you talk to my supervisor.” I couldn’t believe it. I asked to talk to a resident, if they were at the nurses’ station. The one whom I look exactly like was there, knew me, and transferred me to the nurse, and I found out that the patient had progressed barely at all overnight. So I got to spend more time on devotions this morning after all.
I mean, HIPAA, great, and patient confidentiality, and all that, but what scam artist would wake up at 5:30am, know the right number to call, and give the patient’s precise name? I could have recited her H&P, I filled it out yesterday. I just wanted to check, because people usually forget to call me at the crucial moments, and for all I knew she could have delivered overnight. If I were in the hospital, I could do a vaginal exam, and no one would object; surely I can call on the phone?!
When I got to the hospital, I found that there was another patient, who had in fact come in and delivered during the night, and I never heard about it. It’s a little frustrating to spend all these weeknights away from home and family, and then nothing comes of it anyway.

The Chinese-American doctor I’ve been with the last few days really frustrates me. I already feel guilty enough for existing as a student, and for forcing myself into these women’s private moments, but he makes it worse. He sends me to get a history from a patient coming for her annual. I go in, with my best professional manner, introduce myself (the nurse has already asked permission for a student to participate in her care today), try to get to know the woman with some common questions and small talk, go conscientiously through all the questions for an annual check-up, do the non-invasive exam (heart, lungs, etc), then step out to get the doctor. I present to him in perfect textbook style. He comes in and says apologetically, “Thank you so much for letting my student Alice talk to you and get a little information.” Grrrr. Like I’m a child, and that episode was purely for my benefit, and I did nothing by way of getting some necessary information for the patient’s care, or saving him time. And then he doesn’t let me do any of the rest of the exam, unlike his partners, who let me do the whole deal. Or we go into a pre-op visit, to discuss a scheduled operation, and, without even giving my name, he waves his hand and says, “This is a student, she’ll just be observing.” So I stand there and try to be invisible.

This constant switching between responsibility and inadequacy is jarring. One day I’m managing a patient’s labor, the next day I’m not allowed to call the nurse, and the doctor seems to wish I didn’t exist. I want to be a real doctor. Although I have a nagging suspicion that the residents feel the same way, with the attendings looking over their shoulder, and often overriding their treatment plans for personal preference reasons; the interns probably worst of all, because everyone’s keeping an eye on them.