Re: Today was a GOOD day

From: Meenan, Anna (annam@uic.edu)
Sun Mar 2 18:52:11 2008

There's the problem Allen. You interpret my post as gloating. That was never the intent, and I'm sorry if that's what you thought. The clinical part WAS pedestrian, and if everything had gone as intended, it would have been just another ordinary day, not a tragedy. When i left the hospital a week ago Friday, I had assumed that my good friend's grandchild would arrive over the weekend when I wasn't there. When I returned on Monday, I was happy to hear that I hadn't missed the birth, and assumed that I would be attending a c-section as pediatrician sometime that week, or that I would miss it entirely anyway if they brought her back for an afternoon c-section, since I only work mornings. When I arrived Thursday morning, I was pleasantly surprised to see that my good friend's daughter was in labor with a vertex baby, but figured that, being a primigravida who was only 1 cm, and not likely that any further augmentation would be a good idea because of the decels, she would probably get sectioned later, or at the very least, deliver vaginally much later in the day, after I had left. I was pleasantly surprised again when she was found to be 9 cm a little after 10 in the morning and that I probably would be able to be there for the birth, assuming she was able to push the baby out. I assumed that, because it was a decent-sized baby, it would take her the better part of 2 hours to push it out, so when I saw the decels after 10 or 15 minutes of pushing, I figured she was probably nowhere near delivery yet and would need a c-section. I was again pleasantly surprised to find that she had already brought the baby down to forceps/vacuum territory. I informed the OB simply because I didn't consider it quite "outlet" and because it was a "big" baby. I was AGAIN pleasantly surprised to find her crowning when I returned to the room. The ultimate outcome was a nice vaginal birth and that I did get to be there, and my intent was simply to share the elation of that moment with my friends here at OBGyn.net. The midwives apparently understood, as I expected they would. I wasn't gloating.

We don't hand our patients off from doctor to doctor. The patient's FP resident provides continuity and follows the case all the way through. The attendings are usually quite peripheral unless there is trouble. I too did all my own OB for over 15 years, taking call for my OB patients 24/7 unless I was out of town. It was a great experience, but I eventually burned out. My current schedule works for me because I have a 21-year-old son who became addicted to a computer game, flunked out of the Big State U, and is now doing well in community college. I have to be home by 2PM to unlock the internet for him so he can do his homework before going to evening classes. My priorities have changed. Kids have a way of derailing our best-laid plans. Another reason the good days are precious.

Such is life.

Anna Meenan, MD, FAAFP

>In a message dated 3/2/2008 8:57:02 AM Eastern Standard Time,
>annam@uic.edu writes:
>
>Just makes my point that I would not go to you for obstetrical care.
>
>I don't see flaws in our system. You must work in a huge hospital
>with unlimited empty OR's and bunches of scrub nurses and
>anesthesiologists just sitting around twiddling their thumbs, even
>on weekends. How nice for you. In the real world, there are plenty
>of excellent hospitals doing excellent work with the resources they
>have. BTW, my mother used to be a nurse surveyor for JCAHO and once
>surveyed this hospital. She told me I was lucky to be working
>there, because it was easily the best hospital she had ever
>surveyed, of the hundreds all over the country that she had seen.
>
>It was a good day until I decided to tell my friends at OB-Gyn.net
>about it. I'll keep my good days to myself in the future.
>
>Anna Meenan, MD, FAAFP
>
>In a message dated 3/2/2008 9:02:57 AM Eastern Standard Time,
>annam@uic.edu writes:
>
>I don't call an OB to put on a vacuum, only to do a c-section. And,
>since I mentioned speaking with consultants a couple of times in the
>story, I'm not sure why you couldn't figure out that I was an FP.
>
>Anna,
>
>You don't think obs consult each other? If that's the case, we
>wouldn't have this list. Right from the beginning, I was not even
>interested in how you managed your patient. The clinical part
>seemed pedestrian. I was only curious in why you gloated when
>seemingly everything had to have gone wrong (or at least not as
>intended) before you could have had your normal vaginal delivery.
>That really implies that the flip side would not have been so
>desirable if everything HAD gone according to plan. If the outcome
>of your planned actions were not as desirable, how can you continue
>to have faith in your own practice? I think your gloating might
>have underscored some of the frustration that a day-to-day
>practicing OB has to contend with. That's why I found your
>jubilation in little odd!
>
>All your assumptions about me was wrong! You can try to make me
>feel bad that you would not come to me as your ob. If being handed
>off from physician to physician, and from FP to Ob to FP, is what
>you desire with your care, then you shouldn't come to me. Until a
>month ago, I was solo. I took care of every single one of my
>patient 24/7. I was with every patient every single step of the
>way. I am my patients' biggest advocate! Patient satisfaction is
>never overlooked. Contrary to what you think, I practice in a small
>hospital where people would go out of their ways to accommodate.
>And I did work with FPs and CNMs before, they preferred to work with
>me! Heck! One of them even married me!
>
>I don't mean to tear your case apart. I just wanted to make a point
>that not everything was Jim Dandy. I don't want to second guess
>your management. I just know that I wouldn't be feeling so good if
>I was in your shoes. I am happy that you are happy. I learned
>something about human nature from our discussion, albeit awkward.
>Let me apologize for the third time if you felt I rained on your
>parade.
>
>Allan
>
>Delicious ideas to please the pickiest eaters.
>the video on AOL Living.

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