Assume the Position: Memoirs of an Obstetrician Gynecologist (24 page)

     The ER docs had no interest in ever delivering a baby at the Medical center at 8500 feet above sea level where oxygen was at a premium, with no blood banking or operating facilities, and with no neonatal care facilities.  Mostly everyone in Telluride who was pregnant went to Montrose or Durango. The problem was that the hospitals were both at least 1.5 hours or longer away, over mountain passes which at times were closed or treacherous due to rapidly changing weather conditions. On two occasions women came in to the facility in active labor and there was no time in either case to put them in an ambulance.  I was called and in I came.  The first was an easy term delivery with no problems.

      The second one was a bit different.   When I arrived at the facility and walked into the emergency department cubicle, I saw my son’s math teacher sitting next to the woman on the gurney.  For a moment I was perplexed why he would be there.  Then I realized it was his wife on the gurney grunting away and calling for the ‘eye doctor’.  I quickly examined her and found with one push she was going to have a premature baby.  The problem was that she was only about 26 weeks pregnant, 6 ½ months or so.  The odds of a baby surviving at 8500 feet above sea level at 26 weeks were slim to none. Oxygen was at a premium for undeveloped lungs.  We got the pregnant patient prepped and draped as fast as we could, I had her push once, and out came a 1 1/2 pound baby male that fit in the palm of my hand.  A stat call went out to Grand Junction air flight neonatal team, but I had no idea how long it would take for them to get here by helicopter, land at the airport outside of town then motor in to the Medical Center.  I thought back to my years as an intern under the Father of Neonatology at Pennsylvania Hospital, and went into rescue mode.  We did have a small endotracheal tube. Although I hadn’t intubated a baby this size in decades, it went remarkably well.  IV fluids were out of the question since we had nothing to catheterize the umbilicus with or small enough to place in a vein in a premature baby this size.  So it was going to be all about acid base and oxygenation, warmth, preventing body heat loss, digital x-rays to check for tube placement, and bagging the baby with oxygen since we didn’t have a respirator.  It was kind of amazing to watch the color of the baby change with the rate of bagging, correct tube placement, and a bit of luck.  It went from amazing blue to amazing pink in seconds with just the slightest movement one way or the other of the endotracheal tube. His skin was so fragile and translucent that judging oxygenation was easy.

      This went on for an hour and a half, the time it took for the flight crew to get assembled and get here.  I was never happier to see a support crew.  The neonatal nurses came with all the right equipment and took over immediately, squirted surfactant down the endotracheal tube to help expand the baby’s lungs, put in fluid lines, got him set up on antibiotics and respirator settings, and flew him back to Grand Junction where we had already sent the Mom by ambulance so that she would be there when the baby arrived. The Dad went in the helicopter.  To my amazement, five years later I was so happy to see a good outcome. This kid was walking down the street with his Dad, as normal as any five year old could be.  Mother Nature is definitely strange and unpredictable at times, and truly amazing! If you have good protoplasm and genes, and good medical care, life is on your side.

      For the first time in decades when Board terms expired there was now sufficient interest in the community such that for the three seats available, four people wanted to be on the Board. This necessitated a county wide public election for the Board seats and I was a candidate.  It was all fun, local politics at its best, and a wholly unanticipated experience for me.  I was now an elected official.

     Before I left for Africa I established a professional web site, essentially an electronic business card that highlighted key aspects of my past medical career.  The major areas of my past experience that I emphasized were practice management, medical legal consulting, pharmaceutical and medical device research, and medical industry consulting. I felt I had knowledge and expertise I wanted to share, but on my own terms.  I had an 800 number listed on the web site, my curriculum vitae, a picture and biographical background, and an email contact.  Somehow people who were interested in an OB-GYN consultant found my website.  I clearly had a disclaimer on the site that I was not looking to dispense medical advice over the Internet to individual patients, something I considered unethical without the ability to examine the patient. I was grateful that the business took off faster than what I had imagined it would.

     My business generated some interesting twists. I received a call from a ‘Young and Restless’ TV soap opera producer to consult on a story line about keeping a pregnant pre-eclamptic woman in a coma for a while.  I consulted with a Wall Street firm interested in understanding the potential of a new medical device being brought to market.  I did work for a Pharmaceutical company on a new hormone trial on which they were about to embark. I did some practice management consultations, helping other physicians with difficult business decisions they needed to make.  But by far the largest part of my new business was the medical legal expert witness consulting.  Interestingly, though all the medical legal work I did while still practicing medicine was for defense of physicians, once I accepted one case for the plaintiff, the defense work disappeared.  It was as if I had become a traitor now that I was willing to testify on behalf of patients who had indeed been maligned.  So it was plaintiff’s attorneys that found me, often either by word of mouth or by repeat business.  I enjoyed the work.  I could spend the morning skiing, come home to a nice warm mountain retreat, and spend part of the afternoon on the phone either discussing new cases with inquiring attorneys, or reading through medical charts that had been sent for me to review and offer opinions.  I would write opinion letters, accept or reject cases that came my way depending on my sense and established written best practice standards of the American College of OB GYN.  I would either arrange for my depositions to occur in the town of Telluride, or I would travel as necessary, both for depositions and trials.  I had no payroll, no staff, no office problems, and no mutinous partners to deal with.  The new professional role I had created suited me just fine.

     Nothing in life, however, remains the same for too long.  My wife had devoted most of her adult life continuing her education while being the primary care giver for our family.  I was clearly involved in raising our family since other than medicine my family life was my primary interest.  I didn’t play cards, hit the bars at night, golf, or find other things to do that kept me away from home.  When I wasn’t working, I was always involved with family life by choice.  But I worked a lot, and that kept me on the go away from home a lot, which was just the way life was for me.   My wife was clearly the major source of a steady home life, homemaker, bread maker, Mom, and daily constancy for the kids. Before we left Arizona, she completed her Bachelor’s degree in studio arts, years earlier having left her first career as a medical laboratory technician.  She produced art, she taught art in the school districts, she instructed the kids in art, and she got involved with the local art therapy community, her true love.   Then it was no surprise that when we were in Colorado, she decided to pursue advanced education and received her Master’s degree in Art Therapy and Counseling.  During the educational process, she worked with various local internships in Colorado to complete counseling requirements.  When she graduated, she then decided to seek employment in the field, and found a permanent position with the State of California, which required another move for us.  By this time in our life, we were open to change and looked at it both as a challenge and a new experience for us.  My consulting business was portable, so off to California we went for the next four years of our life. Our kids were all gone from home, and we were free to relocate.  Once again friends said to us:  “ How can you leave Telluride for California?” particularly at a time when everyone travelling on the interstate was leaving California for Colorado.  We were once again in touch with our nomadic genes, as we called them, and didn’t mind swimming upstream away from what everyone else was doing. There was no longer a fear of the unknown. We embraced change, and the excitement it brings.

Although actively licensed in medicine, I became subject to more criticism from the witness stand, and it just wasn’t where I wanted to be.  The case at hand needed to be the focus, not me.  I too needed a change of direction. And I needed to be supportive of my wife’s desires and aspirations for her new career.

     As a licensed physician, there are many paths to explore and many directions in which one can turn if so inclined. Fear is the only reason not to do so.  An MD degree is a valuable and portable degree, especially if one is open to new and challenging things.  I eventually found employment as a medical director for a Philadelphia based company with a new office located in California and went back to work.  I had skiing out of my system, and enjoyed the opportunity to continue to use my medical knowledge on a daily basis.  I was surprised how much information about general medicine was still in my head. As I tell people, I used to be a physician before I was an obstetrician, and I still am a physician.  It was nice to be working for someone else, especially a large corporation owned by someone else, and watch others deal with the business headaches. I didn’t always agree with their business decisions, but I enjoyed the work I was doing, found it quite easy, and no one was asking me for my opinions on how to run the business anyhow. That wasn’t my role anymore. There were no malpractice issues about which to worry. Admittedly, when I started, I was a bit apprehensive having been out of active practice for a while. I needed to learn new computer skills, and dealing with medical issues outside of Obstetrics and Gynecology, but it didn’t take me long to get up to snuff. They provided all the training necessary to do the job.  So it turned out to be a good fit for them and for me.

     After retiring from active practice, I incorrectly assumed that my acquired sleep disorder would at some time disappear.  Now that years have gone by, there seems little hope that will ever happen.  Years of up and down at all hours of the night, the necessity to be instantly awake when called upon to make at times life and death decisions, the need to give orders over the phone to the nursing staff and to direct patients what to do and when to do it, driving back and forth in the middle of the night, performing surgery and/or deliveries have all left me with a pattern of sleep that is hard to change.  I have tried just about everything, including medications, and now simply just deal with myself as I am.  I can fall asleep at the drop of a hat, but rarely can I stay asleep for more than 3-4 hours straight, after which I wrestle with my covers and myself the rest of the night.  I wander around the house in the middle of the night when I am unable to fall back asleep, and eventually distract myself and my thoughts sufficiently that I can usually fall asleep again, but for only short intervals for the rest of the night.  If one were to add up the hours, I suppose it is enough sleep, at least for me, but never what I feel is truly restful.

     As I inevitably age, as we all do, we tend to find ourselves sitting on the exam table in front of other physicians.  Most of my life I was comfortable seeing a physician every day by just looking in the mirror and making a quick assessment.  But that isn’t always going to work.  So now I have turned myself over to others and just bite the bullet like everyone else in the world.   I have many observations about the state of medicine now, most of which I won’t share.  I simply will discuss two of them.

     Obamacare.  What an interesting word.  I assume the term is at least partially patterned after Medicare, a program in which I now participate because the calendar tells me I am eligible.  But take Obama out of Obamacare and substitute ‘Medi’ again, and we are back to where we should be. Why reinvent the wheel? I am intimately familiar with the medical side of Medicare, since most of the work I did as a medical director involved hospitals and Medicare patients.  I find it most interesting that the conservative side of the political isle denigrates government medicine and government intervention in medicine.  I believe current statistics will show that almost 18% of the Federal budget is Medicare dollars, a rather astounding figure of billions of dollars.  The simple fact is that the system works.  Even those who denigrate Obamacare on TV, in Congress, and wherever they have the chance to pontificate still belong to Medicare and utilize it. Why?  Because overall it is a good system, it works, it keeps people healthy, and it keeps them from financial disaster when illness strikes, as it will for the elderly.  It pays hospitals and providers.  It just works!  Sure, it has problems, but so does everything that chews up a large part of the federal budget.  After all, isn’t paying several thousand dollars for a toilet seat an important part of the Defense budget? Come on folks, let’s get real. Take the greed and selfishness out of medicine where it has no place.  Keep fixing the problems, keep auditing hospitals and doctors offices, keep returning money to the federal government when the audits produce millions of dollars of overpayments and expose fraud.  Isn’t that what elected officials are paid to do?  Including the President, whomever he or she may be.  Manage the government and exhibit fiscal responsibility.  But don’t scuttle programs that work for everyone, and which keep us healthy and out of financial ruin.  Which brings me back to Obamacare.  The system we have is what we have because of some sort of compromise forced upon us by the vocal minority and the Democrats who couldn’t stand up for what they knew was right. If any system doesn’t work properly, just fix it and make it better.  Kind of like what we do with disease systems in medicine. The easier and wiser path would have been to just extend Medicare to people under the age of 65. How many millions were wasted in initiating and keeping a new program up and going? The system was already in place, it already works, and even though Republicans hate government intruding into our lives, better to be alive and solvent than poor before one dies.  Government running medicine, they say.  Horror upon horrors! It will never work.  Just like Medicare and the VA don’t work, yet keep millions of us alive and functioning well as vital parts of society while we age long beyond what anyone thought possible just decades ago.   Government managed medicine – I am all for it.  And just think how much money will be saved as we watch the private medical insurance business slowly drift off into the sunset where it belongs! Billions of dollars of profit in the insurance industry returned to investors. Why should there be profit in sickness and the medical insurance industry? Do we really want to profit from other people’s misfortunes? Doctors and hospitals can be well paid without the private insurance sector. Don’t get rid of government medicine, expand it, fix it, audit it, and keep it healthy.  How many Republicans over the age of 65 do you hear complaining about Medicare?  None, you say!  Why not?  Because they are happy with it, like everyone else; they just don’t have the courage and honesty to tell you so.