From the Trenches
Forum
The pleasures and pains
of being a parent
Dealing with expectant parents and newborn babies is one of the
greatest delights of general practice, writes John Latham
My two offspring are fledged and have left the family nest
for foreign lands, yet in the practice I can enjoy brief encounters with neonates, infants and toddlers without worrying if
they will wake me at night, ask awkward questions when I am
tired or become impatient on a long car journey.
Pregnancy, babies and six-week infant checks are often
the icing on the cake of general practice, and not only for the
GP. Recently I joined a group of women in the waiting room
smiling, cooing and ogling at a tiny Indian baby whose young
mother was visibly radiating pride and love. So absorbed was
I in this act of baby worship that I momentarily forgot which
patient I had come to call in for consultation.
I have always relished seeing an antenatal visit
on my computer appointment list. A relaxed prenatal exam must be one of the most pleasurable
of consultations (for the GP). Over the past few
years there has been the added kick of undertaking antenatal care for couples who have been
infertile for many years... the father invariably
comes along for the visits and for a few minutes
the three of us share far more than the taking
of blood pressure, examination of urine and the
triumphant galloping of the foetal heart monitor.
Despite the hundreds of combined antenatal
care cases over the years I haven’t witnessed the
delivery of a baby for 21 years, since the arrival
of my eldest daughter in the Rotunda. Presence
at my youngest daughter’s entrance via a Caesarean section
was denied me because of a new hospital rule prohibiting
fathers from entering the theatre. I sat in the tiny theatre
coffee room, close enough to hear my second child’s first
celebratory cry.
Two or three years before my daughters’ births, I had been
rushing up and down the corridors of the labour ward, first
as an obstetrics houseman and then a neonatology registrar.
Drama, tension, satisfaction, joy and occasionally tragedy are
some of the words I could use to describe the atmosphere in
which we worked.
My first night on duty in the labour ward taught me a lesson
about accuracy in assessment, honesty... and luck. The first
mother I examined was the wife of a man who had been
senior to me in school, an authority figure who had been very
good at rugby, unlike myself. Because of my complete lack of
experience in assessing a cervix, I took a very long time trying
to get an idea of the lady’s state of advancement in labour. I
reckoned her dilation was about 2 or 3cms only... but I was
not absolutely sure what I was feeling! I asked the experienced midwife’s opinion (bizarrely she was not allowed to do
a PV exam). Her intuition was that I was right. So I gingerly
went out to my former senior prefect, who asked if he had
time for dinner and a pint of Guinness. I delayed my answer
for 30 nerve-wracking seconds and then simply said ‘yes’.
Their baby was born 12 hours later and to this day the father
remembers me as that unathletic weakling who unexpectedly
seemed so skilled, decisive and experienced!
Plainly, human reproduction does not always go according
to plan and GPs often face the shared grief of miscarriage and
the prolonged heaviness of spirit in those who are infertile.
We are also involved with the long drawn-out international
bureaucracy necessary for a foreign adoption. The happy
arrival when this process is successful is usually
the culmination of what seems to have been a
prolonged and complicated gestation... but what
welcoming and loving parents the adopted kids
have!
Inner city Dublin is generally a supportive place
for children and the family network, often including three generations, is very caring. I am sure
this is the reason requests for termination are
extremely rare and even the youngest and least
prepared single girl is encouraged to welcome the
new addition into the world. That is not to say
that some of our patients do not have huge problems with parenthood, particularly young addicted
mothers. It is heart-rending to see a neonatal discharge summary with details of the dose of phenobarbitone
required to detox the baby.
I guess that Shakespeare viewed babies and children in
much the same way as we ageing GPs do: “This were to be
new made when thou art old”... or at least 40!
“When forty winters shall besiege thy brow,
And dig deep trenches in thy beauty’s field,
Thy youth’s proud livery, so gazed on now,
Will be a tatter’d weed, of small worth held:
Then being ask’d where all thy beauty lies,
Where all the treasure of thy lusty days,
To say, within thine own deep-sunken eyes,
Were an all-eating shame and thriftless praise.
How much more praise deserved thy beauty’s use,
If thou couldst answer ‘This fair child of mine
Shall sum my count and make my old excuse,’
Proving his beauty by succession thine!
This were to be new made when thou art old,
And see thy blood warm when thou feel’st it cold.”
John Latham is an inner city GP in Dublin
FORUM June 2009 51
Latham at large/JMC/NH2* 1
27/05/2009 12:08:55