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…