Before each of my midwifery appointments during my pregnancy last year, I tried to silence an anxious little voice in the back of my mind.
“The patient is a 35-year-old woman presenting with her first pregnancy, confirmed by a first trimester ultrasound,” the voice told me. He went on to recite other relevant facts: I had been feeling particularly nauseous lately and had trouble sleeping. It was possible that these were normal pregnancy symptoms, the voice said reasonably enough before jumping to the worst-case scenario: it was possible that these were signs that I was about to die.
The voice was me as a doctor. But instead of being a kind, rational guide during a time of transformation in my life, the voice was really, really stressing me out.
Pregnancy was my first real experience as a patient. I had spent the past ten years observing our health care system as a medical student and now as a primary care physician, but that did little to prepare me for the vulnerability I felt on that day. freezing November when I went for an ultrasound to find my due date. It was the start of the first pandemic winter, and my husband waited outside on a street corner, banned from the exam room due to hospital policies regarding visitors due to COVID-19. He listened to our son’s heartbeat for the first time via video chat.
Sure, I’d been to the doctor here and there before that, but I’m a typical healthcare worker, which means I’m terrible at taking my own advice. Rather than having regular check-ups with the kind of longtime primary care doctor I aspired to be for my own patients, I would have my co-workers check my blood pressure or send a friend a picture of my blood pressure. a mysterious rash.
When I got pregnant, I couldn’t avoid it anymore. I finally had to make an appointment.
For my antenatal care, I chose a well-respected midwifery practice that was not at the hospital where I work or the hospital where I was trained. I didn’t want to be seen by colleagues. If I was the patient of one of my old professors, I’d be afraid they’d think I was stupid if I asked too many questions.
But even under the care of a warm and competent midwife, it proved difficult to switch off the doctor part of my brain. Perhaps it was no surprise: I worked hard to train myself to think like one, describing patients thousands of times in the highly structured style we learn early in medical school.
The classic “patient presentation” script begins with age and gender, moves to the patient’s current medical condition, and then notes medical facts from their past. We describe the patient’s vital signs, physical exam, and then speculate on anything that could possibly go wrong. This list of potential conditions — and the evidence for and against each — is called “differential diagnosis,” and getting it right is one of medicine’s most revered traditions.
During my training, I was taught to take the messy, distraught stories of my patients and turn them into neat, organized narratives, describing their innermost fears in clinical language. I learned to methodically rank the ailments in order of what was most probable. We then rule out what is the most dangerous, either by reassuring details in the patient’s account, or by additional tests. We sometimes keep these rare and deadly possibilities hidden from our patients, but it’s essential to consider them to ensure we don’t miss a thing.
The patient presentation format is so ingrained in our minds that physicians can jump right into it, literally, in their sleep. During my training, in the middle of a long night shift caring for the sick, I returned to the structure like a mantra, letting it remind me that I was more competent than I feared. It’s a pattern that ensures we don’t miss anything important, that guides us when we feel lost.
But during my pregnancy, my deliberately cultivated medical thinking turned out to be anything but therapeutic.
The night before every prenatal appointment, I could barely eat, plagued by familiar anxiety. This was how I felt during my training, the night before I started working in a new part of the hospital or with a new supervising physician whom I hoped to impress.
I felt my belly grow, my son kicking inside me, and remembered working in the labor and delivery unit during residency, introducing my patients to the entire team for get feedback. My heart raced as I wrote down the details of my patient’s exam on a whiteboard in front of our small work room crowded with doctors and nurses, steadying myself to be peppered with Socratic questions: “Why don’t I “Didn’t you think of that possibility, Dr. Gordon? Why weren’t you prepared?”
I now felt a perpetual sense of splitting the body as I presented on myself. It had to be perfect, every rare complication taken into account. With myself as a patient, I couldn’t get rid of a vague feeling that something terrible was about to happen, a form of karmic retribution for times in my training when my clinical acumen wasn’t bright enough.
Take my experience with one of my prenatal labs that screens for abnormalities, a blood test called maternal serum alpha-fetoprotein, or ms-AFP. A positive test is inconclusive because it is associated with many different conditions, but it signals that a patient needs further testing.
My level was very slightly high. When I found out, I couldn’t drown out the voice in my head: “The patient is a 35-year-old female at 16 weeks gestation, who was found to have an elevated ms-AFP.” I felt helpless as my mind whirled with all the options: It could mean problems with my baby’s spinal cord, or a condition where her intestines were growing outside of her body. It sent me on what I later called a “PubMed bender”, a weekend spent obsessively searching medical literature about the test, waking up in the middle of the night to cry.
All the paperwork I found should have been reassuring, reminding me how unlikely there was that anything was seriously wrong. But I couldn’t think clearly like I do when I’m at work, instead focusing on the one-in-a-million cases I discovered online. Being a patient was like being a first-year medical student again: knowledgeable enough to be frightened by what I was reading, but too inexperienced to apply it to the current situation.
Five endless days after my initial test, an ultrasound revealed a normally growing fetus, along with the probable culprit for the abnormal level: a two-lobed placenta and an unusual connection to the umbilical cord, a variant that is not particularly dangerous. I was delirious with relief.
Throughout my near-normal pregnancy, I found myself panicking over and over again. When my midwife told me not to worry about symptoms that appeared, symptoms she had seen thousands of times before, I couldn’t trust her. I had to research the worst-case scenario myself. When she kindly suggested that I forego any medical discussion because it seemed to make me more anxious, I realized how disorderly my thinking had become. My doctor’s voice was making me worse, not better.
Then came the ultimate test: work. When my contractions finally started, I kept staring at the monitor that was tracking my son’s heart rate. Was he in distress? Did he have enough oxygen?
When her heart slowed, I secretly tried to reposition myself to relieve her umbilical cord, a task I had performed for my own patients hundreds of times during my training. But I couldn’t move, numbed from the epidural and exhausted from work. It was a heavy metaphor: I was physically unable to be my own doctor. I had to let myself be cured.
My son is now a healthy, playful, laughing 7 month old and the source of a deep and complex love that I am only beginning to understand. My training as a doctor is an undeniable privilege, which has so far enabled me to avoid a 2 a.m. call to her doctor when her nose starts to run or when her poo turns dark green after a healthy serving of eggplant hummus.
Since he started daycare earlier this year, he’s had a series of colds, a rite of passage that any parent would tell me was almost inevitable. When he cries and struggles in my arms, I sometimes hear that same doctor’s voice whispering the most terrifying diagnoses I studied in medical school. “The patient is a 7-month-old boy, post-spontaneous vaginal delivery at 39 weeks, with a new upper respiratory tract infection.” I imagine everything else: the children I cared for with tumors, bacteria in their blood, holes in their hearts. I think of babies struggling to breathe, bent over as they suck in air. I think of my own pediatric patients in my family medicine practice, coughing from COVID infections, feverish and distraught.
I gently calm the voice and remind myself that I’m not her doctor. I am his mother. It’s not my job to examine all the medical possibilities that might befall him; my job is to comfort him, protect him and ask his doctor to play that role. Part of parenting, for me, is deliberately forgetting what I learned in med school and instead giving myself permission to be a mom.
Mara Gordon is a family physician in Camden, NJ, and an NPR contributor. You can follow her on Twitter: @MaraGordonMD.