There are only three things in this world that are certain: death, taxes, and babies.
Nobody knows this truth better than Emily McCoy, a third year resident working in Baby City, the affectionate nickname for the busy Labor and Delivery unit at a New York City hospital. On a typical day in Baby City, Emily delivers more babies than the number of hours of sleep she manages to squeeze in that night. And definitely more than the number of dates she's been on since she started her training in OB/GYN two years earlier.
As Emily works tirelessly to safely herald baby after baby after baby (after baby) into the world, she becomes well acquainted with the three hard facts of Baby City:
1) Babies never come when you want them to.
2) Babies always come when you don't want them to.
3) You don't know who your true friends are until your baby is sliding down the birth canal.
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An interview with Dr. Kelley Stoddard
Review on AMWA
Read an excerpt:
I am going to make this medical student cry.
I don’t know how I know it, but somehow I can sense it. I know it the second she walks into the resident room on Labor and Delivery at Cadence Hospital, her perfect blond ponytail swinging behind her. And I’m certain of it when she holds her slim hand out to me and says, “Hi! I’m Caroline! I’m the new medical student!”
No, I am not exaggerating those exclamation points.
“I’m Emily,” I say. (Note the lack of exclamation points.) I stay in my seat, but I reach out to take her hand, which is as smooth as a baby’s bottom. And I’ve touched a lot of babies’ bottoms lately, considering I’m working on Labor and Delivery right now. “I’m a third year resident.”
My co-resident and sometimes friend, Jill, who also happens to be the chief resident for OB/GYN, looks down at Caroline’s outstretched hand and shakes her head. She leaves Caroline hanging as she says, “I’m Dr. Brandt.”
Actually, maybe Jill will make her cry.
“I’m so excited to be here!” Caroline says, practically bouncing on the heels of her practical shoes. She’s wearing the requisite blue scrubs—if she weren’t, Jill would be chewing her out as we speak. “I’m really interested in women’s health.”
“Do you want to do OB/GYN?” I ask her.
Caroline shakes her head, trying not to look too horrified at my question. Most people are freaked out by the very idea of doing what we do every day. I have Caroline pegged as more of a family medicine or pediatrics type.
“I want to go into family medicine,” Caroline says. Bingo. Then she adds, “But I’m considering a fellowship in women’s health.”
Jill snorts. She doesn’t think much of family medicine residents who want to horn in on our territory.
This is our second day on Labor and Delivery, which somebody years ago nicknamed Baby City, like one of those discount places that sells TVs or computers. Baby City, as in bring home the baby of your choice in any shape or size at low, low, low prices! Of course, it isn’t really an accurate comparison. You don’t get to choose the shape or size of your baby. And I definitely would not describe the prices as “low, low, low.” If this were a real store, we’d definitely go out of business.
We were sort of hoping that we wouldn’t get a medical student this month. I do believe in teaching and all that crap, and I was excited about having medical student when I first started out in residency. But since then, I’ve learned a very important lesson: most medical students are very annoying. Occasionally, we’ll get some rare gem who is just wonderful and who makes our lives easier. But the vast majority seem to be lazy, whiny, and disinterested.
Or in Caroline’s case, overenthusiastic. Which is very possibly the worst of all.
Caroline hovers in the center of the room, as if afraid to sit in our presence. Jill looks up in disgust, and rubs her temple with one skeletal hand. In residency, many people tend to get either really fat or really skinny based on what they do with food when they’re stressed out. Jill obviously starves herself when she’s under stress, as evidenced by the fact that I can make out every single bone in her hand. I bet I could count her ribs.
I wouldn’t say this to her face, but if Jill gained about 15 pounds, styled her hair, and put on some makeup, I think she would be gorgeous. She has wispy white blonde hair that is clearly natural based on the roots and the fact that there’s no way she has enough time to dye it. Her crystal blue eyes are always slightly bloodshot with purple circles underneath, and her high cheekbones only make the hollowness of her cheeks more exaggerated. I don’t think I’ve ever seen Jill looking any less than gaunt and completely exhausted.
But she’s only got one year of residency left. Maybe after that, she’ll start taking care of herself again.
“Emily,” she says. “They just put The Princess in a room. Why don’t you take Caroline here to go see her?”
“The Princess is here?” I ask. “Why?”
“Elective C-section,” Jill says.
I sigh. Figures.
I turn to Caroline. “Do you want to come see a patient with me in triage?”
Caroline’s eyes light up like she’s a puppy who just found out she’s being taken for a walk so she could go pee.
“Oh, yes!” she gushes. If she had a tail, she’d be wagging it.
Baby City consists of three parts. The first part is what you traditionally think of as Labor and Delivery: a bunch of rooms where women’s cervixes are busy dilating or else they’re busy trying to push out their babies. The second part consists of an operating room for C-sections, D & C’s, or whenever other procedures may be required over the course of bringing babies into the world.
And the last part is Triage. That’s where the women go when they think they’re in labor, are waiting for a C-section, or have some other pregnancy-related problem that is yet to be diagnosed. That’s where our patient, The Princess, is waiting.
The Princess is well-known to pretty much every resident in OB/GYN. We take turns doing outpatient clinic throughout residency, and The Princess seems to show up there almost daily. If this woman breaks a nail, she needs her OB/GYN to check it out and make sure it’s not early labor. She’s been asking for a C-section since she was 32 weeks pregnant. The part that surprises me is that we’re actually doing it. When did we start letting the patients run the asylum?
Caroline follows me down the long hallway to Triage. I’d prefer if she walked next to me, but instead she walks directly behind me. I feel like I have a stalker. I keep turning my head, to see if she’s still behind me, and being slightly disappointed to find her there.
The Princess is in Room 2 in Triage. I pick her chart off the door, and quickly ascertain that she is only 37 weeks pregnant. Pregnancy is supposed to last 40 weeks, so I can’t imagine why she would be getting an elective C-section three weeks before her baby is done cooking. Presumably, there’s a good reason. None of the attendings that I work with would deliver a baby early just
because the patient asks him to.
Well, none except one.
I knock twice on the door to the room where The Princess is waiting. She’s lying on the table, her long dark hair impractically loose. And she has on way, way too much makeup for a woman about to have major abdominal surgery. (Although I think any amount of makeup is probably too much for that.) The first thing I notice is that she’s on her cell phone, and when she sees me enter, she holds up a manicured finger to indicate she will just be a minute.
So I wait.
I recognize in this day and age, everyone has a cell phone. So it’s not completely crazy to expect that occasionally you will walk into an exam room and find the patient using one. I don’t like it, but I accept it. But most of the time, the patient will quickly say something into the phone along the lines of, “The doctor’s here. I need to go.” I wait for The Princess to say something like that, but she doesn’t. She seems to just be continuing her conversation as if I’m not even standing there. Moreover, the conversation seems to involve some juicy gossip from work. Seriously, you would not believe what Dave said to Angie.
I clear my throat twice, and am this close to throwing her chart on the floor and storming out of there, when The Princess finally says, “Okay, I’ve got to go have this baby now.” And then she hangs up the phone.
“Well?” she says to me impatiently. “Are they ready for me yet?”
“Not yet,” I say through my teeth. I can tell she has no idea who I am even though we’ve met several times, so I say, “I’m Dr. McCoy.”
The Princess nods, and then her eyes rest on Caroline.
“Why did you bring your daughter with you?”
Okay, I realize that I am very tired and probably look it, but I really don’t think I look old enough to be the mother of a 24-year-old. I mean I’m only 30 years old. Not even 30 and a half.
“This is Caroline,” I say. “She’s our medical student.”
The Princess shakes her manicured finger at me. “No medical students.”
“Mrs. Woodhouse,” I say. “This is a teaching hospital.”
“I told Dr. Brandt no medical students,” she says firmly.
So Jill knew about this when she sent me in here with Caroline. That bitch. I’m going to get back at her for this.
“That’s all right,” Caroline says quickly. She smiles brightly at The Princess, who looks like she wants to make Caroline cry just as much as I do. “I can get you something while you’re talking to Dr. McCoy. Is there anything you would like?”
The Princess nods. “Yes, I would like a vanilla Coke Zero.”
The Princess is not allowed to have anything to drink, because she’s about to go into surgery. She knows it, I know it, and Caroline ought to know it, but clearly does not.
“I’ll be back in a jiffy!” Caroline says.
I probably ought to stop her. But I don’t. It will give her something to do. I’m pretty sure there’s no vanilla Coke Zero anywhere in the hospital.
“Mrs. Woodhouse,” I say. “I’m looking through your chart, and somehow they haven’t recorded the reason for scheduling your C-section so early. Is your baby measuring large?”
“Oh no,” she says. Then she adds proudly, “I only gained 15 pounds in my entire pregnancy.”
Actually, The Princess looks pretty fabulous for being 37 weeks pregnant. A lot of women are gigantic by this point and also very swollen. But she looks like a model of pregnancy. If I ever get pregnant, I want to look like her at 37 weeks.
“So here’s what happened,” she says. “A few nights ago, my belly got itchy. I mean, really itchy.”
I wait for her to tell me more. Were her liver tests elevated? Was she cholestatic? Did her blood pressure go up? What was the indication for this early delivery?
But it turns out the story is over. That’s it. She’s having her baby because she’s itchy.
“Dr. Buckman said I was full-term,” she explains. “I mean, there’s no reason for me to continue being pregnant and keep getting fatter. He said the itchiness might mean I’m getting a new stretch mark. Ew, can you imagine?”
I grip The Princess’s chart hard enough that the papers start to crinkle. Dr. Buckman, the doctor with 50% C-section rate. That explains everything.
The Princess sighs and adjusts her body on the table. She hasn’t gained much weight, and most of it is in her belly. She looks the way I used to look when I was a skinny little kid and I put a soccer ball under my shirt and pretended to be pregnant.
Every resident, myself included, wants The Princess to deliver her baby, because that means she’ll be out of our lives. But we can’t be selfish right now. I look down at her belly and think about that tiny little baby inside. That baby deserves another three weeks to grow in the best possible environment. It doesn’t deserve to come out gasping for air, because its mother was itchy one night. I have to advocate for this baby. God knows, somebody has to.
It’s up to me to convince The Princess not to have this baby today.
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