It’s a little past 3 a.m. when I’m called to the delivery room as I am for every delivery at Eden Hospital. The high-pitched beep of the unit cell phone wakes me like a hammer. A nurse with inpatient voice tells me that I am needed in room such and such. In the dark I sit, my scrubs wrinkled, eyes closed, my mouth open. I attempt to lower my voice to convey authority but my voice betrays. “I am coming,” I squeak.
Before flipping on the light, putting on my black Adidas, tucking in my scrub top, grabbing my stethoscope, looking in the half length narrow mirror above the cracker-package strewn side table and wanting to cry at the man with bad hair and liver-spots, I actually lay back down on the call room bed thinking that I don’t care. I start to count to twenty bargaining that 20 more seconds of sleep isn’t going to hurt anyone. I rationalize that I am actually helping to avoid a situation in which I arrive to the delivery only to see that the baby’s head not crowning at the vagina and me being annoyed.
I know which room to enter from the many possible rooms by the hushed voices, occasional cry and persistent rhythms of the fetal heart monitor escaping the edges of the thick light brown privacy curtain hanging from the ceiling. In the past I would get caught in this curtain. Thinking it would whisk away, I would dive toward its middle, sweeping across it with one of my arms but the steel runners would instead play net edge, catching the pediatrician like unintended dolphin or carp. In the past, I would also think that I was being called for an emergency. I would have forgotten that Eden advertises a pediatrician present at every delivery (for the safety of your baby…). I would have presumed such conditions as high or low fetal heart rate, very premature delivery, eclampsia, thick meconium, or pre-identified cardiac defect, and upon extricating myself from the tendrils of the privacy curtain, said to the many upturned faces at my appearance, “Good morning. I’m Dr. Wang. What’s going on?”
“25 year old prima gravida at 39 weeks. Group B Strep negative. Good variability. No temperature. Membranes artificially ruptured 14 hours ago,” the obstetrician would say.
“Great, and the reason for calling?”
“The delivery.”
“And the risk factors?”
“There aren’t any.”
(Silence)
“We always call pediatrics for deliveries.”
“Well then I guess you don’t need me now.”
“We need you to give us the baby's weight and vitals,” a nurse would interject.
“Right…” I would say.
The interaction because of shaky foundation would degrade from there. I would weigh the baby and record its temperature while dad took videos but inevitably the baby would pee towards my face or I would find an extra finger on exam, which I would try to hide because I didn’t wanted to talk about it. Focus on the baby not the job. I mean, focus on the baby through your job. Things could be worse. You could be a poorly paid male nurse.
On this early morning, having recovered from the initial shock of being awakened, I am relatively nimble. I slide instinctually past the edge of the privacy curtain, towards the sink where I lean in to grab a large pair of blue latex gloves, which I then lean back to stretch on. With the crook of my elbow, I edge my matted hair in the opposite direction. I have already cleaned my eyes. Upon exiting the anteroom leading to the larger room, my entrance elicits a distinctive yell, not from the woman in stirrups naked from the waist down, but from the man positioned next to her at the upper end of the bed. A petite elderly woman wearing black head cover standing next to him also yells out at the sight of me, quickly turning her head away as if she has just witnessed something gruesome,
“Get out!” the man cries again, “get him out.”
Startled at the reception, I myself let out a yelp. I look to the obstetrician preparing for the delivery for guidance. She is fully gowned in blue paper protective clothing and has donned a mask with plastic facial shield. She turns to me and says, “Parents are Muslim. Apparently no male besides a husband is allowed to see a woman naked."
I am irritated because might I have been told this information before hand?
“No problem,” I say retreating, my hands up in the air as if on the receiving end up a stick up. What I say internally is much different. The monologue is spontaneous and quick but not expressed without regret. I hate you. Your wife’s vagina is not a sexual organ to me. There is a baby coming out of it and incidentally below it is stool. I am here in case your baby needs help. It’s easier for me not to have come here. In fact, I was sleeping and dreaming of something so perfectly neutral and peaceful I forgot the dream, which is a shame. By the way, take a look at what is happening at the other half of the bed below you. It’s a miracle that you are polluting with your yelling.
I used to teach a course in health care quality. The acronym I used to formalize and organize better the traditionally loose concept of care quality was S-T-E-E-E-P: Safe, timely, equitable, efficient, effective, patient-centered care. The most important piece of S-T-E-E-E-P was the patient centeredness part. In the construct, the patient and provider enter a relationship whereby the provider serves the patient much like a sales person serves a customer. The quality of care is dependent not at all on whether the health care provider thinks s/he did a good job, but rather if the patient was satisfied with the experience-- the health care product. Because there is typically knowledge disparity between provider and patient, patient centeredness subsumes the other parts of care quality. The satisfied consumer would want a nurse or doctor to provide care as fast as possible that solved the problem without too much risk, that didn’t waste resources and which wasn’t dependent on one’s socioeconomic status, if they didn’t know about these things. .
