The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Wednesday, October 18, 2006

A Dying Breed

This is what happens when I have too much time to think. In recent days, it's likely due to the amount of time I've spent travelling in planes, trains and automobiles (honest! all three!) to get to various emergency medicine fellowship interviews. Which are done now, thank God.

So I've been more than a little pre-occupied with thoughts of procreation lately. Partly because now that I'm married apparently everyone thinks it's the next logical step. And partly because I'm 32 years old and am starting to picture my ovaries shrivelling up like a pair of raisins from both age and neglect. And I do want kidlets... I just don't feel ready. But if I DO wait until I'm ready, we may be pulling the goalie shortly before I start getting pension cheques from the government. Which is not promising for fertility.

So here's my first observation. Medicine begats medicine. I remember reading a statistic somewhere that nearly a quarter of medical students in Canada today identify at least one parent as a physician. It's hard to say why. Maybe simply from being exposed to medicine as a career earlier than other kids? Maybe from parental pressure? Maybe it's a reflection of socio-economic status? Maybe from some weird genetic mutation that confers on them the desire to pick at scabs? Who knows? But the point is that the children of physicians are more likely to pursue a career in medicine than other children.

Here's my second observation. Residents have trouble making babies. This isn't based on anything other than my own observations of the people around me. I don't know any female resident who has managed to get pregnant easily, stay pregnant to term and have an uncomplicated labour and delivery. Scary, isn't it? Male residents don't seem to suffer from the same curse, getting their wives and girlfriends knocked up at a dizzying rate. But female residents struggle. There are plenty of reasons why the cards are stacked against us. We delay childbearing later than the norm since we tend to spend our peak childbearing years studying. We work crazy hours that stress our body to the point that achieving a regular menstrual cycle is nothing short of a miracle. We work through pregnancy in conditions that expose us to a number of bacteria and viruses. We work though pregnancy in conditions that are often stressful. We eat erratically, often from vending machines. We spend one night out of four sleepless, and often compensate with higher-than-average caffiene intake.

It's scary. As a medical student, three of my female classmates had babies before graduation. There were miscarriages, early rupture of membranes (and I'm talking before 30 weeks gestation), preterm labour, multiples (although this one was through word-of-mouth since the mom in question left med school during pregnancy and didn't come back before the class graduated)... nothing simple or straightforward. Most recently, the resident that I did surgery with last year gave birth at 33 weeks. Her baby is still in the nursery, plagued with many of the problems common in premature infants. So it seems that women who get pregnant during residency not only have problems getting pregnant, but don't have much luck carrying their babies to term without problems or complications.

Add observation #1 and observation #2 together, and I'm forseeing a major physician shortage in the next 30 years or so. It's pure Darwin. Or IMpure Darwin, at least.

It's trains of thought like this one that are the reason why I need to be kept busy at all times.

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10 Comments:

Anonymous Anonymous said...

Tick, Tick, Tick....

11:24 AM

 
Blogger doctor T said...

I think the same thing is true of most women in high-stress positions. Stress doesn't not equal easy procreation or pregnancy.

2:20 AM

 
Blogger Dex said...

I offer words, and you should take them knowing that I have no personal experience in this matter. On with it!

Children are not simply the result of a genital spasm between male and female. They are the tangible evidence of love between two people. It ain't just you, honey.

Life will find a way. The entire universe is degenerating entropically into the vast heat-death of everything. Life is the only physical process that decreases entropy and increases complexity. Engendering a new, unique, independent engine of organization is a profound stroke contra entropy. Your system will compensate and expand to incorporate the support of this poop-generation machine. Such a thrill.

I've always wondered why the rich, the educated, and the societally advantaged have fewer children than the poor, uneducated, disadvantaged proles. What good does it do humanity to have the least capable among us procreate the most? Those who have the most to provide for their childrens' future, in terms of a safe, nourishing, stimulating environment have only one or two children? WTF is that?

Finally, you are succumbing to the power of anecdotal evidence to support your claim of succesful women having complicated pregnancies. (Despite the obvious rejoinder that they are best equipped, in terms of coping mechanisms, to deal with it.) According to emedicine.com, preterm labor comprises 6-8% of pregnancies. That's pretty low already.

Identifiable risk factors for preterm labor, and you KNOW this, include BV, UTI, GDM, structural abnormalities, uteroplacental insufficiency, and abruptio placenta. Are you really worried about these things complicating your pregnancy? Yeah, not really, right? I thought not.

Maternal stress is at the bottom of the list, assuredly far below idiopathic (50%). What you are ruminating on simply has no support in the literature. Quit stalling.

Sorry if I've been too forceful on this delicate topic. I hope my words help you make a decision.

--Dex.

3:38 AM

 
Anonymous Anonymous said...

My mom raised my brother and I by herself on her salary from being a med tech. We spent more than a few days in the hematology department peering down microscopes and inhaling the intoxicating scent of the hospital. We saw excitement, interesting things and most of all...a solid career. My brother is now an anesthesiologist and I am an RN.

I offer more anecdotal evidence (sorry, Dex) of women in the medical profession having a hard time with pregnancy and getting pregnant. After two rounds of IVF/ICSI, daily heparin shots, gestational diabetes and pre-eclampsia I delivered a healthy 7 lb baby girl. All was well afterwards until I went into congestive heart failure and was diagnosed with Peripartum Cardiomyopathy.

On the PPCM website where I am a member, we have at LEAST seven or eight nurses and an NP. Go figure. I know WAY too many nurses and MD's and other healthcare workers with similarly horrific stories.

10:10 AM

 
Blogger Fat Doctor said...

Regarding conception issues: Doctors are always at work, even during ovulation. Contrary to what people may see on TV, as you know there is little if any sex going on when on-call.

Regarding pregnancy complications: I had them and we did a month in the NICU, which sucked, but when I look at my healthy, normal, gorgeous Son, now 2, he takes my breath away. It is worth it.

Now get out your thermometer and start tracking your cycles!

BTW, I'm sorry that when I rebuilt my template many weeks ago I mistakenly left you off my blogroll. I will rectify that with my next post!

11:59 AM

 
Anonymous Sandra said...

Perhaps too much thought is put into this for you.

Yes be prepared and read up on everything to help your fertility and your pregnancy. But too much knowledge can be too much.

Stop thinking about it, stop analizing it, stop worrying about it and stop listening to all outside family opinions.

You will have a baby when you see fit, when you feel the timing is right for both you and your new husband.

Sometimes in life there are things you just can't control and those are the things that are the most wonderful to enjoy, feel and have. Miracles happen when they are suppose to happen.

Enjoy your new marriage, enjoy the moment. And when you both decide it's right enjoy that moment.

12:15 PM

 
Anonymous Anonymous said...

I have to agree with Sandra. Let life take care of itself, and go along for the ride. Life is stressful enough as it is, don't make it more stressful for youself by trying to control things that are out of your control.

1:41 PM

 
Anonymous Alice said...

As long as we're doing anecdotal evidence :), I have heard of very few pregnancy complications among students or residents at my school. A couple of twins, uncomplicated, and actually more post-dates than pre-term labor. This school is pretty friendly to families. Even among the surgery residents, most of the women have at least one baby. Maybe think more about how good it will feel to hold the baby and play with it - don't focus only on the possible negatives.

11:47 AM

 
Anonymous Anonymous said...

Yep. If it is a rough residency, problematic pregnancy or difficulty conceiving is the rule, not the exception.

" I don't know any female resident who has managed to get pregnant easily, stay pregnant to term and have an uncomplicated labour and delivery. '

6:47 PM

 
Blogger Alison Cummins said...

Um, my question is... why breed? Babies are cute and all, and they smell terrific, and being responsible for someone else will make you a better person in some ways, but there are already about 3 billion of them on the planet. You don’t need to make your own.

Dex: from the VHEMT website:

“Some say, "The wrong people are having children these days." How many times have you heard this expressed? We can be sure they're not talking about themselves: it's those wrong people. It's "those stupid, slack-jawed degenerates who shouldn't breed. Those too poor to raise children, or so warped they don't even like children and might abuse them." Certainly, this logic follows, "bad genetic specimens should never duplicate their defects."

Implicit in these opinions is the attitude that some people are the right people to pass along their genes. Smart, financially secure, responsible, socially aware people with superior genes ought to make more of each other. After all, someone is going to, right?

Maybe so, but even if intelligence could be measured or inherited, there's no evidence that smart people's exhaust stinks less than morons'. And, since the wealthy are better able to provide materially for their dependents than are the economically disadvantaged, they're also likely to do the most damage to the environment with their excessive consumption.

...

It goes beyond elitism for us to create replicas of ourselves while tens of thousands of Others' children die from lack of care each day.

Anyway, simply increasing the sheer numbers of people who share a philosophy or genetic makeup doesn't always improve their status. "Breeding wars" between rival groups have shifted political power in a few majority-rule governments, however, members of those groups usually aren't any better off just by being in a larger voting block. Breeding for power is a remnant of that ancient tradition of mass murder we call genocide. The motivation remains the same.”

http://www.vhemt.org/biobreed.htm

7:29 PM

 

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