Like her own mentor, this physician encouraged her residents to embrace the fear that comes with obstetrics and conquer it to become confident and competent physicians.
Dr. W, a white-haired, robust appearing, full-bird colonel in the Army Medical Corps, was tasked with teaching me, a nervous intern, how to safely deliver a baby. My obstetrics experience in medical school was, in a word, horrible. I watched one of my supervising interns go into acute renal failure after not eating, drinking, sleeping, or going to the bathroom during a 36-hour shift. It seemed that every patient who made her way to the L&D unit of our large inner-city hospital was addicted to crack or heroin or was HIV-positive, or both. The only baby I was allowed to deliver was a 22-week-old stillborn.
Needless to say, I was not an enthusiastic pupil on my first obstetrics rotation during my family-medicine residency training. The night I started my OB rotation, I could not reliably check a cervix and, frankly, had no interest in doing so. I determined to grit my teeth and gut through each of the required four-month-long rotations before abandoning obstetrics forever, or so I hoped.
Dr. W was an exceptionally fine physician, human being, and officer. His uniform - whether his Army greens or his hospital scrubs - was always worn impeccably. He was respectful with patients, nurses, and resident physicians alike. He was the kind of guy who stops in the middle of the hall to pick up a straw wrapper because he saw it as his duty to keep the hospital looking nice. Years upon years of experience delivering babies in all kinds of scenarios and situations armed him with both the knowledge and confidence to supervise residents without letting his own fears interfere with our training.
I was often a timid learner, hesitant to roll up my sleeves and put hands on the patient. He coaxed me into more and more involvement, not because my grade depended on it, not because he took a laissez-faire approach and stayed in the background, and not because I was such a super-star resident. It was because he had trust in me long before I had any in myself. Both because of his position as a senior officer and my attending, he had every right to call me "Jennifer" but he always called me "Dr. Frank." Because he saw me as a doctor, I started to see myself as one, too.
Dr. W appeared fearless, although he would readily talk about times he was fearful about a patient's outcome. He never urged me away from the delivery table. If the situation called for it, he would just step next to me and put his own hands over mine. I did all kinds of things that, in retrospect, were quite unusual for a family-medicine resident to learn including amniocentesis, culdocentesis, and cervical blocks. He helped me apply forceps and vacuums and allowed me to take a great role in cesarean sections as I proved myself capable. I remember being on call with him and getting paged to the emergency room at 2 o'clock in the morning. He was cheerful, even at that hour, more than willing to continue to teach and train me despite the hour.
Once, I was in a delivery with Dr. W in which we experienced a shoulder dystocia. These can be terrifying moments in the delivery room; everyone's breath held as we wrestled the newborn from an unyielding pelvis. With my first attempts unsuccessful, I tried to pull my hands away, telling Dr. W that I couldn't do it. He insisted I put my hands back on, put his hands on mine, and guided me through the successful delivery. Afterwards, as we were debriefing, I asked him how he could be so calm in moments like those, especially with a resident being the delivering physician.
He looked at me and serenely said, "There's nothing you can get yourself into that I can't get you out of."
After hearing that, I was an unstoppable force on L&D. I couldn't get enough OB and grew to love taking care of moms and babies. When the situation called for it, I could decisively step into a challenging clinical situation and perform well. Because I received and eventually earned Dr. W's respect, the nurses and patients respected me too. Eventually, I learned to respect my own abilities and competence.
Dr. W did all the other things a good teacher does. He gave me timely feedback - both good and bad. He was consistent in his approach and expectations. He taught by example. He struck the right balance of supervision and allowing independence. And, he was a good physician demonstrating excellent patient care.
As I graduated residency, I knew that wherever I ended up practicing, I wanted to continue to do obstetrics. During my training, Dr. W taught me that obstetrics can be intimidating for even the most-seasoned practitioners but that labor management is a skill that can be learned and mastered as long as you continue to learn and stay humble. Somewhat unexpectedly, I myself became a teacher of residents. I channeled many of the lessons I learned from Dr. W into my own teaching. Obstetrics became one of my favorite parts of clinical practice and remains so. I encouraged my own residents to embrace the fear that comes with obstetrics and conquer it well enough to be a confident and competent physician. I tried to be consistent and encouraging.
Dr. W's influence goes beyond my clinical practice and teaching. He was a fine person, all around. I remember him proudly receiving an award for his lifetime contributions to the medical literature. As he stood at attention waiting for another ribbon to be added to his chest, his face demonstrated such pride - not haughtiness, but pleasure. His remarks included the adage, "A man will work hard and long for a tiny strip of fabric." That quote has stayed with me as I look for ways to acknowledge and motivate those around me. His commitment to his profession - both medical and military -continues to challenge me regularly to make sure I'm doing my best, and that whatever I do as a physician is honorable and worthy of respect. Most importantly, though, I can't pass a piece of paper or litter in the hallway or stairwell without feeling guilty if I don't pick it up.
Jennifer Frank, MD, FAAFP, is a family physician in private practice in northeastern Wisconsin, and in perpetual search of the elusive work-life balance that she's heard so much about. She is a mother of four, whose husband, also a physician, is a stay-at-home dad.