The Soapbox

This page written circa 26 December 1998.

On The Art of Medicine

Merinda Sequoia, as several of our correspondents speculated, will be unhappy with her birthdate of 24 December. Who can blame her?

We had hoped that she might be a little late from her due date of 26 December, and statistics and the example in point both favoured this scenario. I'd prefer a birthdate N days after Christmas day rather than N days before. We'd have been better able to deal with the event then, because of the shutdown at work. Also, I guess that Kay would have preferred a drug-free as well as a swift labour. With her physique, she'd have got it, but for the interventionist approach of "one of the most medically advanced countries in the world", as one supporter described our environment.

That description, however, is not quite right. Interventionist, perhaps, but that is a symptom, not the cause. It has taken me days to put into satisfactory words why I felt what I felt instantly and instinctively when I first met Kay's doctor: Resistance. She did exactly what needed to be done to ensure the physical well-being of the baby of a stupid person. There seemed to be no elegance, no allowance for the possibility that the mother might be intelligent. It was clear, Kay said so, that she was uncomfortable with the timing, that she needed some more days to be prepared. It was clear that Meri was, during the 12 hours of continuous monitoring in the hospital, in no distress at all. The stress followed Kay's driving by herself, in a manual car, to a test that upset her enough for her to call me at work---the so-called "No-stress" test! Yet they pushed for an induction.

OK, there was little amniotic fluid, which meant that the shock absorber was not functioning, but that just means avoid potholes, take the risk of some mechanical bruising if you like, in exchange for a delay if it is worth it. (I think it would have been. Certainly the long pre-labour hospital stay, and the absence of pitocin-induced foot swelling, drips and monitor cables, would have allowed better chance of coping with labour and easier recovery, apart from the psychological readiness aspect.)

A colleague at work summed it up rather more incisively: The doctor did exactly what could not lead to a law suit. I attributed the doctor's attitude to the fact that she had not devined that Kay was sensible, she had not assessed her patient. I knew the doctor was competent, I watched her carrying out a subtle surgical repair to Kay (a small tear that had caught a vein, in a difficult recess), but she did not readily communicate details to Kay or me, and she seemed not to take on board all the information we gave her. In fact I now suspect that she does not bother with that communication because it would not alter her zero-exposure trajectory---it would be a waste of energy.

The anaesthetist we had was another story. He was quick, kind, thoroughly informative, had risk statistics and event prognoses at his fingertips, explanations of everything if you asked, or the latest speculations from the literature if the answer was not solid. As one scientist to another, he rapidly betrayed both a responsive approach, and a complete grasp of his trade.
In talking to him it turned out that he had spent years at UCSF as a teacher, in one of the "two best anaesthesiology departments in the country", and had eventually left for the same reasons I left Sydney University: It was augering in, and he could get far better pay and conditions elsewhere. Eject!

This is my soapbox, so here's a paragraph with me standing on it: I have an intense preference for the way I operate in life: In any dealing, I am prepared to be purely an assistant, happily at the controller's beck and call, with little or no control and no responsibility, or absolutely in charge, taking responsibility in that case... but not anything in between. I am either in total control, or I take no responsibility; if you don't like that, I walk. There is one near-exception to that situation, my work, where I am often required to contribute as part of a team, but then I am paid well, and I still tend to partition my part of an effort, and to regard communicating my output, synchronising with others, as part of my responsibility. Put another way, I hate being dependent upon another person; one advantage of working at HP is "no turkeys"... as companies go, it seems that HP has very few people you can't trust to do their jobs. (RF Technology and, once upon a time, Sydney University, were the same.)

Because of my reaction to Kay's doctor, and the fact that I could not have control for the well-being of my family, I had a lot of resistance to being part of the birthing process. Of course, walking at that stage was not an option!

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