My impending fatherhood has sparked a wide range of thoughts and emotions, from mundane worries about how to pay for all the new expenses or how best to keep Hanna happy and healthy, to more contemplative musing on the meaning of being a dad, how best to set a good example for my children, and my own mortality. In the last few days, however, a new complication has been introduced in my rapidly changing life; the medical industry.
When we found out Hanna was pregnant, the next step was to choose a doctor. Neither of us had a regular family physician, since outside the occasional sports injury we have both been fortunate not to need medical care. Thankfully, we had a friend in Hanna's department (and therefore, also on the University's medical insurance) that had recently had a daughter and could recommend a OB/GYN to us. We were quite pleased with this doctor; they were friendly, listened well to our concerns and questions, and were generally enthusiastic and excited to help us expand our family.
Of course, when we moved to California and Hanna changed jobs, we had to find a new physician. Since Mountain View is a much more densely populated area, there is no shortage of doctors from which to choose. The choice is limited, however, to the subset of practices that are covered by our health insurance. (Opponents of nationalized health care often claim that so-called "socialized medicine" will limit patient choice and move decisions to a faceless bureaucracy. This is absurd, and implies -- incorrectly -- that Americans currently have a choice. Our doctor was chosen far more by our insurance company then by any decision we made.) Hanna reviewed the available options, and scheduled an appointment with a hospital that was close, easy to get to, and had doctors experienced in twins.
When we arrived, I was both impressed and intimidated. The facility is large, but the layout is well planned and there are clear signs everywhere that make navigation simple. The staff all seemed polite, friendly, and well organized. This organization, however, comes at a price. Medicine as practiced by these large hospitals tends to be rather more industrial than Hanna or I would normally care for. Upon meeting our new OB/GYN, this was made clear. Almost immediately after giving Hanna a quick exam and looking over her records, he told us how Hanna was going to have a C-section, how this was better for not only for the babies, but the schedule of the doctors in his practice. Hanna's question about if he would be the attending physician at her delivery (which reminded me of the movie "Knocked Up") was met with a similar response about how the rotation of on-call doctors worked, and how if she carried the babies to the scheduled date he would be there, but if she went into labor early someone else would attend to the surgery.
I can understand, and even respect, having a process, and the hospital's desire to place us in those procedures and rules to do things by the book. The methods used are not simply there to cause us annoyance or inconvenience, but have been developed over decades of practicing modern medicine. Some things work, and go into the metaphorical "book". Other methods, procedures, and techniques do work, and those get adopted. As a software developer, I have a great deal of respect for processes such as this; working efficiently and attending to all of the details in a methodical manner is as important as being able to write code, or knowing that medicine x treats disease y. In fact, you could argue that the ability to examine past actions and then plan, organize, and execute a strategy is one of the characteristic traits of humans, and something that accounts for a great deal of our success as a species.
At the same time, there are problems with doing things "by the book". The process only takes into account what has been anticipated and planned for; situations outside of what has been foreseen may or may not be effectively dealt with. Additionally, the process has to balance various, often competing or conflicting goals and resources. For example, it might be best for a given patient to have a single doctor assigned to them, who sees no other patients and does nothing else but treat their particular case. Of course, this one to one doctor-patient correspondence might work best for a patient, but it would be an incredible waste of the doctor's time and resources. Conversely, it might be most efficient for a hospital's resources to run every patient through a series of questions with no chance for the patient to ask questions or discussion options. Processing each person in a factory-like manner by whatever physician was on duty at a given time in such a manner might mean more patients seen per hour, perhaps, but I don't think very many people would find a completely impersonal, machine-like medical experience comforting.
The reality of what we currently do in this country seems to be somewhere in the middle of these two extremes; trying to balance limited resources while still making sure every patient is given personal attention and feels at ease. Were we having a single child, Hanna and I were planning on going pretty far towards the comfort end of this continuum; a natural home birth with a midwife, no pain medication, etc. Given all of the dangers and possible complications when having twins, however, we decided to go with more formal medicine; even the "crunchy" books about childbirth recommend this, and midwives will generally not do home births for twins, due to all of the possible problems that can arise. As we talked about it more at the hospital, we could see several advantages to this more industrial approach to medicine; scheduling a day does make the logistics of having family visit easier, we don't have to worry about sudden dashes home (assuming all goes as planned, anyway), and the C-section is by all accounts safer for the babies, something of paramount importance. At the end of our visit with the new OB/GYN, we felt pretty good about our decision. We got all of the paperwork sorted, did the lab tests that were required, and went home feeling pleased with our choice. The next day, however, we got a phone call.
Hanna had taken a one hour glucose tolerance test on Wednesday at the hospital, and despite my efforts to feed her and keep her steady, this wiped her our pretty badly. Thursday morning, we received a call from the hospital lab, informing us that her blood glucose after the test was measured at 143; since the cutoff for "normal" was 140, she needed to come back and do the three hour test (and fast beforehand) to ensure she didn't have gestational diabetes.
The last time Hanna had such a test was when she was first diagnosed with reactive hypoglycemia; she came close to passing out before the end of it, and her blood pressure was unmeasurable. Her abnormal processing of sugar was mentioned on the forms that we filled out at the hospital, and both the nurse and doctor had asked about it. Nonetheless, they wanted Hanna to do a test that would almost certainly wipe her out for three or four days. This got me going in full on protective husband mode; I was ready to rail against the doctor, or change hospitals entirely, and generally wanted to kick the crap out of anyone who would dare try to inflict something like that my wife and mother of my future children. Hanna accepted her fate, however, and scheduled the test for Friday. She assured me that it wouldn't be that bad, and pointed out that over the years she had gotten more resilient to changes in her blood sugar.
We did the test, with me watching Hanna carefully the entire time to make sure she didn't fade or show other signs of distress. During the hours we had to wait, I also took the time to walk to our OB/GYN's office and speak with the staff. I'd calmed down quite a bit since I first heard that they wanted Hanna to do the test. I politely explained to them that I wanted to make absolutely clear how my wife responded to sugar, how we kept the hypoglycemia in check with her diet, how glucose tests were very hard on her. and how I wanted to make sure everyone was absolutely clear about the conditions of Hanna's particular case. I also emphasized that I was by no means an expert in medicine, and that I was simply describing my experiences and observations and relying on the hospital staff to make informed, correct decisions. The nurse I spoke to listened to me quite politely, and assured me she, the doctor, the lab, and everyone else involved with treating Hanna during and after her pregnancy would be mindful of her condition. I also made a point of apologizing for playing the role of overprotective husband and father, and expressing my concern for my wife along with my trust in their work. Perhaps she was just humoring me; however, I think she was being genuine about listening to my concerns.
Overall, what I took away from this experience was the realization that it is my responsibility to be proactive in getting answers, and making sure that Hanna's individual needs are being attended to and properly factored into decisions. Perhaps the test was necessary; for that matter, it may even illuminate something that needs to be treated or otherwise addressed. Going forward, however, I intend to make sure that we are fully informed at each and every juncture. I want everyone -- especially Hanna and myself -- to know what is being decided, and why, as well as what the possible outcomes are.
I do believe that mainstream medicine works. Unlike homeopathy, or acupuncture, or any number of examples of "alternative therapy", it has been scientifically evaluated; it's repeatable, verifiable, and demonstrably effective. (If alternative medicine worked beyond the placebo effect, it wouldn't be "alternative"; it would be tested, added to the literature, and become mainstream.) However, sometime the needs of the individual can get lost in the process, and it's my job as a husband and future father to make sure that doesn't happen to my family.
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