Last OB Call/the path forward!

I just wrapped up my last day on OB call (ever?!). It feels surreal, as I made the decision and posted many months ago  (poem pasted below) about my plans to "retire" from birth work with Open Door. My last shift was actually a back-up call only for high-risk patients or surgeries/complicated births for a bright, new midwife, Hannah, who is starting with our prenatal program. It was met with some phone calls and guidance for work she was doing,  but no births or even in-person services necessary, which was a perfect (gentle, out with a whimper, not a bang) way to mark changing of the guards!

I likely have (two weeks ago) "caught" my last baby ever (delivered by an emergent cesarean after which I could not locate my wedding ring, which I apparently flung off in the scramble to get scrubbed, until it fell out of my scrubs pant leg [? trapped in my bra?] about 12 hours later!). I got thrown in to care for a family I didn't know, but whose trust I did build through the process and (good baby) outcome; however, the absence of true prenatal connection reminded me that I am more human than just a baby-catcher and the loss of continuity in our practice was the deal-breaker for me to continue to work in this system. 

Who knows if I'll ever deliver a baby on the sidewalk, airplane, or other (or become a midwife as I probably should have been in the first place!). Catching babies probably is like riding a bike, although prenatal care and management of medical complications of pregnancy evolves.  But if one is a doctor who stops attending hospital births, one loses the ability to keep or reestablish "privileges" pretty quickly (after about two years) and I probably cannot "un-retire" (AHEM, Lindsey Vonn!), so it's pretty clear that I will be out of the scene forever.

I had a lot more tears back earlier in the year, when I was praying over the weighty decision (albeit right for me) to pivot to a new chapter-- birth work has certainly been for me the best and most fulfilling part of medicine.  Now, I'm truly so happy to leave the 2 a.m. baby-catching to other professionals -- the release of the anxiety and hypervigilance of on-call work in exchange for more presence in parenting/relationships and more sleep is truly a huge relief.  Attending so many wonderful births for the last many (almost twenty if you include residency!) years has truly been a joy and a privilege, but when it became more stressful than meaningful (and I was absolutely dreading my days being ON), I knew it was time to step away.  I am truly at peace with the plan, and "celebrated" today (no other fanfare planned!) with a long post-call run to Eureka's Target and back (~14 miles)!

    

  

 

Emily P. Freeman's words in Annie B. Jones' Ordinary Time, a book I recently read, spoke really loudly to me: "To be human is to know what it feels like to sit all the way down for the long haul, to stand all the way up and leave rooms that no longer fit, and to carry the sorrows and celebrations that may accompany both."  

I also loved what Jen Hatmaker wrote in her new memoir, Awake:  "What if Mary Oliver is right and this is our one wild and precious life? What if we don't really get any days back, and this whole life is ours either to grind our way through or throw our arms open for delight, for wonder, for joy and beauty and connection? What if we keep putting off happiness until later and later never comes? What if we hang doggedly to 'surely this thing will eventually get better' but it doesn't? Are we really just helpless recipients of stalled, drained, broken things, or do we have some agency? What if a life exists so full we would barely recognize it against our hustle and exhaustion and emptiness? Have we settled when we don't have to? What if there is a different path, a different pace, a different peace? Apparently people can choose the life they want." 

I have chosen.  A new chapter begins. I'm on a new path.  Life goes on....

My poem from May 2025:  LIFE GOES ON

The miracle of birth,

of welcoming new life,

is something that not many have the privilege to witness.

So many years,

So many babies,

So many mothers,

So many families.

So many connections-- 

as a result, many familiar faces

seen at the park,

at the library,

at the market,

at the school, 

in the community,

so many of them now dear friends.

Once newborns, now children, growing alongside my own,

as life goes on.

So many tears-- 

from mothers,

from fathers,

and wailing infants.

Happy, joyous tears,

as well as tears of grief and loss.

Some from patients, 

and many my own.

So many happy days, 

and some of the hardest to bear,

when some of those babies didn't breathe.

There were more patients to care for.

Life somehow goes on.

Countless hours at the bedside, 

during marathon labors,

96-hour call stretches,

long nights and weekends,

(and then clinic the next day),

all while missing my own babies at home,

and taking so much time to recover.

Too stressed to snuggle. 

"Mama, you're too tired to play with us!" 

ringing in my ears, 

as their lives (without me present) went on.

Trapped in a call schedule for a more than a decade,

working weekends, nights, and holidays,

missing weddings, 

anniversaries,

birthdays,

Christmas mornings,

family travel,

bedtimes,

rest,

and freedom.

Honored to be present at families' major life moments,

but knowing that it comes at a great cost,

feeling so often as my own life

was passing me by.

Sleep interrupted,

2 a.m. phone calls, 

rushed drives to the hospital for precipitous births.

Emergency after emergency,

decels,

distress,

hypertension,

hemorrhages, 

C-sections,

vacuums,

twins

(and even a few breeches!).

Adrenaline, cortisol

constantly flooding the body,

rushing, yet trying to stay calm, 

the oppressive weight of hypervigilance

stealing the present,

and so often squeezing out the joy.

And then there came a heavy transition.

Loss of a community birthing center.

Loss of choice.
Loss of autonomy.

Loss of stability.

Loss of continuity.

Loss of the best clinic,

to join a large group,

a major hospital.

The interpersonal connections-- so vital to trust, 

and meaning,

lost in the broken system.

Too-short office visits to check the boxes,

going through the motions,

patients treated as interchangeable,

more as numbers, 

pathology, and problem lists,

than humans.

Depersonalization.

Disorganization.

Distance.

Quantity, not quality.

Shift work, 

not soul work.

The job not only hard, and very different,

but also feeling deeply wrong.

The long days--and nights-- 

now too much to bear.

We have been conditioned to 

stick it out. To persevere,

regardless of the cost,

to show resilience, 

even if your soul despairs.

To have grit, and not quit,

lest we seem selfish,

not hardworking.

To withstand moral injury,

without the space or time to heal,

even while we try to heal and care for others.

But if only we could all have the choice,

to leave the tyranny of toxic expectations, 

and relinquish the guilt,

in favor of the grace of escape

(knowing "when to hold 'em,

 fold 'em,

walk away,

and when to run" (1).

For only when our schedule aligns with our values, 

will we begin to know peace (2).

Midlife- 

is where I am. 

Life half over (if I'm lucky). 

It's been a devastating decision, 

a hard good-bye,

to release what has been my life's most rewarding work,

a huge part of my identity,

my calling,

a gift (to others and to me).

Birth work a unique type of medical care,

a special way to demonstrate and share love. 

But the body keeps the score, 

and gives a definitive sign that it's soon time to step away --

from being there for so many of those very first moments and breaths --

to being present for and living more of my own.

“You're replaceable everywhere but home."

Loved ones, social connections,

the ultimate keys to a meaningful life.

Rest can be resistance,

Change is inevitable,

but suffering is optional. 

A boundary is a type of self-care.

One can continue to love and care for families and this community--

sparing (and honoring) one's own life (and family) as well.

A chapter closes.

Life is not over, but takes a different path.

It is not necessarily an end of a career, 

but rather the light bending into a new direction.

Maybe once out of the rain,

I will once again be able to feel the warm blessing of the sun.

Feeling the glimmers of hope at what the future holds,

even as I step into the unknown,

which may even bring more joy than what lies behind,

my "one wild and precious life" (3) goes on.

1. Don Schlitz/Kenny Rogers, “The Gambler”

2. Steven Covey

3. Mary Oliver, “The Summer Day” 

The needs of the patient come first

Our local hospital, Providence/St. Joseph's (now the only hospital in the country that takes care of laboring women, since Mad River's closure last October), has made the national news this year due to at least one lawsuit against the hospital by our state's AG due to infringement on women's rights by forcing religions/ethical directives and limiting the emergent care by providers of women with incomplete pregnancy loss or non-viable pregnancies due to preterm complications. 

A recent hearing last month (which I was unable to attend) re-discussed the issue, and attorneys for Providence challenged the previously agreed-upon responsibility to treat antepartum emergencies (like inevitable miscarriage, pre-viable preterm labor, PPROM, antepartum hemorrhage, etc. even if a fetal heartbeat is present) as situations requiring nuanced medical (not religious/political) decisions between providers and patients. 

Several doctors in our delivery group collaborated to publish thislocal journal article that came out this week, which explains that our duty is not to unjust and often patriarchal, inhumane, or rigid hospital systems, but to our patients, many of whom already drive long distances to reach our maternity ward in the desert that is Humboldt County.

I have stood up for women and their rights in the childbirth setting for many years, and even as I fade off into the sunset in this part of my career, I vow to continue serve our patients humbly and compassionately in some of the hardest days of their lives.  I am thankful to have so many colleagues that vow to do the same, even as we may face the threat of hospital retaliation.   

As I learned way back in medical school,  "THE NEEDS OF THE PATIENT COME FIRST."

(- Dr. Will Mayo).

Life Goes On

After a lot of prayer and soul-searching, I recently made the difficult decision to step away from pregnancy care with Open Door by early next year, after more than fourteen years of attending births locally (and close to 1000 babies!). It was definitely not an easy decision, fraught with lots of conflicting emotions and tears, but life goes on. I'm so thankful for the wonderful years working with incredible nurses, colleagues, and lovely patients. Here's to the future.

LIFE GOES ON

The miracle of birth,

of welcoming new life,

is something that not many have the privilege to witness.

So many years,

So many babies,

So many mothers,

So many families.

So many connections-- 

as a result, many familiar faces

seen at the park,

at the library,

at the market,

at the school, 

in the community,

so many of them now dear friends.

Once newborns, now children, growing alongside my own,

as life goes on.

So many tears-- 

from mothers,

from fathers,

and wailing infants.

Happy, joyous tears,

as well as tears of grief and loss.

Some from patients, 

and many my own.

So many happy days, 

and some of the hardest to bear,

when some of those babies didn't breathe.

There were more patients to care for.

Life somehow goes on.

Countless hours at the bedside, 

during marathon labors,

96-hour call stretches,

long nights and weekends,

(and then clinic the next day),

all while missing my own babies at home,

and taking so much time to recover.

Too stressed to snuggle. 

"Mama, you're too tired to play with us!" 

ringing in my ears, 

as their lives (without me present) went on.

Trapped in a call schedule for a more than a decade,

working weekends, nights, and holidays,

missing weddings, 

anniversaries,

birthdays,

Christmas mornings,

family travel,

bedtimes,

rest,

and freedom.

Honored to be present at families' major life moments,

but knowing that it comes at a great cost,

feeling so often as my own life

was passing me by.

Sleep interrupted,

2 a.m. phone calls, 

rushed drives to the hospital for precipitous births.

Emergency after emergency,

decels,

distress,

hypertension,

hemorrhages, 

C-sections,

vacuums,

twins

(and even a few breeches!).

Adrenaline, cortisol

constantly flooding the body,

rushing, yet trying to stay calm, 

the oppressive weight of hypervigilance

stealing the present,

and so often squeezing out the joy.

And then there came a heavy transition.

Loss of a community birthing center.

Loss of choice.
Loss of autonomy.

Loss of stability.

Loss of continuity.

Loss of the best clinic,

to join a large group,

a major hospital.

The interpersonal connections-- so vital to trust, 

and meaning,

lost in the broken system.

Too-short office visits to check the boxes,

going through the motions,

patients treated as interchangeable,

more as numbers, 

pathology, and problem lists,

than humans.

Depersonalization.

Disorganization.

Distance.

Quantity, not quality.

Shift work, 

not soul work.

The job not only hard, and very different,

but also feeling deeply wrong.

The long days--and nights-- 

now too much to bear.

We have been conditioned to 

stick it out. To persevere,

regardless of the cost,

to show resilience, 

even if your soul despairs.

To have grit, and not quit,

lest we seem selfish,

not hardworking.

To withstand moral injury,

without the space or time to heal,

even while we try to heal and care for others.

But if only we could all have the choice,

to leave the tyranny of toxic expectations, 

and relinquish the guilt,

in favor of the grace of escape

(knowing "when to hold 'em,

 fold 'em,

walk away,

and when to run" (1).

For only when our schedule aligns with our values, 

will we begin to know peace (2).

Midlife- 

is where I am. 

Life half over (if I'm lucky). 

It's been a devastating decision, 

a hard good-bye,

to release what has been my life's most rewarding work,

a huge part of my identity,

my calling,

a gift (to others and to me).

Birth work a unique type of medical care,

a special way to demonstrate and share love. 

But the body keeps the score, 

and gives a definitive sign that it's soon time to step away --

from being there for so many of those very first moments and breaths --

to being present for and living more of my own.

“You're replaceable everywhere but home."

Loved ones, social connections,

the ultimate keys to a meaningful life.

Rest can be resistance,

Change is inevitable,

but suffering is optional. 

A boundary is a type of self-care.

One can continue to love and care for families and this community--

sparing (and honoring) one's own life (and family) as well.

A chapter closes.

Life is not over, but takes a different path.

It is not necessarily an end of a career, 

but rather the light bending into a new direction.

Maybe once out of the rain,

I will once again be able to feel the warm blessing of the sun.

Feeling the glimmers of hope at what the future holds,

even as I step into the unknown,

which may even bring more joy than what lies behind,

my "one wild and precious life" (3) goes on.

1. Don Schlitz/Kenny Rogers, “The Gambler”

2. Steven Covey

3. Mary Oliver, “The Summer Day”

Midlife Transitions

Many people have some sort of midlife reckoning, it seems.

For some, it comes in the form of a crisis (men dropping their wives and buying sports cars comes to mind). For others, it comes as more of a gradual recognition of how we want to live in the world, and I think I'm at that point!

At forty-three, I'm tired. I have struggled with balancing the pace of 20-minute office visits and the "metrics" of productivity in the primary care office setting for almost fifteen years.  I've taken overnight OB call at least once or twice a week (excepting my own maternity leave) during the same stretch of years, and now our prenatal and call model has changed (not for the better, I'm afraid). I'm finding that pulling all-nighters regularly is not good for my body, and I don't tolerate sleep deprivation as well as I did a decade ago.  When I am forced to park it in the hospital for 24-48 hours, I miss my family. I miss.... life, and feel at times like it's passing me by.   I often don't have the time, energy, or patience to play and kindly respond to my children and spouse or connect with others outside of work.

Last week, I had a break from patient-facing medicine and attended (virtually) a wonderful Inaugural CME (continuing medical education) course, "WHAM" (Women's Health and Menopause) put on by Harvard Medical School. I learned so much (with some self-interest) about the changes to women's bodies in middle age, along with how our moods, sleep, and outlook are affected by our fluctuating hormones. I also learned a ton about evidence-based treatments (including sessions in "Culinary Medicine" and WE. SHOULD. NOT. BE. AFRAID. OF. HORMONE-REPLACEMENT. THERAPY) that can reduce a lot of the symptoms, and suffering, unique to women at this point in our lives, when we have a lot our plates (demanding jobs, demanding kids, and more), and are undergoing some serious inevitable but disruptive physiologic changes. There were key talks about the interplay of stress, trauma, and hormones on our bodies and that living in a high-cortisol state constantly depletes us in so many ways, leading to burnout (duh, but validating). I got a serious break from my daily cortisol spikes-- and felt so much better.

While she was not a presenter at the conference, doctor Mary Claire Haver is another contemporary menopause expert, whose books and work are really illuminating about how our diet and exercise routines can really improve how well we feel (as well as our overall health. In short: Eat way more protein. And do strength training 2-3x per week because cardio alone cannot do it for you). 

In any case, I have realized with a lot of major contemplation that I really don't want to stay burned out, tired, and grouchy! I know I have to make some serious changes in my work life to stay more balanced, and it may have to start small, but I think it's worth doing (in fact, it's probably imperative). Stable misery is not a way to live! I can't get an A-plus at everything, and I don't want to rush through my days. Life is (probably?) half over, after all, and is meant to be enjoyed.  Stay tuned...

"Your ordinary life has extraordinary value. You don't have to work to uncover a secret dream because there might not be one. Your dream also doesn't have to include hustle and influence and numbers. Dreams don't have to be measurable to have meaning. Everyone has the right to dream big, but that doesn't mean everyone has to. It's all just life and all of it counts.."

..."You're not measured by greatness, success, or completed goals. In fact, I personally don't want to 'measure' my life at all. I want to live it." 

 - Kendra Adachi (fellow recovering perfectionist) in The Plan

#LadiesOfNPS say good-bye

 “How lucky am I to have something that makes saying goodbye so hard.”

        -AA Milne, The Complete Tales of Winnie-the-Pooh

If you received/read our family's Christmas letter, you know that 2024 was a rough year!  We pivoted on vacation spots due to the middle east conflict, fled a devastating wildfire on vacation in Canada, lost our beloved 14-year-old pup, Pepper, to heart failure, faced the closure of our local birth center in October, and then endured more terrible election results where he-who-shall-not-be-named prevailed against the better-qualified candidate and superior human being.  The grief and change has been almost too much to process and bear, although we just continue to put one foot in front of the other, and continue to work through it all...

Today, I worked my last day (morning) and saw my very last patient ever at NPS, the delightful and homey prenatal clinic at which, alongside the most amazing team of staff one could imagine, I've served patients and families for over thirteen years (and at which I had my own prenatal visits). After the Mad River Birth center closed, we weren't sure what the future held for our prenatal site. Due to resources, space, and other organizational reasons, Open Door decided that it made the most sense to consolidate prenatal programs under one roof in Eureka. Unfortunately, we were given about one month's notice to swallow the news (although we negotiated for two, having a hard time coming to terms with the abrupt changes and knowing our patients would struggle additionally with little time to adjust to more whiplash).  The prenatal sites are both closed tomorrow (MOVE DAY), so that beds, equipment, supplies, papers, and more can be transferred from town to town to the other prenatal building, RCHC.  

(Now closed for more than lunch)

I was extremely sad when we learned about this (latest) change, grieving another huge community loss. NPS has had a small group prenatal practice with high continuity and satisfaction for patients, families, staff, and providers alike. The COVID pandemic challenged us all (and led to quite a bit of burnout), and, while several incredible prenatal nurses that are dear friends have moved away to other local positions, and providers have also left (or retired from birth work) over the years, we still maintained an extremely high quality of patient care, something uniquely special and unlike anything I have experienced anywhere or any other time in my career. I've delivered multiple children of multiple families, which is incredibly special to me and gets us treasured handwritten notes, cards, and baby photos!

I also have loved commuting 10 minutes to and from work and being able to drop off my kids at school and pick them up (now, likely, and sadly, a thing of the past).  And, although we will be continuing prenatal services at RPS/RCHC in Eureka and, with hope, will continue to offer high-quality and personalized care, I know there will be some kinks that need to be worked out and a tough adjustment period for staff and patients alike.  It's so hard when things that have been working so well for so long come to an end (for reasons out of one's control), and change. is. so. hard (especially for "dinosaurs" like me).

Christmas party photobooth photos from years past...

From a White Elephant Christmas Party- IYKYK

(#LadiesOfNPS, including Aileen, Molly, Dani, and Kayla)

One of the very last sessions at this workstation, my second home

I'm genuinely trying to find the silver linings in the clinic merge (additional exceptional colleagues and less care fragmentation are a plus!), despite the upheaval of everything we've been through in recent months. I've accepted the changes (even logging of EPIC today and walking off campus without tears), am looking ahead to effecting positive change at my "new" job location. Nevertheless, today, I reflect and hold space for grief and feelings, grateful for the wonderful years and laughs I've had and all the friends and memories I will keep despite this conclusion. It's been a huge blessing and privilege to work with the best humans and at the best prenatal clinic around... 

 

Bye Bye, Birth Center

We found out in August that the Mad River Birth Center was, after more than fifty years, no longer going to be offering maternity care/birth services after October (the hospital plans to stay open otherwise).  While shocking (and the timeline was way too abrupt), it was also not surprising, given the hospital's nursing staffing struggles in recent years as well as trends in maternity care in this country.  There are many expanding "maternity care deserts" in the U.S. due to rural community hospitals deciding to cut obstetrics programs, as high-quality maternity care is not a money-maker (in large part due to horrifically low insurance reimbursements for women's care and birth).

Over the last couple of months, I've read a million e-mails and attended "transition" meetings about a shift in birth in the county-- with all hospital births in the county now heading to Providence St. Joseph's Hospital in Eureka, which has also made national news due to a lawsuit involving other less-than-optimal treatment of a local woman with a impending loss of a much-desired but high risk pregnancy due to ethical/religious directives. Redwood Memorial Hospital in Fortuna closed down in 2021.

I just completed my last call shift and attended some of the very last births (one vaginal, one scheduled cesarean birth in my final hours!) at the hospital where I've worked for thirteen years alongside many incredible nurses and birthworkers. I've been a part of some truly miraculous and joyful experiences of so many families, and also sobbed in the hallway with some tough births and traumas (especially during the COVID pandemic). I chose to have my two children there. I went from a brand-new attending to a (mostly unflappable) veteran, crafting my birth style in a way that I'm proud of-- aiming to support patients for empowered, physiologic birth whenever possible (and ruffling some administrative feathers from time to time when fighting for patient bodily autonomy).  I had one last partial night of sleep in the tiny (and cold) call room where I've spent many a night (most weeks, in fact) over more than a decade. It's hard to to believe we're actually done.  I wish lots of luck to the ER docs and nurses for the unplanned/out of hospital births/transfers and other pregnancy bleeders, which will inevitably hit the hospital doors (and, most of all, I pray for the women and babies, who will bear the burden of the risk and outcomes with the hospital's decision).

I didn't actually leave the unit with tears today, but feel somewhat numb, and am trying to stay neutral (cautiously optimistic?) about what the change will bring to me personally.  I will start providing obstetrical care and attending births with an expanded group of Open Door providers in Eureka starting in November. The hospital is about twice as far from my house and we are shifting to more of a organizational laborist model. For now, I'm looking forward to not to have to multitask constantly, juggling both outpatient and inpatient patient care including labors as well as and nurse calls from clinic and the hospital at the same time. I'm excited to not be "the call person" the ER calls periodically, because my former hospital didn't staff or pay OBGYNs for providing consult care. I'm so happy to not to have to be on for ninety six straight hours of OB call (?ever again) and to have fewer call shifts per month (while possibly being busier when working).  I'm looking forward to working at a hospital which seems to have a better and safer staffing model-- for nurses, for surgical crew, for anesthesiologists, for doctors, and for patients, even though there will be some growing pains with the added birth volume.

However, it's  hard to teach me (an old dog) new tricks-- I'm intimidated by the new hospital's medical records system, and have to had to jump through a ton of hoops with log-in training, EMR training, and in-person "orientation" to come soon.  I have some degree of anticipatory anxiety about being a "newbie" in a different system, with different nursing staff and work-flows, as well as supervising residents, rather than working as an individual on my own. However, I know it will get easier with time.

I'm hoping that the state of California and Partnership Medi-Cal can work to encourage better support of local women's birthing options (Moonstone Midwives birth center is another local player, offering low-risk women out-of-hospital births. However, as we know, sometimes birth turns not-low-risk rather quickly and many women prefer to deliver in a familiar homey hospital, which we've now lost for our community).  I truly feel that supporting women and families is my calling and professional passion so, for now, I plan to keep my "foot in the door" of local birth work-- until it becomes personally or professionally overwhelming or unsustainable while still juggling a family practice panel. 

We also have an important election coming up in seven short days, where women's rights are atop the ballot with repercussions that will be far-reaching if the preferred candidate does not win. While I am fairly pessimistic about the outcome, due to the number of (often clueless about women's health and autonomy) men who still run most systems in this country and who vote in appalling patterns (as well as some serious past election trauma, ahem, 2016), I sincerely pray that we could have a different future-- where all women in this country are granted the rights, choices, and health care we all deserve!

Update: some photos from the "Good-bye Goddess Gala" on Friday night

Some wonderful nurses (Tracy, Michelle, Dorothy, Lori, Christie, Kristen) I've worked with over the years.

Lori, Patricia

Group pic (a few generations of birthworkers)

A Whole Community's Loss

"Birth is the sudden opening of a window, through which you look out upon a stupendous prospect. For what has happened? A miracle. You have exchanged nothing for the possibility of everything." 

- William MacNeile Dixon

We obstetrical providers received a cryptic e-mail on Monday about an emergency hospital obstetrics meeting on Wednesday morning, a time not convenient to any of us involved in direct patient care/clinic. 

Rural maternity centers across the country have been suffering in recent years, in large part due to payment models for maternity care to hospitals and the staffing required to keep this specialty medical care safe and high quality (I went to a Partnership Medi-Cal conference locally earlier in the year about this very topic which hit chillingly close to home), as well as declining national birth rates.

Our local Birth Center  has been serving local Humboldt County for more than fifty years, proud to (since 1972) be a center providing a home-like environment, supporting natural childbirth and receiving accolades for a low primary cesarean rate, something I personally have worked very hard to achieve in my professional career in birth work.  However, the hospital has been struggling for years to maintain adequate nursing staff to take care of the patients who desire to birth with us, as they don't get paid as well as at other hospitals to deal with the high-stress environment-- and the departure of highly skilled staff strains and burns out the remaining employees. All of the above has put an enormous strain and stress on us as providers (many of whom have also left or decided not to take obstetrics call) to have a rotating and inconsistent cast of nurses and to maintain the same quality of community-based care we strive for and have been doing for years (thirteen here at this hospital for me, my first and only job out of residency!). A lot of us have had the uneasy sense (for years) that the hospital/unit was teetering on the brink of some sort of catastrophe but were in limbo and truly in the dark about the practicalities of staying "in business."

However, finding out this week that hospital higher-ups have decided to shutter the local hospital Labor/Delivery unit in less than two months was a shock to us all-- nurses, providers, patients, staff, and the community (many of whom had their own children at the birth center, myself included), who learned of the news just after we did via a local Lost Cost Outpost article. Patients, staff, and local midwives have all reached out to me to see "how I'm doing." I'm still processing it all-- as I still have a day job (seeing clinic patients every 20 minutes) to do during the day, which has actually been a welcome distraction.  However, patients have been calling the prenatal office, crying and in a panic about their future birth plans, now upended by forces out of all of our control.  I can't imagine what it must be like for a local labor and delivery nurse to just have to "find a new job" all of a sudden.

I am saddened for the women and birthing families of this county who, after another small local Fortuna hospital closed in 2021, have no other option than the Eureka based Providence hospital to give birth unless desiring a community (out-of-hospital/home birth). I am considering continuing to do birth work locally if I can be integrated to the other hospital's practice, although I don't know what that looks like in terms of volume, scheduling, or call burden.  I am thankful that I still have job security in primary care medicine, although doing office family medicine full-time is not something I am very excited about. While, some days, it's tempting to have a day job without night, weekend, and holiday work and my life may feel more manageable/balanced, I don't think I would be able to easily dodge the burnout that comes from the too-short office visits with too-sick patients with many complaints, the never-ending inbox, and the electronic click-burden, without the balance of the true joy of medicine (for me), which is birth work and supporting women and growing families. 

I hope that, someday (even if not in my lifetime), the men, politicians, and health insurers with all the power will realize that taking care of women and their families lifts up whole communities and is actually cost effective, because money speaks louder than health and lives.

Truths in Medicine

As soccer season is upon us...

On burnout in family medicine: 

 

The Gift of Sight

    

I blogged a few months ago about our little "Helen Keller" Pepper and her loss of sight /hearing. She had a big health scare in October with diarrhea, little oral intake and was diagnosed with hepatitis, but she recovered after backing off her prednisone (for skin allergies) and taking a course of antibiotics.  She still seemed totally deaf and blind, falling off the porch, curbs, and stumbling around, bumping into things.  Once her health was better, we explored the idea of cataract surgery as a referral was offered by our primary vet,  but had to take her for a consult at Bliss Animal Eye Care all the way in Medford, Oregon (close to four hours away) at the closest veterinary ophthalmologist (that's living in a rural area for ya!). We weren't sure if she was a good candidate (or the success rates) for cataract surgery, or if they were willing to perform the procedure with her age and overall health (and we recognize that many fur parents may not be willing or able to pursue it, either).

However, Kelvin was able to rearrange his clinic schedule to bring her there in December for the first consult, and after examining her, repeating labs, and checking her retinas, the ophthalmologist actually said that Pepper was a great surgical candidate and that there was a 95% chance her vision could be restored within days to weeks (!). 

The surgery had to be paid for in advance and was not cheap, so we had to think long and hard about whether it made sense to give her a chance at a better quality of life for her remaining time (?years) of life, and whether the benefits would justify the cost, distance and hassle of travel.  At this time, we can't really take Pepper new places, anywhere dark, or on long walks, because she is so disoriented due to the loss of her vision.  Ultimately, we decided that it was worth it, and financially within our reach, and while it is inconvenient with the multiple multi-hour road trips, Kelvin was willing to make the drives-- this week (Tues) for the procedure and one-day post-op check, then again at two weeks (we're making a family weekend out of it) and at four weeks for routine (and unfortunately, not able to be virtual!) post-op appointments. 

So, after returning the 6-7 hours from Sunriver, Oregon on Sunday (although I drove for the second half) Kelvin turned around and on Monday afternoon drove back to Southern Oregon (Pepper wasn't allowed at our Sunriver rental and we didn't end up wanting to take two cars or boarding her closer. Our friend Brenda kept an eye on her and Kelvin just bit the bullet for the back-track driving). He stayed in a pet-friendly AirBnB with our little (old) lady for two nights. 

Good-bye hugs

On the road (which she probably couldn't see at that time!)

Pep was able to get up on the bed with this "stairs" (we obtained doggie stairs for her to get up on her couch perch at our home.)

The bilateral cataract surgery (phacoemulsification and intraocular lens placement OU)  lasted a few hours on Tuesday, and Pepper then spent a few hours post-op recovering from anesthesia (which she's had and tolerated twice before-- for her spaying procedure and for her dental extraction) and then resting at the apartment with Kelvin.  K was able to work remotely during the day when he wasn't taking her to/from the appointment.

Newly post-op with now-brown (no longer milky white!) eyes!

After the post-op day one morning check, Kelvin was planning to head home to Humboldt. However, we had a huge Pacific rain/windstorm (which is still going on), and he got stuck in Crescent City (1.5 hours north of us on the 101) due to downed, obstructive trees all over the place. (He did stop and do some work at the Del Norte Clinic, which still had power). 

Finally, the road was cleared, and was able to drive home, surprising us in evening instead of having to spend another night (or more) away at a rented room with Pep. The kids were thrilled to see him, and we're so happy to have our pup home--although she's overall (these days) a calm, low-energy, and quiet pet, her absence from the house was definitely felt! 

The best part of all of this it seems like Pepper can actually see again!  How satisfying it has been to have such a (seemingly) curative procedure!  She wags her tail at us, seeing our faces, is roaming around the house with renewed interest (by not just scent), and not stumbling walking outside.  She's on an intensive regimen of four different eye eye-drops (antibiotic, steroid, glaucoma drop, and NSAID) each three times daily for the time being, and has to be in a cone for at least three weeks so she doesn't scratch or disrupt her eyes/corneas, but is doing amazingly well.  She's still (we think) totally deaf (despite Brenda telling us she enjoyed her singing renditions of "All the Single Ladies"), but we're so glad she has one of her key senses back. How much we take the gift of sight for granted!  Here's hoping for many more years of good vision and health for our little and beloved fur-child!