Doctor for A Day - The Governator Visits Labor and Delivery

Mount Kilimanjaro - Tanzania

Scott Sturman
fliesinyoureyes.com

“The road to Hell is paved with good intentions.”

Sometimes when working on the labor and delivery service I want to scream, “Does anybody outside the medical profession know what is going on here?” I've fantasized about Governor Arnold Schwarzenegger or some high ranking official in the California Legislature spending some time in the hospital to witness the events experienced on a daily basis. I have the impression most politicians responsible for implementing large government social programs either have no idea how they function in the real world or simply ignore nagging problems they wish would go away. The hospital service guaranteed to shock them into some semblance of despair would be the obstetric service, traditionally acknowledged to be the happiest department in the hospital. True, it is a place of great joy, but over the years most deliveries in our institution do not include a mature, responsible mother and a nervous but committed father. A good share of society's social problems start here with a single, poorly educated teenager or an older woman with a history of multiple pregnancies by different fathers. There is a unifying theme – all too often the father of the baby is only a temporary player who abrogates his parental and financial responsibilities to the tax payer.

The following parody details a variety of obstetric cases which would raise the eyebrows of a layman but are routine to the clinician. If the cycle of poverty and hopelessness is to stop, then politicians and academicians need to leave their posh parlors and ivory towers and visit the trenches. It would be a sobering experience to discover the programs which sound so good in theory are dismal failures; in many cases they have made matters worse and driven another generation into decline.

“Welcome to the labor and delivery floor, Governor Schwarzenegger. I can't recall having a political leader join the on call anesthesiologist to observe how the obstetric system functions – much less to volunteer for the full 24 hour shift. Our job is to provide anesthetic services for Caesarian sections, labor epidurals, and obstetric emergencies. We care for a wide variety of patients. Although this hospital is not county affiliated or designated as an indigent care facility, over 70% of our patients are on public assistance, and a substantial percentage are single mothers. As the day progresses you'll notice many of the laboring patients are teenagers who are not necessarily delivering their first child. Teenage pregnancy rates are rising in our community. Children having children if you will. It is a cycle of poverty and hardship where a daughter's future is her mother's past.”

The Governator was quick to respond, “It is good to be here, Dr, Priskna, but I think you are painting an overly pessimistic picture of the situation. The State of Cal-ee-for-nee-a spends substantial resources on welfare benefits, and even though there are problems, I think we get our money's worth. As Governor I want to witness a clinical environment first hand to reassure myself that the state is on the right track. I am looking forward to being here to see the parents and little children when they come into this world.”

“Let's get started, Governor. Before the first scheduled Caesarian section, an obstetrician has requested a labor epidural for her 15 year old patient.”

We entered the room and saw a large adolescent sitting up in bed. Her mother, who could have been 30 or 50 years old, was sitting in the corner and did not say a word. “Good morning, Miss. I'm Dr. Priskna and we have a famous visitor, Governor Schwarzenegger, who will be observing. I understand you would like a labor epidural. Is this your first baby?”

“I've been pregnant three times but this is only my second baby.”

The Governator interjected, “Holy Cow! You're fifteen, and this is your third pregnancy? Where are your parents? This is bogus!”

“Please, Governor,” I reminded him. “We try to keep personal feeling to ourselves. This situation is not that uncommon. A considerable number of these very young patients have been sexually active from an early age. They come to the hospital expecting labor epidurals and receive the same care and benefits as patients who pay for these services. They either have had an epidural beforehand, or one of their friends have told them about it.”

“Now that we've finished with the procedure, let's interview the next patient who is scheduled for a Caesarian. You noticed when we left the room the patient did not thank us for helping her. This is not at all unusual. The service is free and involves an element of risk, but a lot of these patients expect the treatment as a right.”

“Our next patient, Governor, is 24 years old. She is single and this is her fourth baby – all by different fathers. Today's operation will be her fourth Caesarian operation.”
We entered the patient's room to conduct a preop interview and found her to be poised and articulate. She and her boyfriend had been together for a year and a half, and he was at the bedside. At the conclusion of the interview, the patient went to use the bathroom while the Governor, a newly assigned registered nurse, and I chatted with the father. The nurse was doing some last minute charting and asked him to spell his girlfriend's last name.

“I don't know.”
“Well, what's her name then? I can look it up in the computer.”
“I'm not sure.”
The Governor exploded, “You've been with your pregnant girlfriend for 18 months, and you don't know her name? This is bogus!” -- so much for the value judgments in the company of patients and family members policy.

We accompanied the patient to the operating room and placed a spinal anesthetic. To ease the governor's incredulity, I asked the patient, “Did you know your boyfriend does not know your last name?”

“It's not that he doesn't know it. It's just hard to pronounce.”
The Governator jumped on this comment, “Your name has six letters and none of them are silent! How can he not be able to pronounce it? I'm from Austria. English is my second language. I have known you for less than five minutes, and I have no problem pronouncing your name.”

A nurse called into the operating room, “Dr. Priskna, as soon as you finish with the C section we need three more epidurals.”

The first patient was unmarried in her late twenties with one child at home and taking chronic methadone for heroin addiction. Her well dressed and heavily jeweled mother was at the bedside and continually interrupted the interview. She volunteered unsolicited information about herself and tried to answer all the questions directed to her daughter.

The governor pulled me aside, “How can she get pregnant? She's a drug addict, and the State of Cal-ee-for-nee-a is paying for her drug rehab. Her baby will be an addict because of the methadone! Now we will be treating two patients with drug problems – one who is an innocent victim and the other who is highly irresponsible. This is bogus!”

We rushed to the next room and found a twenty-six year old patient in active labor and demanding an epidural. A cursory review of the medical chart revealed an extensive obstetric history. Although in her mid twenties, the patient had been pregnant nine times. She had undergone three therapeutic abortions, had five living children of which four were in foster care, and now was delivering her sixth child. I glanced at the Governor who was sitting in a chair in the corner of the room with his head in his hands and mumbling quietly in German.

Our last epidural request was unusual even by our standards. The patient was an obese woman who was involved with an altercation with her boyfriend a few hours ago. She awakened him in the middle of the night and told him to go to a convenience store to buy her some cigarettes. He was a diminutive man who none the less felt it was wrong for his pregnant girlfriend to smoke. He refused to go, but she found some stashed away in the house and began to smoke. An argument ensued and he attempted to take the cigarette from her. Being only half her size, she grabbed him by the collar, threw him to the floor, and pummeled him with her fists. He called the police, who arrived only to find the woman in labor due to the stress from the altercation. She was taken to the hospital in the squad car. When the Governor and I entered the labor room, we found a huge woman in labor handcuffed to the bed with two law enforcement officers in attendance. The first words from her mouth was, “Gimme an epidural NOW!”

Flexing his massive chest, the Governor ripped off his scrub top and hurled it against the wall. “I'm outta here!” he shouted. He was only 3 ½ hours into the twenty-four hour shift, but he was headed to Malibu to a more sheltered world where most everyone thought the system was working just fine.