Flowers On The Water

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In residency many years ago, a woman who was newly pregnant for the first time, showed up in my clinic for her first OB visit. She was a graduate student at the local university and she did not have health insurance so she qualified for Medicaid.

For the uninitiated, obstetrics is a huge part of any family practice training program even though only a handful of us continue to practice OB on the other side of graduation. I delivered tons of babies as we did virtually all of the indigent care for the county and handled almost all of the Medicaid.

This woman, as it turns out, was married to a man who worked closely with my husband. Over the course of the next few months, we became good friends, having each other over, sharing food and fun. We taught them how to play 42. They taught us how to play poker.

Her pregnancy seemed to be going well until she went post dates (after 40 weeks) and then the baby’s heart rate started doing some wonky things during her follow-up OB appointment. Discussing with the attending, we decided it was time to induce. I sent her over to Labor and Delivery with handwritten orders to get the show on the road.

I was post call that day from a particularly rough internal medicine service call. This was before work hours restrictions and I had already been up for 36 hours. I was exhausted. I felt obligated, however, as her friend and physician, to be present throughout so I stayed on the labor and delivery floor for the next day and a half grabbing cat naps in a recliner in the call room when I could between seeing her and the other patients I was following on the medicine floor.

Thank heavens I had spare deodorant and lip gloss in my call bag and could change into a fresh pair of scrubs from the floor each morning. We won’t talk about my underwear…

Things were slow to progress, despite giving pitocin to stimulate contractions. Eventually, they picked up and she started pushing but the baby’s heart rate began to show prolonged late decelerations, a sign of fetal distress. There was meconium (baby poop), another sign of distress. She pushed and pushed but that kiddo was just not coming.

It was starting to look like we were going to require a C-section.

There were only two L&D operating rooms in that hospital and one OB attending who could do sections there at that time. My friend was third in line for the OR as we already had an emergency section in progress and another emergency getting wheeled into the other OR with a back-up attending on the way to perform that section.

This was not going well.

It was during the next late deceleration, as I waited holding my breath for what seemed like an eternity for the baby’s heart rate to climb back out of the 30’s, that I realized we were going to have to deliver now or lose the baby.

So I yelled at my friend to push harder than she had ever thought she could.

Harder! Harder! HARDER! You aren’t trying! HARDER!

By golly we got ourselves a baby. The chord was clamped and that little cutie pie was handed off to the NICU team.

In case you were wondering the baby did great and is growing up nicely…

A few years later, I stumbled across a post of my friend’s on Facebook, one of those silly questionnaires. The first question was, “What was the most horrible experience of your life?” She answered it with, “The birth of my first child.” The second question was, “What is the most ironic thing you have experienced?” Her answer? “That I am still speaking to the doctor who delivered my first child.” She went on to list her three closest friends. I was not on the list.

How do you tell someone that because they had Medicaid, they had to wait until they were dilated 4cm before they could have an epidural per hospital policy? How do you tell someone that because of staffing and space limitations at the hospital that they almost lost their baby? How do you tell someone, who blames you for a system and circumstances you had no control over, that you are not at fault? Someone that you thought was a friend but who really just thought you were ironic?

So I just didn’t.

We drifted apart. I don’t even think about them now unless it is Christmas. We used to spend all of our holidays together but now we don’t even rate each other’s Christmas cards.

This is the way of life. I do not regret my treatment during the delivery. I do not regret my relationship with her. I don’t regret not confronting her about her silly answers. I don’t regret drifting apart. She served a purpose in my life and we moved on. Like flowers on the water, here for time and then gone.

I do not mourn.

But I do think about them from time to time…

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65 thoughts on “Flowers On The Water

  1. I had a similar situation with a close friend. He was at fault, as usual, but it was always up to me to “make nice”. Well I decided I wasn’t going to do it. Six months later he was gone. I’m still kicking myself for waiting…

    Liked by 1 person

  2. I’ve had an experience like this (but not so life and death). Lost someone who was a bestie for a long time over something I didn’t do. I was so hurt that she didn’t talk to me about it but told everyone she didn’t want anything to do with me. Instead of confronting her (and I can be confrontational), I just let her go. As you say, sometimes people are in your life for a period of time and then they are gone. I don’t regret my decision (nor did she because I never head from her again) but I do think of her from time to time. She’s in her 70s now and I wonder how she is faring. Great post! You make us think.

    Liked by 2 people

  3. It’s hard for people who don’t work in the system to understand the decisions we make or that sometimes we are actually trying to help them when it seems like we are being tough. I don’t think she deliberately meant to sound ungrateful or critical. I think it was just the way she experienced it at the time without knowing the sacrifices you made nor the difficult decisions you had to make at the time. You did great for your friend and when you think about them, you should feel proud of yourself.

    Liked by 3 people

  4. Your post shook my by the shoulders. Just this morning I was thinking about past relationships,friendships. How they changed and drifted apart. And looking back how I wonder how we could have remained friends, and yet I miss them terribly or at least miss what was.

    Liked by 2 people

  5. Omg! I actually cried reading this, when the baby was born! (I rarely cry reading blogs.) I hate policies. I hate telling some one, we have to get this paperwork done before you can have that service. Policies suck. But you did an awesome job delivering that baby. Sounds to me like that baby is alive because of you. Sorry about the friendship. Oh well.

    Liked by 3 people

  6. This one hit a little too close to home for me. Because I am in a situation NOW that is similar.

    A woman who has worked for me for 11-1/2 years has been ill for the last year and a half. Before, she and I had a symbiotic relationship — she always knew what needed doing and did it perfectly. Since she’s been sick, however, her work has suffered. She makes errors all the time, and I need to find them and fix them, which, with assistance I’ve been doing. She calls in sick all the time, doesn’t follow her doctor’s advice — you know the drill.

    For all this time I have been covering for her because I feared she’d be fired by the head of the company who doesn’t think highly of her anyway. I have given her some of my vacation time, granted leeway every which way so that she can not lose money/time due to late arrivals, doctor’s appointments and days off.

    Two weeks ago, she accused me of being impossible to work for, because I am always correcting her work, and am impossible to please. She doesn’t think that she is making errors, doesn’t agree that she is misunderstanding instructions and doing things incorrectly that must be found and corrected, or that it is impacting the work of the team. I probably have been less jovial because I am doing a lot of her work as well as my own.

    I am too hurt and angry to talk with her about it. I will, but I will also think twice before I bend over backwards to help a colleague. And that, frankly, is what bothers me most of all.

    Sorry for the long comment, but thanks for the opportunity to vent.

    Liked by 1 person

  7. Oh hun, that’s really narrow-minded of her. People never think about what the other person is going through, what they have to deal with, or how things affect them.
    I have read through these replies and I am touched to see other people opening up with stories of similar situations. I think the word is betrayal. I lost two “friends” this year. Since then though, I have discovered that my other friends and my family have never really liked them, they only put up with them for my benefit. To me, that’s true friendship.
    I know you did everything the way you needed to and you brought that baby into this world. I hope you are proud of what you’ve accomplished. But I understand that time of year makes us reminisce and wonder why things turn out the way they do. X

    Liked by 3 people

  8. Thank you so much for the post. I really needed it today. I’m going through an icky situation with a “friend” right now and I’m losing sleep over it (I only slept two hours the night before Christmas because I felt so sick about it). I’ve stuck by this friend through so much when everyone has turned their back on her when they’ve had enough. She’s a person who has a hard time keeping friends since she can be incredibly selfish and manipulating, but somehow she’s kept me. Just this last summer two situations came up and I put my foot down (one of the situations — she wanted me to travel to a remote location for her [second] wedding and I had a five month old at the time who was exclusively breastfed, and I said I couldn’t make it). She told me she was really hurt that I wasn’t there, and I told her I’m hurt that she couldn’t step out of herself and see the other side. I’m pretty sure our friendship is now over. I’ve sent her a few emails and she’s never replied. Ugh, it hurts. On the one hand, I feel like it’s all my fault. But on the other hand, I think a true friend would understand. There is WAY more to this story (as there almost always is), but in short, I’ve always let her had her way and this is the first time in the fourteen years that I’ve known her that I’ve stood up for myself in our relationship. And it just feels terrible.

    Liked by 1 person

      • I completely agree with you, but there’s this nagging part of me that wonders if I did something wrong. I was thinking about writing out all my thoughts to her, but my husband thinks I just need to let it go. He knows her and doesn’t think it will do any good. What’s so hurtful to me is that she can’t see my side, so I feel like I need to explain myself so she does see my side. But I’ve tried explaining myself and she didn’t see it then, so I don’t know if more explaining will help things. Perhaps if I let go, she will come back around down the road.

        Just writing about this makes me realize that she really is not a friend at all!

        Liked by 2 people

    • ((HUGS)) Does this sound familiar or what??? I’m sorry this has been going on for you, and believe me when I say that I understand you distress 😦
      I hope you can find some peace eventually (even though I know how hard that is). I lost my first “friend” after standing up to her “always getting her way and never seeing it from my point of view). The pushing point for me was when I was her maid of honour at her “small” wedding but she wouldn’t let me bring my date (now husband) because we had only been together for 8 months and she didn’t know him very well. Then she was pissed off at me because I said I couldn’t afford to fly across the country to go to her “wedding reception” with her family a few months later despite being able to “afford” to go on vacation with my boyfriend that same summer…
      All this to say that standing up for ourselves is hard, but who else looks out for us? Believe me, it has taken every once of my energy not to send an apologetic email to K, even though I know this is not my fault…
      (And sorry, Victo, for using your comment section as a conversation…)

      Liked by 1 person

  9. Boy there are several things going on in my head after reading this one. First off, I love your blog. this one really made me think. You make me want to be a better writer. The rest of the stuff , I probably need to process a little more before saying it…it has to do with reaching out/ relationships, etc.

    Liked by 2 people

    • Depends on where you were. It is not a Medicaid rule per se, but at this hospital if you were indigent or medicaid, anesthesia required you to wait until 4cm. I suspect there were several reasons for that. One was that epidurals can stall the delivery process which might increase the need for more expensive C-sections. With Medicaid’s historically awful reimbursement, $ was in play. The other reason was probably a thought that pain would discourage further pregnancies. If it was someone who never had prenatal care, anesthesia would also refuse to do an epidural at all. You can bet the insured patients never had to deal with that kind of cruelty.

      Liked by 1 person

      • In our hospitals (at least all the ones I’ve worked in), we always wait until women are either at 4cm or being induced with oxytocin before we get an epidural. We do this mostly because we want to ensure the woman is in true, active labour (or definitely destined for that) before we potentially slow down or stall the labour with an epidural. The belief is that if an epidural is given too early and the labour stops progressing, you can never know if it’s becasue they weren’t actually in real labour, or if it ws because of the epidural… then you get un-needed/unnecessary interventions. (but then again, everyone gets “free” healthcare here)

        Liked by 1 person

  10. Looking back on the people who ended up as “flowers on the water” in my own life, there are very few regrets really. I initiated a reunion of sorts via Facebook a few years ago with one of those people and came to regret it almost immediately. Oh, but the ones that have stayed with me through the journey are more precious every year.

    Liked by 2 people

  11. Another wonderful post. I had a dear friend who was kicked out of school. I was not. There was no Facebook then. Years later, when I finally found him, he told me that he didn’t know who I was. Broke my heart.

    People categorize. They lump you in with those who hurt them. So you eventually you learn: If you’re a person who can see the other side, you can’t be friends with those who can’t.

    Liked by 2 people

  12. Pingback: My Article Read (12-26-2014) | My Daily Musing

  13. I wonder how many women would say that having their baby (probably first baby) was the worst experience of their lives? I certainly would, and I expect a lot of women would too, for various reasons.

    Maybe this is an example of “shoot the messenger” – it’s easier to blame someone and dump them like a scapegoat, than to accept that your life-changing hideous experience would have happened no matter who was trying to help you, just because nature planned it that way.

    Liked by 2 people

    • It is easier. As a physician that is part of my role, to be the scape goat simetimes. It is easier that way. You also make an interesting point about first babies. Those things are damn scary, I don’t care who you are! 🙂

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  14. Thanks for sharing this story. I am sure this is the “final destination” of my relationship with K. The circumstances of how you met, how you became friends, what you did for her, and how she eventually found you “ironic,” while different from my situation, are eerily similar. She delivered both of my babies, we became super close friends, and then one of us put an overly high value on the relationship as a whole. I guess it happens to everyone at some point.

    Liked by 1 person

  15. This business about insurance is very distressing. So sad that you two drifted apart but in my experience true friends can deal with and survive the tough stuff: conversations, situations etc. So you’re right when you say some people are in our lives for a purpose: a reason, a season or a lifetime.

    I spent 12 yrs having intermittent (monthly ) pain which developed after my 2nd kid which wasn’t normal for me. For a period of time I had no insurance so I didn’t seek medical help. I just suffered in silence and tried home made holistic remedies. No clinic gyn would send me for an ultrasound for cost issues and most told me I was fine – – “a lot of women have pain” .

    When I was finally able to afford insurance paying close to $400 per month I still couldn’t get the gyn (new doctor, different facility) to order an ultrasound. She too said I was fine! I couldn’t believe it. I was furious. I never got relief until after my 3rd kid (14yrs later). The only ultrasound I got that help me identify the issue was during the pregnancy and that’s when I asked the technician to look at my ovaries or check for fibroids. Bingo! There was a cyst on the ovary and I had fibrous.

    It was so ironic that the help I sought didn’t come from the doctors I put my trust in but from some one who was kind enough to go above and beyond her duties to help – – like you did with your then “friend’ and I’m sure with countless others (as I’m now discovering in your Chronicles/blog).

    The pain is no longer there (I suspect the meds I received for premature/false labor helped the cyst or abated the effects fibroid could have in triggering/mimicking labor, but those are my suspicions no doctor told me so) but I still feel like something isn’t quite right – – the area is still tender. I am now on Medicaid (challenges of single parenthood) and went for a physical since I hadn’t had one for a while. And would you know, the gyn ONCE AGAIN, told me I’m fine! And this is before she even examined me. She said she can’t authorize an ultrasound just because I want to know what’s going on. As if to say, who are you that you must know what’s going on inside your body? Oh the outrage I felt was too much to contain and expressed my frustration, politely but forcefully.

    As I stepped behind the curtain to undress, I spoke silently to myself and to God. I did not want her to be my doctor. I was ready to walk out. But by the time I finished the sentence she returned to the room and said she went ahead and ordered the ultrasound (perhaps to prove she’s right n me wrong – – wrong for questioning her wisdom. Hmm… )

    Either way, I’m anxiously awaiting that appointment since it took 14yrs to get the answers I’ve been needing for so long.

    Liked by 1 person

  16. If you saying “push harder” actually caused her to push harder, she was not already pushing as hard as she could. She is fortunate that you drew from your own reserves to help her. From all view points you did right. She might, perhaps, have drifted away out of shame or embarrassment that she expected you to do her part of the work of delivering her child. Too many new mothers do not expect labor to be just that. LABOR is WORK. Work the mother has to do, herself, one way or another. A mothers body becomes an open portal to the cosmos … how can that be easy? Well you know. You are a mother, also, as well as a physician.

    You are owed a debt of gratitude. I thank you in behalf of the innocent child. The parents will just have to grow up on THEIR own … yes the Papa owes you a thank you, as well. It is the sort of debt of balance the parents will have to achieve, sooner or later, in one lifetime or another.

    You did your part, you went to school all of those long years. You risked the terrible financial burden. You did without much that you wanted, and in some cases needed … like sleep, regular meals, clean socks.

    I thank you, for myself, and all of the mothers and children who have been helped and assisted by, and whose lives and welfare have been preserved by midwives, nurses, doctors, nurse practitioners, physicians assistant, EMTs and all the health care professionals and paraprofessionals. THANK YOU. ❤ ❤ ❤

    it is their turn.

    Liked by 1 person

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