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Teaching and Learning Moments: Waiting

Licari, Addie; Zink, Therese MD, MPH

doi: 10.1097/ACM.0b013e3181637f74
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Dr. Zink is assistant professor, Rural Physician Associate Program (RPAP), Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota.

Ms. Licari is a fourth-year medical student planning on going into family medicine after graduation from the University of Minnesota.

With much difficulty, my husband and I decided that I would spend my third year of medical school 200 miles from home. The hands-on experience I would get with the Rural Physician Associate Program would be worth nine months of living separately, though it would be tough on our relationship. I'd married my high school sweetheart during first-year anatomy. Since that time, we focused on my finishing training and becoming a physician above all else, including plans for children. Three months into our separation, in a town of 3,000, I often had periods of loneliness and shed many tears. In the midst of my OB rotation, seeing happy couples cuddling newborns, the separation was even harder. One patient's story jarred me.

April, a teen with three children, initiated prenatal care late in her pregnancy. She was accompanied by an older patient, Patsy, who we knew from an infertility workup. Patsy said, “My husband and I will be adopting the baby.” Adoptions were common among pregnant teens in this community, but this appointment was odd. Patsy dominated the conversation, asking detailed questions: “Do the social workers need to be involved? How soon can the baby come home with us?”

Later that month, I was present when April delivered a healthy boy. In the hours following, the nurses informed us, “April said that the father of her child is Patsy's spouse. The conception was done at home with a turkey baster.” This was not mentioned during the prenatal visit, so the OB and I became suspicious and reviewed Patsy's records, learning that Patsy's spouse was aspermic. When we confronted her, she stormed out of the hospital. We spoke with April, who tearfully explained, “They're my neighbors. Patsy told me to say her husband was the father so they could adopt without involving social workers.” April still wanted to put her son up for adoption as the child was not her current husband's and she feared for the child's well-being. So we notified the social worker and hospital security, put the baby in a locked room, and phoned the police and state emergency adoption program.

We then learned that Patsy and her husband had previously failed an adoption home inspection and had a police record, having been accused of refusing to return a child to its parents after babysitting.

The adoption program faxed profiles of couples wanting to adopt throughout the morning. April reviewed them and eventually chose a couple with a seven-year-old who had been trying for five years to conceive. They planned to arrive the next morning.

That night the nurses were busy, so I studied for my exam and watched the baby. As I changed and fed him, I reflected on how complicated decisions can be. I thought about my choice to put having a family on hold. It was hard seeing cousins and friends with new babies, getting pressure from eager grandparents, and explaining time and again why we were choosing to wait. Seeing these three very different families, April, the infertile couple, and the adoptive family, struggle with wanting or not wanting to have a child opened my eyes. Despite the best laid plans, life is unpredictable.

The following morning the adoptive couple arrived, grandparents and car seat in tow. Trying to keep my damp eyes hidden, I helped the OB describe the birth. The adoptive family was excited, teary, and immediately in love with their new son.

Minutes later, I changed out of my scrubs and walked to my car, braving the frigid Minnesota wind. The experience was a fierce reminder of the value of continuity of care and of a doctor's knowledge of her patients. As important was the personal lesson I took from it: there will always be uncertainty about the right time to have a child in my career, but knowing the reward when it finally happens, one way or another, is something I would look forward to.

Addie Licari

Therese Zink, MD, MPH

© 2008 Association of American Medical Colleges