When A Doctor Needs A Doctor's Note

As physicians, we can lose objectivity when it comes to our own medical care.
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This story begins when I was a bright-eyed, young doctor. I was just out of residency and I was still learning who I was and how to exist in the world. This comes from the sheltered existence of being in the hospital for up to 110 hours a week for three years and also spending my entire life in school or in training. I trained as a family doctor in a very intense program and then, before I could blink, went through a very complicated pregnancy. My first baby was born when I was less than a year out of residency. My beautiful daughter was born early, but healthy and strong, thanks to my care team.

My second daughter was born in the midst of other big transitions: a cross- country move, a new faculty position, a new city and home to adjust to. When I was only 5 months pregnant, I began having painful and powerful contractions. Despite this warning from my body, I pushed through. After all, I was seeing patients, teaching, establishing myself as a new faculty member and caring for a toddler who was having a tough transition to her new home. Luckily, this baby came only three weeks early, and missed being called premature because she was delivered just after midnight.

This pressure to push through, to put one’s needs aside for the greater good, is one of the legacies on my profession. Everyone around me, my boss, my husband, my doctor had all given me “permission” to slow down, but how could I? I would be letting my patients, my residents, but most importantly myself, down. This feeling tied together with the bravado that everything would turn out fine – and I was lucky, it did.

Fast forward ten years, I was blessed to be pregnant with a third baby, and now, I was an experienced doctor, mentor, teacher, and mother. Although the balancing act and nurturing aspect of my multiple roles was hard, I was loving each role and doing well. I was convinced that because of my contentment and happiness, this pregnancy would be different. It turns out that the Universe was listening when I said that, and she laughed at me. I ended up with multiple issues including being on insulin shots (which did make me a better doctor, by the way!). And, again, too many contractions, too early. But, I had so many responsibilities and could not conceive of being able to slow down. Who is going to see the patients? Who is going to give the talk? Who is going to meet the deadline? Who is going to pick up the kids? My midwife told me is no uncertain terms that I needed to stop working, “Any one of your conditions would make you high risk and any one of them would make it so you should be on leave. Don’t worry, I will write you a doctor’s note explaining the need for you to stay off your feet” she said.

Let’s take a moment to discuss what many of you may be thinking, ‘Why did this doctor choose a midwife for her prenatal care?’ I chose a midwife because I know that they are uniquely skilled at caring for normal pregnancies and normal deliveries in a hospital setting. And in this choice, you see my continued denial: of course this would be a normal pregnancy. My first two pregnancies had necessitated care from a subspecialist (an OB trained in maternal fetal medicine – i.e. complex pregnancies). My midwife was wonderful and she worked closely with the specialist as things became complicated. And let’s not ignore the irony of a doctor needing a doctor’s note! But how could I explain that it was not my workplace that needed convincing, it was me. Deep down, I believe I felt that if I stopped working, that would be a sign of weakness, it would be admitting that I could not do it all. And, I knew the studies: there is no evidence that in cases like mine, bedrest has any effect on the duration of the pregnancy.

Then, one Thursday night, right before Halloween, I started having contractions that were painful and progressive. I laid on the couch, fearful, but doubting my fear at the same time. I ended up going to the hospital – so that someone else could make a decision about what to do next, instead of making my own decision about that. By now, I recognized that I was not objective in assessing next steps.

At the hospital, I was told that I was dilating and that they were worried that the baby would come too early, 7 weeks before the due date. I was flooded with guilt, did I push myself too far? Why didn’t I listen to my perfectly reasonable and wonderful midwife? Luckily, that night, my labor stopped. But it took that terrifying experience and the baby’s cry for help for me to finally understand. From then on, I stayed home. I sat on the couch and answered emails and called into meetings. I was grateful for every day that the baby stayed inside. I am certain now that the peaceful downtime was what bought another two weeks of pregnancy for my little girl. She was born in Mid-November, 5 weeks early, happy, healthy and strong.

In hindsight, I can see clearly that the choices that I made were not in the best interest of myself or my family. But, in the moment, I struggled with giving up control. I struggled with making the choice to stop working, and with believing that it was a choice that I should make. I think that this partially comes from the idea that women can’t have a baby and be a great _______ (fill in the blank). And it also comes from the pressure that I felt to do it all – keep performing at the pace that I had been performing at – that in some way, if I couldn’t do that, then I was failing. An article published in Baltimore Magazine in 2007, summed this up beautifully: “There is an old stereotype that doctors don’t get sick—and there’s a related saying that, when doctors do get sick, they make the worst patients. Doctors are supposed to be infallible, unbreakable — bastions of health who aren’t supposed to fall prey to illness like the average person.” The author goes on to say: “Doctors are used to being in control, and relinquishing that role is very, very difficult.” This was my experience exactly.

In the end, this experience has taught me a few different things: as physicians, we can lose objectivity when it comes to our own medical care. Patients are faced with difficult choices and the decisions that they make about their medical care are complex and we (and they) may not understand truly why they are making that decision. If I had not chosen my health and the health of my babies in that moment, there is no way to know what would have happened. As they say on the airlines, “put your own oxygen mask on first!” Even though it may go against our instincts as doctors, when we are sick, we need to learn to put ourselves first – because it matters.

For more narratives and perspectives on women in medicine, please see this piece, by the curator of this collection Jessica Gold, MD MS for links

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