“Are you going to be there to deliver me, Doctor?” It is a question I hear each time I see a new obstetrical patient and one for which I have to admit I am never prepared. After all, the patient has come to see me because either they or the referring doctor feel that I have something to offer. And however mistaken they may be, a choice was still made. Expectations engendered. After doing whatever research you felt was necessary for your choice, you do not choose a red car and expect to drive home in a blue one, even if it’s just as good.
So the answer to that question is a difficult one for both parties: she bonds with me, but I also bond with her. And given the exigencies of a call schedule, there is bound to be a disconnect. No matter the desire, I simply will not end up delivering all of my patients; the odds are just not there. The patient has to decide if she wants to invest in a long-term relationship of trust and respect with someone who is possibly going to abandon her when she really needs it: at the apotheosis of the entire process.
But nowadays, no matter who she chooses -family doctor, midwife, obstetrician- they are all on call schedules. No one can be available all the time. In my particular practice there are seven other obstetricians, so the chances are only one in eight that I’ll be the one she’ll see on that special occasion. I’ve tried answering their question like that, but the look on their faces when presented with the odds have taught me that it’s helpful to alter the perspective somewhat: same answer, different context.
Pregnancy is a long road, and like any journey, it’s important to be well-informed along the way about what to expect and what to avoid. Guide books do this, don’t they? That’s one of the reasons we consult them; and the more relevant and assimilable information they offer, the better they are. The trip is almost as important as the destination. If the one is enjoyable, if we know a little bit more about the places we pass, it certainly doesn’t detract from where we hope to end up. Reassurance and advice along the way may not shorten the journey, but give us confidence we’ve taken the correct route.
And in my centre, whoever is on call, lives in the hospital for 24 hours, so if my patient were to present herself to the Delivery Room with an unanticipated problem in the middle of the night, or have some worrisome symptoms that need investigation after office hours -and isn’t that when they usually occur?- there is always a specialist available. No need to worry if their own doctor can get through the rush hour traffic in time, or whether his phone is turned on; someone is always there to help, no matter how grave or trivial the problem. And I trust my colleagues’ judgments; I suspect -I hope- this is not unique. In fact many of them were my residents in past years, so I know how they perform in emergency situations. I think sharing this with my patients helps to alleviate at least some of their frustration at a system that seems to franchise obstetrical services to strangers.
In fact, when I am on call and delivering a colleague’s patient, I sense an understanding, an acceptance of the delegation of responsibility to someone else and I try to be mindful of the fearful joy attendant upon the delivery they have so long anticipated. I try to be respectful of their expectations, their customs, and yes, even their idiosyncrasies. God knows I have enough of my own.
I try, in other words, to show them that it isn’t an abandonment, an uncaring assignment of their health to a surrogate simply because I choose not to be available all the time. But I suspect they know this. Neither the doctor nor the midwife, is the pregnancy. And neither of us is the delivery. We -I- am merely the person riding shotgun on the stagecoach making sure that the strong-box makes it safely to Dodge… Where did that metaphor come from..?