Read Online Assume the Position: Memoirs of an Obstetrician Gynecologist by Richard Houck MD - Free Book Online
Authors: Richard Houck MD
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easy decision for us. We visited Arizona again together on a home hunting expedition, and for my wife to see her new community. We liked what we saw. Opportunity for both of us was everywhere. It seemed like a good place to raise a family. Phoenix was a place for the sun to shine on us! We left friends and family behind for a new beginning. My parents couldn’t understand. “Where is Arizona?” they said. “And what happens when we have grandchildren?” “Fortunately there are airplanes,” I explained.
(An Arizona cowboy.)
Chapter 3 Labor and Delivery
There were many things to learn during my internship about Labor and Delivery. One of the things that plagued me as an intern trying to master Obstetrics at Pennsylvania Hospital was how long to leave a woman in labor in the labor room before moving her to the delivery room and table. If the timing was late she would deliver in the unsterile labor bed; and if the timing was early she would labor for a far longer time than desired while in the uncomfortable stirrups on the delivery room table, a situation I had difficulty mastering at first. One could read about labor and delivery all day long in the textbooks, but learning how to manage labor varied with the individual. It took years of experience, observation, and an understanding as to what was within the norms and what was outside of acceptable limits. When in doubt about these things, the best person’s brain to pick was often one of the well-seasoned labor and delivery nurses. So I asked Greenie, who had been there for 37 years, for some advice.
“Doc,” she said, “When they ask for the ophthalmologist (eye doctor) you know it is time to move them”.
‘Huh?”, I muttered, scratching my head. She said it sounds like this. “AYYYY, doctor! “AYYYYYYY, doctor!”
I had been trying to figure it all out from results of my pelvic exams. She had the answer without the exams. Listen to the patient, she told me. Look at her face! Read her sense of urgency, tension, pain and emotion. Listen to the crescendo in her voice. See the furrowed brow and the sweat bead on the upper lip. Watch the little blood vessels in her face pop. A valuable lesson, indeed! I got it, and never forgot it. Why didn’t they tell Greenie to just write it down in the textbook?
Most of the women for whom we cared while in Labor at Pennsylvania Hospital were young, black, poor, and often uneducated. Obviously pregnant, these women were our clinic patients, and received the best care available in Philadelphia. As residents we learned to administer our own epidurals during labor for pain relief, and although we became quite proficient at them, if the patient wasn’t cooperative it was not an easy procedure. I remember well one young 13 year-old clinic patient who came into labor and delivery screaming at the top of her lungs without a support person. She was out of control, writhing in bed, on all fours at times, alternatively climbing over the bed rails and standing on the bed, refusing an examination and refusing to be touched or to even have an IV placed. No amount of calm persuasion, talking, or any sort of communication was effective. She was demanding pain medication. I did my best to explain to her that nothing was going to happen to help her unless she cooperated, we were not going to do anything to hurt her or her baby, and nothing could be done until we examined her first. She refused. There were only two or three times in my career when I raised my voice to a patient, this being the first. It only happened as a last resort when education, communication, discussion, calm persuasion, and all else failed. I closed the door to the labor room so that it was just she and I. In no uncertain terms, with a calm but raised voice, I explained to her that I would not
(An Arizona cowboy.)
Chapter 3 Labor and Delivery
There were many things to learn during my internship about Labor and Delivery. One of the things that plagued me as an intern trying to master Obstetrics at Pennsylvania Hospital was how long to leave a woman in labor in the labor room before moving her to the delivery room and table. If the timing was late she would deliver in the unsterile labor bed; and if the timing was early she would labor for a far longer time than desired while in the uncomfortable stirrups on the delivery room table, a situation I had difficulty mastering at first. One could read about labor and delivery all day long in the textbooks, but learning how to manage labor varied with the individual. It took years of experience, observation, and an understanding as to what was within the norms and what was outside of acceptable limits. When in doubt about these things, the best person’s brain to pick was often one of the well-seasoned labor and delivery nurses. So I asked Greenie, who had been there for 37 years, for some advice.
“Doc,” she said, “When they ask for the ophthalmologist (eye doctor) you know it is time to move them”.
‘Huh?”, I muttered, scratching my head. She said it sounds like this. “AYYYY, doctor! “AYYYYYYY, doctor!”
I had been trying to figure it all out from results of my pelvic exams. She had the answer without the exams. Listen to the patient, she told me. Look at her face! Read her sense of urgency, tension, pain and emotion. Listen to the crescendo in her voice. See the furrowed brow and the sweat bead on the upper lip. Watch the little blood vessels in her face pop. A valuable lesson, indeed! I got it, and never forgot it. Why didn’t they tell Greenie to just write it down in the textbook?
Most of the women for whom we cared while in Labor at Pennsylvania Hospital were young, black, poor, and often uneducated. Obviously pregnant, these women were our clinic patients, and received the best care available in Philadelphia. As residents we learned to administer our own epidurals during labor for pain relief, and although we became quite proficient at them, if the patient wasn’t cooperative it was not an easy procedure. I remember well one young 13 year-old clinic patient who came into labor and delivery screaming at the top of her lungs without a support person. She was out of control, writhing in bed, on all fours at times, alternatively climbing over the bed rails and standing on the bed, refusing an examination and refusing to be touched or to even have an IV placed. No amount of calm persuasion, talking, or any sort of communication was effective. She was demanding pain medication. I did my best to explain to her that nothing was going to happen to help her unless she cooperated, we were not going to do anything to hurt her or her baby, and nothing could be done until we examined her first. She refused. There were only two or three times in my career when I raised my voice to a patient, this being the first. It only happened as a last resort when education, communication, discussion, calm persuasion, and all else failed. I closed the door to the labor room so that it was just she and I. In no uncertain terms, with a calm but raised voice, I explained to her that I would not
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