Before each of my midwife appointments during my pregnancy last year, I’d try to quiet an anxious little voice in the back of my mind.
“The patient is a 35-year-old woman presenting with her first pregnancy, confirmed by first-trimester ultrasound,” the voice would tell me. It would go on to recite other relevant facts: I had been feeling particularly nauseated recently, and I was having a hard time sleeping. It was possible those were normal symptoms of pregnancy, the voice would say quite reasonably before leaping to the worst-case scenario: it was possible those were signs I was about to die.
The voice was me as a doctor. But instead of being a kind and rational guide during a transformative period of my life, the voice was really, really stressing me out.
Pregnancy was my first real experience as a patient. I’d spent the last ten years observing our health care system as a medical student and now as a primary care physician, but it did little to prepare me for how vulnerable I felt that chilly November day when I went in for an ultrasound to find out my due date. It was the beginning of the first pandemic winter, and my husband waited outside on a street corner, banned from the exam room because of the hospital’s COVID-19 visitor policies. He listened to our son’s heartbeat for the first time over video chat.
Of course I’d been to the doctor here and there before then, but I’m a typical health care worker, which means I’m terrible at following my own advice. Rather than having regular check-ups with the sort of long-trusted primary care physician I aspired to be for my own patients, I’d ask my colleagues to check my blood pressure, or text a friend a picture of a mysterious rash.
When I became pregnant, I couldn’t avoid it anymore. I finally had to make an appointment.
For my prenatal care, I chose a well-respected midwifery practice that wasn’t at the hospital where I work or the hospital where I trained. I didn’t want to be seen by any colleagues. If I were the patient of one of my former professors, I’d worry they’d think I was stupid if I asked too many questions.
But even under the care of a warm and competent midwife, it turned out to be difficult to turn off the doctor part of my brain. Perhaps it was no surprise: I worked hard to train myself to think like one, describing patients thousands of times in the highly structured style that we learn from the very beginning of medical school.
The classic “patient presentation” script starts with age and sex, transitions into the patient’s present medical condition, then notes medical facts from their past. We describe the patient’s vital signs, physical exam, and then speculate about everything that could possibly go wrong. That list of potential ailments – and the evidence for and against each one – is called the “differential diagnosis,” and getting it right is one of the most revered traditions in medicine.
In my training, I was taught to take my patients’ messy, distracted stories and turn them into neat and organized accounts, describing their most intimate fears in clinical language. I learned to methodically rank ailments in order of what was most likely. We then rule out what’s most dangerous, either by virtue of reassuring details in the patient’s account or with further tests. We sometimes keep those rare and fatal possibilities hidden from our patients, but considering them is essential to ensuring we miss nothing.
The format of the patient presentation is drilled into our minds so thoroughly that doctors can launch into one, quite literally, in their sleep. During my training, in the middle of a long night shift caring for sick patients, I returned to the structure like a mantra, letting it remind me that I was more competent than I feared. It’s a template that ensures we don’t miss anything important, that guides us when we feel lost.
But during my pregnancy, my deliberately cultivated medical thinking turned out to be anything but therapeutic.
The night before each prenatal appointment, I could barely eat, plagued by a familiar anxiety. It was how I felt in my training, the night before starting work in a new part of the hospital or with a new supervising doctor I was hoping to impress.
I would feel my growing belly, my son’s kicks inside of me, and I’d remember working on the labor and delivery unit during residency, presenting my patients to the whole team for input. My heart would race as I’d write the details of my patient’s exam on a whiteboard in front of our tiny workroom crowded with doctors and nurses, steadying myself to be peppered with Socratic questions: “Why didn’t you think of this possibility, Dr. Gordon? Why weren’t you prepared?”
I now felt a perpetual out-of-body sensation that I was giving a presentation on myself. It had to be perfect, every rare complication accounted for. With myself as the patient, I couldn’t shake a vague feeling that something terrible would happen, a form of karmic retribution for the times in my training when my clinical acumen wasn’t brilliant enough.
Take my experience with one of my prenatal labs which screens for abnormalities, a blood test called the maternal serum alpha-fetoprotein, or ms-AFP. A positive test isn’t conclusive, since it is associated with so many different conditions, but it signals that a patient needs further testing.
My level was ever-so-slightly high. When I found out, I couldn’t quell the voice in my head: “The patient is a 35 year-old female at 16 weeks of gestation, found to have an elevated ms-AFP.” I felt powerless as my mind whirred with all the options: It could mean problems with my baby’s spinal cord, or a condition where his intestines were growing outside of his body. It sent me on what I later called a “PubMed bender,” a weekend spent obsessively searching the medical literature about the test, awakening in the middle of the night to cry.
All the papers I found should have been reassuring, reminding me how low the chances were that something was seriously wrong. But I couldn’t think clearly like I do when I’m at work, instead focusing on the one-in-a-million cases I’d unearthed online. Being a patient was like being a first-year medical student again: knowledgeable enough to be scared by what I read, but too inexperienced to apply it to the situation at hand.
Five endless days after my initial test, an ultrasound revealed a fetus growing normally, as well as the likely culprit for the abnormal level: a placenta with two lobes and an unusual connection to the umbilical cord, a variant that isn’t particularly dangerous. I was delirious with relief.
Throughout my mostly normal pregnancy, I found myself panicking again and again. When my midwife would tell me not to worry about symptoms that came up, symptoms she’d seen thousands of times before, I couldn’t trust her. I had to research the worst-case-scenario myself. When she gently suggested that I forgo all the medical talk because it seemed to be making me more anxious, I realized how disordered my thinking had become. My doctor voice was making me worse, not better.
Then came the ultimate test: labor. When my contractions finally started, I couldn’t stop looking at the monitor tracking my son’s heart rate. Was he in distress? Was he getting enough oxygen?
When his heart slowed, I secretly tried to reposition myself to take pressure off his umbilical cord, a task I had done for my own patients hundreds of times during my training. But I couldn’t move, numb from the epidural and exhausted from labor. It was a heavy-handed metaphor: I was physically unable to be my own doctor. I had to allow myself to be cared for.
My son is now a healthy 7 month old, playful and giggly and the source of a deep, complex love I am only starting to understand. My training as a physician is an undeniable privilege, one that thus far has allowed me to avoid a 2 am call to his doctor when his nose starts dripping, or when his poop turns dark green after a hearty portion of eggplant hummus.
Since starting daycare at the beginning of the year, he’s had a series of colds, a rite of passage that any parent would tell me is almost inevitable. When he cries and thrashes in my arms, I sometimes hear that same doctor voice whispering the most terrifying diagnoses I studied in medical school. “The patient is a 7-month-old male, status post spontaneous vaginal delivery at 39 weeks, with a new onset upper respiratory infection.” I imagine everything else it could be: The children I have cared for with tumors, with bacteria in their blood, with holes in their hearts. I think of babies struggling to breathe, hunched over as they gasp for air. I think of my own pediatric patients in my family medicine practice, coughing from COVID infections, feverish and distraught.
I gently quiet the voice, and remind myself that I am not his doctor. I am his mother. It’s not my job to consider every medical possibility that could befall him; my job is to comfort him, to keep him safe, and to ask his doctor to play that role. Part of the task of becoming a parent, for me, means deliberately forgetting what I learned in medical school, and instead giving myself permission to be a mom.
Mara Gordon is a family physician in Camden, NJ, and a contributor to NPR. You can follow her on Twitter: @MaraGordonMD.