When, as a medical student, I took the plunge into obstetrics, I remember thinking that delivering babies was so much fun that I’d be willing to pay for the privilege.
It was fun for years. I spent my twenties, thirties, forties at it. I sacrificed many a night’s sleep and plenty of my own life on that altar. My own children complained about it. Night call got harder, physically, and the workload, day and night, became ever more demanding. I’d always been in academic medicine, so working harder did not translate into more money. But that was OK too. Still fun. Still it was work that was important and valuable. Still, I thought, I was doing some good for mothers, babies, students, residents. The shape of the job changed over time: there was less time for reading, or writing, or research, or thinking. It got to be all clinical, all the time. We covered more clinics and took more call. Expectations burgeoned like mushrooms after rain. It was no longer enough to be physically present in the hospital: the attending had to come to every delivery, scrub for every case, see every consult, see every patient in triage. Oddly enough, this did not grow us any extra attendings. But it went some distance toward driving out the older, experienced ones.
I got sued. It was traumatic the first time. I got dropped. I tucked my tail and kept going. I got sued some more. Sometimes I got sued for deliveries I didn’t even do, deliveries I wasn’t even in the hospital for. I got dropped some more. Most of these were cases where I didn’t even know there was an unhappy outcome. You brace yourself after the bad shoulder dystocias, or the bad babies, but those aren’t the ones that surprise you. The ones you didn’t see coming are worse. As an attending physician in an academic medical center I have my fingerprints on a lot of patients, one way or another. Did I read a straightforward ultrasound at 18 weeks? Did that patient go on to develop preeclampsia 2 months later and deliver prematurely at some other institution? Could she read my name in her records? Because if so, she could advance a legal theory about my culpability. More calls and more clinical duties cut down on the time I could spend with any given patient, increased the number of patient exposures, forced multi-tasking even when focus would have been best.
It was like dancing through a minefield. You could never tell when something was going to blow your legs out from under you, but it wasn’t any safer to go back. I did my best to keep the mission in mind, but the joy was leaking out of a hundred different punctures. I became wary of patients. I got tired of everybody else’s needs. I tried to dodge the bullets.
This year, the bullet had my name on it. The case blew up out of nowhere, like they do; it was another 24-hour in-house call at the academic medical center. There was nothing memorable about it, at least from the perspective of a few years later. No standout crises that day. But a patient admitted that day delivered the next day, after a second stage I didn’t manage and wasn’t there for. I read that chart through in the lawyer’s office: she rejected the cesarean offered after a few hours of pushing, went on to a spontaneous vaginal delivery. Normal fetal heart rate tracing throughout. Normal cord gases. Lousy Apgars and intracranial hemorrhage. I felt bad for the patient and her baby: she thought it would take about $20 million to raise him.
My lawyer—-strike that, the university’s lawyer—-figured I’d be dropped. I hadn’t written a note, which was unusual, but sometimes you miss one in triage or on the labor floor. The plaintiff’s lawyer started out with a theory about the strip but gave it up. The theory fibrillated a little, eventually settled down, exhausted, on the notion that if any of the attending physicians had personally retrieved the prenatal clinic record over the weekend, the patient should have been offered cesarean at admission—- the same procedure offered, and declined, in labor.
Depositions were duly taken and experts ordered up. A court date was duly scheduled. I arranged coverage for my clinical duties and dreaded the date. A settlement was proposed, rejected, renegotiated. I got a phone call: the university is going to settle, it’s a business decision. One of the seven million dollars in that settlement would be assessed in my name.
My consent was not sought. Settlement was reached over my objection, and I had, by the terms of my employment contract, no right to refuse settlement or go to litigation. No confidentiality agreement was imposed upon me. I asked what would happen if I wrote about the case, and was met by shocked silence…because it’s a shameful thing, a secret we’re supposed to keep in the closet.
I didn’t lose this case: I never had an opportunity to fight it. But there is a record now in the National Practitioners’ Data Bank with my name on it; you could look it up. It will follow me the next time I apply for a medical license, or hospital credentialing. And in the eyes of patients or consumers…well, you know what it means. Those doctors are damaged goods, subprime mortgages, product recalls.
But I know what else it means. It means I’m hanging up my gloves. It means I’m done with delivering babies. Is there an emergency on L&D? Is the department strapped for nighttime coverage? Do you need a senior physician to take a junior one through a breech delivery? Did you call for help with that shoulder dystocia? Sorry, but I already gave.