Long has the stereotype of the arrogant, self righteous doctor permeated society.  Some doctors have even been accused of having a ‘god complex’.

Is it because they constantly balance life and death? Does shocking heart rhythms back in sync, bringing new life into this world and cracking skulls to remove deadly brain tumors cause their own craniums to arrogantly expand?

Some might suggest such obvious reasons, but I think the true source of their supernatural pride comes from a more mundane source: the power of their pen.

I postulate that it is the power of the the almighty ‘doctor’s note’ that can lead to the ‘God complex’. At exactly what point in history did the doctor’s note achieve such a powerful status? I have no clue, but over the years I have been requested to attach my magical signature to some very interesting requests.

Change the law

Husbands racing to the hospitals with their pregnant wives will often request notes to get out of speeding tickets they got on the way. I’m unsure why my signature is necessary to prove the large screaming pregnant woman in the seat beside them is in labor. Evidently my unintelligible squiggle is sometimes more convincing than common sense.

Very commonly I get a requested to write for handicap parking stickers for my pregnant patients. But sorry ladies, pregnancy is not a disability.

Get out of EVERYTHING

From school to jury duty, I have been asked to write notes to excuse people from nearly every responsibility in life. No, I will not write you off school/work for:

• Yeast infection (neither will I give you Percocet–but that’s an entirely different post)
• Pregnancy (sorry, miserable pregnancy alone isn’t enough, you must have a complication)
• You got your period (women have been going to work on their period for years)

Sex

Some of the oddest requests for doctors notes have concerned sex. I have been asked to write a note saying that a pregnant woman was OK to have sex. Evidently her husband was afraid to hurt the baby and wanted an ‘official’ doctor approval.  On the other end of the spectrum, several women whose libido was negatively effected by pregnancy have asked me to write them ‘off sex.’

I’ve also been asked to write note to get husband off work while his wife was ovulating so that they might procreate.

Change of religion

My all time strangest request involved Beef. A pregnant woman requested I write note to her priest saying that it was OK for her to eat meat. Her religion normally did not allow her to eat meat, but since she was pregnant and had anemia, her priest said he would approve it if she had a note from me.

I never determined her exact faith, but with the stroke of my pen I essentially changed her religion.

And that, my friends, that is why doctors can easily have “God Complex.”

All kidding aside, it’s truly amazing the crazy things I’ve been asked to put in a doctors note. Luckily, I have many people in my life to keep my pride in check.

What would YOU like a doctors note to get out of?

Young Dr. Rupe, Circa 1998

“You must have the grossest job in the world. Why on earth would anyone want to be a Gynecologist?” my twenty something patient asked, as I was examining her ‘nether regions’.

“Well, I do enjoy helping people” I lamely replied. I was doubtful she heard me, as she had already returned back to texting at this point.

I smiled as I left the room, remembering my surprisingly similar thoughts at her age.

I wanted to be doctor for as long as I could remember. But when I started medical school, the two specialties I knew I didn’t want anything to do with were OB/GYN and Pediatrics.

There was little doubt in my mind that Family Practice was my chosen path.  I chose Oklahoma State University because of its focus on primary care. I had shadowed several FPs and truly enjoyed the continuity of care and relationships that occurred in Family Practice.

When I started my rotations as a third year student, I excitedly picked FP as my first month. The practitioner I worked with was amazingly kind and knowledgeable.  He also had a passion for teaching and I was appreciative of the time he spent instructing me. Though we saw some interesting patients, there was also a lot of mundane colds and earaches. After about 3 weeks, I started to have doubts whether this was really what I wanted to do for the rest of my life. I was a little concerned, but knew I had a few (our school required 6 months of Family Practice) more months to decide.

The next month, I did an away rotation in internal medicine with a wise internist who had been in practice for 30 years. While I didn’t love internal medicine, I did love the doctor. I soaked up every bit of wisdom about life and medicine he sent my way. He inspired me to THINK and not just memorize facts. On my last day of the rotation he sat me down and said essentially that I had done well on the rotation, but he thought my personality was the most suited for OB/GYN.

I smiled on the outside, but internally I rolled my eyes.

My first thought was, “What a sexist!” I was sure he was saying that merely because I was a woman. OB was becoming a female dominated field, and it had been commonly suggested for me to consider it. However, the last thing I could possibly be interested in was doing PAP smears all day. Yuck. Child bearing had no interest to me whatsoever. It was WAY too messy.

I composed my initial thoughts and replied, with a simple, “I don’t think so.”

“When’s your OB/GYN rotation?” he asked.

“The last one of the year.” I replied, having postponed it to the end.

“You should seriously consider moving it up earlier” he encouraged me.

I thanked him for his advice as a courtesy. Then thanked him profusely for the other things he had taught me.

On the drive home I was still fuming about his remark. However, my thoughts began to wander. His wife and all 3 of his daughters were doctors, but none OB/GYNs. There were no other sexist things he had said or done the whole month.  I respected him greatly and had trusted all the other advice he had given me. Perhaps, I should listen and at least move my rotation up to earlier in the year. After all, I wasn’t loving FP nearly as much as I thought I would.

After several frantic phone calls, I managed to set up a rotation with a local private practice doctor, in desperate need of some CME’s.  I ‘did’ very little during this month, but what I observed was life changing.  I observed his daily practice: his rapport with his patients, interesting procedures and complex diseases.  He was able to practice preventative medicine in a real way (one of my passions) and also do fascinating surgeries.  I witnessed babies born then later the same day the removal of a giant ovary full of teeth and hair from another patient. It was thrilling. On my last day of the month, I broke down in tears on the way home. I couldn’t believe my month was over. I didn’t want it to end. I had fallen in love with the crazy life of being an OB/GYN.

Then began the soul searching and prayer. How could I have a family and be an OB/GYN? As much as I loved my month of OB, the hours were harsh, and I wasn’t sure I could hack it. Was being an OB really God’s plan for me or just a selfish whim? After months of pro’s and con lists and long discussions with my husband, I finally felt a peace from God that this was the path I should take.

Finishing my last 6 months of family practice rotation only confirmed my decision.

This life is NOT easy. The hours do get crazy. Yes, there are days when I do get tired of looking a vaginas all day long. But the longer I do this job the more I love it. So here I am, 8 years into private practice reflecting on how my life is nothing like I expected it to be when I began this crazy adventure in medicine. I realize that it is amazingly better.

Thank you Dr. Bruns for telling me I should be an OB/GYN. You were right.

Sometimes our lives take a path much different than we expected. Have you ended up on in a different role or calling than you once anticipated? How did you get there? What would you say to encourage others seeking answers about their life calling?

 I was recently accused of being glamorous.

This made me laugh so hard that I snorted water through my nose.

I try to be transparent and real on this blog. With all my stories of being covered in bodily fluids, I can’t imagine anyone finding me glamorous, but just to put an end to that silly rumor let me tell the back story behind the above picture.

This is me and the love of my life at the hospital Christmas party all dressed up in our fancy duds.

An hour before this picture was taken I was in my underwear on my hands and knees, bleaching my bath tub, cleaning up toddler diarrhea. I felt like a rock star for managing not to get either bleach or poop in my hair.

After the party I rode around in a limo drinking champagne and eating Grey Poupon. Yeah, right. Nope came home, changed into jammies and spent two very exciting hours finishing up my charting for the week. I know, you’re jealous of my rock and roll lifestyle.

Not that I’m complaining, I am blessed to be both a mom and doctor. Truly, I count both callings as an honor and a privilege. This is just a reminder {for you and for me} that when we see people’s glossy Facebook and Twitter feeds, we are often seeing them at their photoshop’d best.

Everyone’s life is a little messy. Especially mine.

Does your life seem messy to you? What is one time you truly did feel glamorous?

Mr. Stacey was the awesomest of all humanities professors when I was a student at Oral Roberts University.  Why was he so awesome? Was it because of his LEGO hair, that appeared to be painted on and aligned perfectly with the ear piece on his glasses? Partially, as this became the subject of may of hours of  discussion amongst us undergrads. Was it the fact that he rarely cracked a smile and was likely a cylon? Maybe. He was awesome mainly because he refused to answer stupid questions.  He wouldn’t spoon feed us the obvious or repeat something he just said.  He treated us like adults and told us what we needed to know without a lot of fluff.

As a doctor, obviously I want patients to feel comfortable asking me anything. I answer all questions with as much empathy and compassion as I can muster.  Sometimes, though, I wonder if women really think before they speak. It’s said that there is no such thing as a ‘stupid question’, but I have to disagree. Here are some of the winners I’ve been asked over the years, that would have made Mr. Stacey roll his eyes and say, “Next Question!”

10. Did you deliver your own baby?

Why yes, I sliced my own stomach opened and pulled out my baby. Because I am, in fact, just that good. I have been asked this by people, even after they know I had a c-section. All the women in my practice have been asked this, which I find intriguing.  Speaking of women:

9. Since you have all women working in your office, are you all on the same menstrual cycle?

Surprisingly, I have been asked this weird and personal question many times. We don’t really discuss our cycles around the office. Menstrual synchrony has never been scientifically proven, by the way.

8. Do I need to take my tampon out before you do the pap smear?

Yuck, yes you do. Additionally about once a month, a women will change into the gown, put herself into position on the exam table, then as I go to perform the pap smear, I will discover that she still has her underwear on.  This always leaves me quite befuddled. There is a subset of women who do not understand their basic anatomy.

7. Will this medicine hurt my baby?

This is not as much a stupid question as an poorly worded question.  Almost every time I prescribe a medication to a pregnant woman, she will ask me this. Yes, I went to school for 12 million years, so I could poison your baby with Benedryl.   Obviously, I would not prescribe a harmful medication to a pregnant woman.   A better phrasing would be ‘what are the risks of this medication in pregnancy’ as ALL medications have risks.

6. Will you see my boyfriend as a patient?

No, I do not do boy stuff. I am a GYNECOLOGIST.

5. Are scrubs comfortable to wear to work?

No, wearing pajamas to work really stinks.

4.  Should I stop my birth control pills if I am trying to get pregnant?

No. If you have to ask this question, perhaps you should not procreate.

3.  Me: ‘Are you sexually active?’  Teenager: ‘Sort Of’

This is a common ‘stupid answer’. On further questioning as to the nature of said pseudo sexual activity, the actual answer in most cases, should have been a simple ‘yes.’

1.  I ask stupid questions too.

I am also guilty of the stupid question. I recently asked a teen patient if she had ever been sexually active. She then paused and looked at me like I was an idiot and said, “Yes, I have a baby.”

Face palm. Sure enough, there on her intake form as plain as day, she had noted that she had a one year old. Now she is probably looking for a new gynecologist who understands how babies are made.

What is the stupidest question you have ever heard or asked. . .or been asked?

While I have never actually read Emily Post’s book of etiquette, something tells me that there is not a section that specifically addresses how to react when you see your gynecologist in Target. Without clear guidance on the topic, ladies have to wing it.

I work in a smallish sized town of about 62,000 people. I have been in practice for 7 years and  have delivered over 1000 babies. I can’t go to Target without seeing at least 3 people I know. Make that 10 people, if I am wearing Yoga pants and no makeup.

When I see a patient at the store there are various responses:

1. Uberexcited

This patient will see me from a distance, her eyes will light up and she will immediately race over to see me. As she’s racing past the motor oil to reach me, I rack my brain to remember some detail about her. Hopefully I can remember who she is, but rarely her actual name.

She will exuberantly proclaim how I have improved her life by fixing her most recent gynecologic problem. Then after a couple of minutes she will ask, “Thanks for curing my cramps, but now I’m  having this discharge that’s kind of green and chunky, what could that be?”

Now usually my kids are in the cart, so I have to answer the question the best I can, without scarring my 8 year old for life.

2. The horrified

The horrified patient will see me from across the aisle. Our eyes will meet. I will smile and say hello. Her eyes will get as big as saucers. She will then awkwardly dart to the nearest isle, even if it’s the adult diaper section. She would rather be there, than to see her gynecologist in public. She will never mention this encounter to anyone.

Please note, horrified patient, that I see AT least 35 vaginas a day. I do not remember what yours looks like.

3.The normal

The normal patient will treat me like a regular person. Say hello, with a smile, maybe make small talk and be on her way, as you would with any acquaintance.  They will be kind enough not to judge me on my screaming 2 years old or disheveled hair. If they are really awesome they will introduce themselves to my husband and kids, so I won’t have to guess their name.

There you have it Ms. Post, feel free to add #3 to your next book of etiquette. Yes, just treat me like a regular person. Don’t run and hide, but don’t ask me about your nether regions in public either.

What would you do if you saw your OB/GYN in public?

{Photo Credit coolmikeol via Creative Commons}

As I looked at my screen to check which patient was next, seeing her name made me smile.

The patient was a delight. I had delivered her first baby two years ago, an adorable baby girl with curly blond hair and rolls on her thighs. The patient pushed like a champ, but despite her efforts, her 10 pound bundle of joy entered this world through a low transverse abdominal incision.

She was newly pregnant with baby number #2.

A perfect flutter of a heart beat was seen on the ultrasound, and all was good.

“Doc, do you think I should try for a VBAC (vaginal birth after c-section) or have a planned c-section this time?” she inquired, as we finished up with the usual questions.

I carefully reviewed the risks and benefits of each, encouraging her to weigh which option would be best for her.

As I finished, I noticed she was pursing her lips in anticipation of a question that she could barely contain.

“But Doc,” she asked smugly, like a jeopardy contestant who knew they had the right answer, “What would you do if it were YOU?”

The favorite question. I smiled and leaned back on my rolly stool.

“Nope.” I said as I shook my head back and forth with a smile, “I don’t answer that one.”

Somewhere there has to be a Readers Digest Article, ‘Top Ten Questions to Ask Your Doctor’ and this is probably #1, based on the number of times that I have heard it.

Initially, when I started practicing and my newly board certified brain was bursting with memorized textbook knowledge and randomized controlled trials, I would fall for this trick. I would rattle off my personal opinion on such matters. Because obviously, I knew best.

It didn’t take me long in practice to realize that every women is unique. I was biasing these women with my personal opinion on issues that really, I had no business discussing.

I am not saying I don’t give advice. Of course I do, I am a doctor. I give my best medical recommendation in all situations.  However, I do not give patients my honest, personal opinion of what I would do in their specific situation, because I am not them.  And I am not in their situation.

In obstetrics there are multiple situations when women really need to decide for themselves:

VBAC vs. C-section

Natural vs. epidural

Circumcision vs. no circumcision

These are just a few of the very personal decisions that women need to make for themselves. Options that should NOT be decided by their moms, NOT by their friends and definitely NOT by me.

How do you feel the ‘suggestions’ of others effected your pregnancy decisions?

We’re linking up today with Ooh Amanda’s Top Ten Tuesday. Check out her blog for more fun and practical top ten lists.

10. The First Flicker

When a patient comes in for their first pregnancy visit, I usually do a sonogram.  At 6 weeks, when the baby is smaller than a grain of rice, the heart beat is first visible as a tiny flutter. Miscarriages are very common, so I’m always a little nervous for the patient as I turn on the machine, but when that flicker pops up on the screen, both myself and the patient both exhale a little. Sometimes they tear up, other times they smile and stare in wonder at miracle life growing inside them. No matter the patient response, seeing that tiny flicker signifying the beginning of life, makes me grin from ear to ear.

9. Patients Who Follow Directions

Doctors get a lot of flack for being ‘pill pushers.’  I read a recent FB post where a women was complaining that her doctor never talks to her about diet or nutrition, he only prescribes her medication. {Ironically she had posted a picture earlier that day of the giant cheese burger and fries she was eating}.  I have the opposite complaint.  For every 50 people that I discuss exercise,  lifestyle changes or quitting smoking, probably only about 1 actually does it.  When I see someone back for their annual and they have quit smoking, finally lost the weight or started exercising it’s all I can do to contain myself from breaking out into a happy dance.  It makes me want to hand out gold stars.

8. Surgery

People think of OB/GYNs as delivering babies and doing pap smears all day, but we also do a lot of surgeries: cesarean sections, hysterectomies, laparoscopies, etc.  This is something I really enjoy. Surgery is interesting intellectually and fun to do.  It’s also satisfying to be able to solve a problem:  you have a giant cyst that hurts? I cut it out, you feel better.  All done!

7. When an Appointment Type Changes from ‘Discuss Infertility’ to ‘New OB’

We always run a pregnancy test when patients come in for infertility testing.  Every once in while it will come up positive.  That is always a great day!

6. Relationships

At the beginning of each day I scan my list of patients to be seen that day and some names just bring a smile to my face. I’ve been in practice for almost seven years now, so I have gotten to know some of my patients pretty well.  I’ve seen them get married, have a couple babies and watch their babies grow through the pictures they bring in at their visits.  When you have taken care of women through 2 or 3 pregnancies you get to know them pretty well.  Then, when they come back later for their checkups, it’s so fun to catch up on their lives.  I have to watch myself that I don’t get too chatty or I can run behind, but I do really enjoy the relationships I have formed over the years.

5. The Perfect Call

Those of you that already have babies are probably familiar with that slightly panicked feeling you get the first time your baby sleeps through the night. You wake up (on your own), glance at the clock  and realize with a shock that it’s morning. “Wait? but I never got up with the baby,” you think as you run to the baby’s room to make sure he’s OK.  Did my husband get up with him? Did I sleep too soundly and not hear his cries? Then you see him sleeping peacefully in his crib, and you realize that a wonderful, wonderful thing has occurred:  your baby has slept through the night!

I’m on call every 4th night. Most of these nights include middle of the night phone calls and/or deliveries at 4 am.  That is fine. That’s my job. I love delivering babies… even at 4 am. But once in a blue moon there is a magical call night. I will awake in the morning with a feeling of  slight panic as I check my phone to make sure I didn’t sleep through any calls, only to realize that it was a perfect call.  No pages. No babies. Just wonderful precious sleep.

4. Never Being Bored

As a child, one common complaint I had for my mother was, “I’m Bored!”  This is not a phrase I have uttered in a long time. This morning as I was eating my cereal, I got a call form the hospital, ” Your patient just arrived and she feels like she needs to push!”.  Twelve minutes later I was in a hospital room delivering a baby as I caught my breath, having literally run from the parking lot.  I enjoy the variety of things I get to see, and if I am truly honest with myself, the excitement as well.

3. Surprise Gender Births

Growing up I, like everyone else,  would watching people have babies on TV shows.  The TV doctor (who was always a man) would hold up the baby and say, “Its a Boy!” and the room would cheer.  Nowadays, most couples find out the gender of the baby at the ultrasound appointment, so the ultrasound tech is the one who gets to tell the fun news.  I feel a little betrayed by TV doctors on this matter.  On the rare pregnancy that a coupe has kept it a surprise until birth, I get really excited.  I FINALLY get to say, “Its a Girl!” to a room full of cheering family. This is a job I take very seriously and get very excited about. I encourage  patients not to find out… but alas they usually don’t listen.  However, on the rare occasion they do, it’s really fun.

2. Telling Someone They are Having Twins

There is something so very fun about telling someone they are having twins.  They almost always freak out.  When you point to those TWO flickers on the ultrasound screen, it transcends all language barriers. People just go into joyful shock.  I once had a woman scream so loud that the entire office rushed into the room thinking something was wrong. Sometimes incredulous, joyful laughter occurs, other times they are speechless. Whatever the response it is the best thing ever, well at least the second best…..

1. First Breath

I’ve delivered a lot of babies over the years, but I still love it when the miracle of life happens before my eyes:  the baby takes its first breath of oxygen and begins to cry.  In those precious moments of birth I have a lot going on, my mind is going through multiple checklists to make sure mom is healthy and doing well.  But for a few seconds, as I lay that precious baby in the mom’s arms, I just let myself soak up the parents’ joy and wallow in the miracle of life.  I still shed a tear from time to time (especially when the dad starts bawling, that always gets me). I continue to count it a privilege that women honor me by allowing me to be a part of their births.

Every evening before I go to bed, I check my schedule one last time to determine what the next day is going to look like. How many patients are there in the hospital for me to check on before office? How many inductions? Any meetings or  scheduled surgeries  on my lunch hour? How does my office schedule look. I attempt to schedule my time appropriately, but it seems no matter how hard I try, I will often end up running late. Looking back on each day, it almost never went as expected the night before.

I don’t run late every day. Our office is often complimented that it runs smoother than most. We have an awesome nurse practitioner, Ashley, who helps out on days I am delayed. I build in flex time into my daily and weekly schedule to help accommodate the need for emergency patients and unforeseen circumstances, but despite these efforts some days everything just gets out of control.

The reasons I run late are innumerable: patients in labor, emergencies, surgery that didn’t start on time, a wreck on I-65 that makes my first 5 patients late creating a snowball effect for the remainder of the morning, patients who get lost (our address is not in most GPS systems). It seems to never fail that on days when one of these things happen, I will also have a return OB patient come in that will have an unexpected complication requiring an additional 30 minutes to admit to the hospital. In other words, things will run smooth for days, then everything seems to happen at once, which is also usually going to coincide with half our staff calling out sick and our computer system crashing.

One of the reasons that I run late is that when patients have a problem and call for an appointment, they don’t know what the problem is: THAT’S WHY THEY COME TO THE DOCTOR. I cannot hold that against them in any way. For example, a  patients requesting  an appointment for a yeast infection is given a 10 minute slot by the receptionist. This is the amount of time it takes me to diagnosis and treat someone for a simple yeast infection. However, it is rare that things are that simple.

Here are some examples of what I have actually found when patients have come in to be seen for a yeast infection:

Retained tampon- time 15 minutes
“Doc I’ve had this ‘yeast infection’ ever since my period two weeks ago, the smell keeps getting worse and worse. It smells like something crawled up my vagina and died.” This is the classic description of a forgotten tampon. This visit takes about 15 minutes. Five minutes to remove said tampon, 10 minutes to deodorize the room.

Suicidal patient – time 1 hour
I have had more than one patient come to see me for ‘ yeast infection’, only for them to tell me on arrival that they also want to kill themselves. I’m not sure why they would come to the gynecologist for this. They must trust me and feel comfortable with me. Obviously, it takes time to talk with someone in this situation and arrange to get them the appropriate help.

Herpes-30 minutes to 1 hour
Sadly, this is one of the more common diagnoses I have to relate to women.
The conversation goes something like this: “Doc, I have this yeast infection that’s just not getting better, and now I have these little blisters everywhere… it must be a reaction to the Monistat.” Often when I am telling women that they have herpes, I am also telling them that there husband has been unfaithful. This is a very difficult conversation to have.

The Chatty Patient (or doctor) -time ???
Some patients give a VERY thorough history that might entail everything that’s happened in their life over the last two weeks since this yeast infection has developed. I will also admit that I can get chatty as well. Come in for a yeast infection, but mention you are applying to adopt a baby and I will talk to you so long, my nurse Kim will start knocking on the door to hurry me along.

The Hormonal Patient- time 30 minutes
“Doc, I just know this yeast infection is caused by menopause, as are all my problems. Should I take hormones?” Hormone replacement therapy is a highly individualized decision that takes a lot of discussion and counseling. It does not fit in the 10 minute slot.

The Chronic Issue -time ???
“So how long have you been having the symptoms of this yeast infection?”
Patient, “Seventeen years.”
“Alrighty then.” Once again, not going to fit in the 10 minute slot.

The Worried Patient
The patient who thinks they have a yeast infection, but is actually fine usually takes longer to see than the one who actually has a yeast infection.
“Are you sure everything’s OK? Three weeks ago I had a little bit of itching and then last night  I think I saw some discharge when I wiped. Here’s my toilet paper, I saved it for you.*”
Yes, all is fine down there, I explain.
“Then what caused the itching three weeks ago?”
I am not sure.
“I MUST know.”

I could probably come up with a similar list for each appointment type, but I think you get the gist. SO, for any patient of mine who has had to wait in the paper gown, with cold toes, while sitting on the the exam table for longer than you felt necessary, I am sorry. It’s not purposeful. I and my staff do make an effort to keep things running smoothly, but it is also impossible to control or predict how much time each patient will need.  Also realize that if the day comes that you are there for an unforeseen diagnosis, I will  give you the the time and attention you deserve.

My New Stirrup Covers

*REALLY, not necessary!