Wednesday, April 16, 2008

Sick and tired

I forgot to mention that I haven't been sleeping much lately, mostly because I'm getting such bad heartburn now that if I lie down flat, I throw up in my sleep. I'm propped up but it isn't helping. Over the weekend, I started to aspirate my own barf and was so terrified to go to bed, I gave up sleeping at all. I'm convinced I'll die if I lie down.

So now I'm a little nuts. My Doctor gave me a different prescription for the heartburn on Monday but I can barely make it to the pharmacy. I feel like shit.

And then after he and I had looked at his schedule a few weeks ago and figured out what day I'd get my early induction, based on when he is on, and based on the condition of my placenta....another of his fucking vacations have been added. Apparently the other 15 weeks a year he takes vacation aren't enough. *eyeroll* I'm being ABANDONED. He's gone from May 26th to June 9th, and loads of other high risk OBs are covering him, but so what? I chose him for a reason. My only option now is to either get induced on May 25th, a Sunday and pray I do my entire labour and delivery within that 24 hours, or wait 2 whole weeks for my placenta to deteriorate and suffocate my baby to death. And induction that early, before my body has done much dilating, is not so easy, even for a woman whose cervix has dilated before.

Cause hey, it's not like I've ever had this issue come up before, right? You know, emergency high-risk deliveries with placental tears and menconium and babies who barely make it out alive....nahhh, not even an issue for me.

And yes, when I found out that he had added this vacation, I burst into tears in front of his secretary and panicked completely. She got him from his office and he told me we'll work it out somehow and he hugged me and maybe it will be fine, but I can't even think about this logically anymore I'm so scared and sick and exhausted.

Whatever happened to docs working long hours and having a commitment to their patients? I know CEOs who work longer hours these days, never mind the average working person. I swear you'd think they were special or different. My GP, my pediatrician, my OB, every Doc I get referred to it seems. Meanwhile, being a Doctor seems to have become a part-time profession these days....I haven't noticed them taking any paycuts though.

Funny that.


  1. Aurelia, I am so sorry you are feeling abandoned and upset.

    However, why shouldn't physicians be able to work part time and take vacations? They have families too. Some of them are parents with young children. Is working long hours, rarely going on vacation and neglecting your own family really a requirement for providing quality patient care?

    I fail to see that working part-time or going on vacation means a physician is not committed to his/her patients. Your OB provided "loads of other high risk OB's" to cover for him. This suggests that he has done his best to ensure his patients are cared for in his absence.

    I understand that you would like to have him there for your delivery, I really do. But perhaps his family would also like to have around to see his kids grow up or what have you.

    If an OB did all of his or her own deliveries he/she could NEVER take a SINGLE day off. He/she could never attend a school concert without a pager, never, ever, commit to any of their families activities etc, etc.

    In addition, 90% of physicians in Canada are paid "fee for service" ( which means they are paid for the patients they see and hours they work - so indeed reducing their (admittedly generous) pay if they work less.

    I know you've had a terrible time with physicians and I certainly don't think they are entitled to "special status", or god like reverence, but working part-time, or going vacation, or putting your family before your work, particularly when you have made reasonable professional arrangements for you absence, is not exactly an outrageous idea - for anyone.

    You've made an excellent point in this blog that physicians are ordinary people who make mistakes, maybe they should be permitted some semblence of ordinary lives too.

  2. Hmm, Call me crazy, but I think if you're going into a profession that deals with high risk patients delivering babies that you're signing onto a life of slightly less time with the fam. It's one of those plus/minus things: you get a nice paycheck, and hopefully a sense of reward helping moms have healthy babies and live through their pregnancies, but maybe you work 5-6days/week, and only get 3 weeks plus holidays off. Which is more than most people who work much less interesting jobs with less pay. These particular patients, in this particular niche profession, DO need you around the clock, and if you develop a relationship with a patient who will obviously need you during a certain time period, I think it's professional to let them know IN PERSON that you are terribly sorry, but you won't be in the office, and make a point of introducing them to the person who will be, and explain your case in front of them so you know your complicated file won't get lost in the In Box. And I don't care if it is Canada, and it is free.

    Aurelia, I know you're beyond tired, and logical thinking, and this is just piling on. I've said it before: sometimes after going through hell, the big things are water off your back, but the little things really fucking piss you off. And I think this might be one of those things. I'm so sorry.

  3. I think that people who have not walked in your shoes can not possibly understand how scared and stressed out you must be feeling. I do not blame you one bit for being upset that your doctor has chosen to take a vacation at this scary and crucial time in your pregnancy.

    I hope that everything works out perfectly for you.


  4. Jen,

    I was out and couldn't be blunt, I was not exaggerating about the number of weeks he takes vacation, not to mention the fact that since he is paid part salary due to his position and part fee for service, he gets paid full time, yet works part time.

    He also has still kept up with the same number of patients as before, yet gets paid as if he is meeting with them all. Well, he sort of is...since he saw 60 patients in one day a few weeks back...something forbidden under OHIP rules if I ever felt like reporting him. He is supposed to be spending a half hour consult with each one. Not quite, eh? I make him take his time with me, but how many other women just get rushed through?

    As for the other OBs on call, one is an asshole as I mentioned. The other one is the same one who delivered Matthew and it would be pretty upsetting to me to see him delivering this live baby after what happened then. The rest are not familiar with my case and when I've met with them, they treat me like a trainwreck. A horror story...makes me feel all warm and special.

    Being a Doctor is a full time job, it's never been a part time job, especially for high risk OBs. And yes, I am annoyed when my Docs build up a huge full time practice, and agree to be there for people and make commitments---then decide to go part time, and try to dump patients, or make us wait ages for appointments.

    Other OBs decide not to take any patients delivering in say--August, and then take that 4 weeks off. They book it in advance so all the patients know in case they go over or early. School schedules are known a year in advance. So why has my OB decided to suddenly at the last second take another 2 weeks, even though he just committed to me that he was on call then?

    Who knows---but if you make a commitment you stick to it, barring an actual personal emergency. At least in my world.

    As for being at every concert, etc. or doing child care? Most average employees cannot do this, so frankly, too bad. They can try to make some and their spouse makes the rest.

    It's the price you pay for making that kind of salary.

  5. Hi Aurelia,

    Thanks for your frank and fair reply. Certainly I agree that if you are being paid for a full time job, you should, well, be doing a full time job. And physicians of course should only take on as many patients as they can treat in a timely and appropriate manner. 60 in one day is over the top. When you describe the circumstances in more detail, I have to agree with the inappropriateness of this particular situation.

    I do however, maintain that doctors should be able to work part-time (with a part-time pay check, and part-time case load, and good coverage for their patients when they are away, etc), and to take some reasonable number of vacations. And I think EVERYONE is entitled to make their own family of some priority.

    Anytime a high risk OB takes even a weekend off, they are probably going to leave one or more patients with complex (and probably heart-wrenching) histories to deliver with a colleague. I don't think it is a good outcome, I just think that no one should have to work all the time.

    Suppose a woman trained to be an OB, and then ended up, not of her own choosing, as a single Mom. I think she should be able to work part time if she wants to, and can arrange a group practice that continues to provide quality care for her patients. She should not have to completely give up her livelihood in order not to be on call 24/7/365. I think it IS possible to be a good doctor in less than full time hours, and the spouse Aurelia suggests may not be in the picture.

    One of the (many) things I like about your blog is your lack of reverence for the medical profession. You remind us they're all human.

    I wasn't trying to minimize your situation, and I'm really sorry it came accross that way. I understand it all too well. I was just generally objecting to the general idea that to be a good doctor you needed to work full time, all the time. That's all.

    Sorry it came out otherwise.

    Very best wishes,

  6. About the early induction - I was induced with Nomi due to GD, about 3-1/2 weeks earlier than I went into labor naturally with Yirmi. Mine went relatively slowly and it was around 10 hours from the time they started the pitocin. It seems reasonable to expect that you could give birth within 24 hours. If labor progresses slowly, they can rupture your membranes, which usually moves things along... I just can't imagine the stress you'd be in waiting those extra 2 weeks, unless you have frequent monitoring (I base this on my experience of having just been 2 weeks overdue with Yirmi & actually waking up in the middle of the night to make sure I felt him moving).

    I can really understand your frustration at your doctor. I was depressed the whole day when mine told me that I was being shifted to the 'post-date' clinic...

  7. I'm so sorry, Aurelia. That's terribly frustrating that your doctor may not be around to deliver your baby.

    There are some good ones still out there, though. My OB is young (late 30/early40) and because he doesn't yet have a family, he tells his patients he's able to devote more time to them. He is only unavailable 7 days out of the year. He's a sole practicioner too, but I don't know how much longer he'll be able to keep this up. I was grateful for him for all we've been though.

    Hang in there; it seems optimistic that he told you you'd work it out together. I'm sure you can both work out a plan that would benefit you, your healthy baby and the doc. I'm wishing you all the best.

  8. Blah, don't even get me started on OB woes.
    I am so sorry you are feeling that way but I totally understand why you would.
    I hope you and your OB come up with a solution that makes you feel better.

  9. Jen, no need to apologize. I'm thinking that from what you have said that you are the wife of a Doc or a Doc?

    Anyway, I'd really like to see a decent halfway response from some Docs. I'm not asking them to work 24/7/365, but a full workday would be nice.

    And yes, for OBs the hours are longer simply because of the nature of the job. Thing is, no one forced them to become OBs. They could've chosen a different specialty. They don't have to work every weekend, but at some point, they logically will be working weekends and be on a pager or a blackberry.

    Anyway, I should probably turn this into a is an interesting subject.

  10. Hi Aurelia,

    Thanks. Sorry if I am posting this comment twice - I thought I'd posted it but it hasn't appeared.

    Anyway, I'm not a doctor nor is anyone in my immediate family - but I do indeed have some close friends who are physicians. Including a young Mom who is a part-time OB. As far as I can tell she is very dedicated to both her patients and her family.

    Right then. Here's to the end of my very ungraceful de-lurking.

    Take care,

  11. Heh heh -- funny that I should surf by on today: when I showed up at the office 45 min early as a "special" favor for a good client, only she no-showed!
    (she did call at least, but I was already here)
    Already lost my tiny slice of Quality Time w/my son (I generally take him to Fri AM church service) which becomes all-the-more-poignant when he'll be gone for a long weekend...
    Oh well, I didn't comment just to bitch & moan -- but I did want to throw my support behind ya, Aurelia, I think choosing high-risk OB as a profession does/should shift the priorities a lil' bit!
    (There's good reason I run MY clinic as I do.)