Expat Bostonians

Bedside manner.  Respect.  Clear communication.

These are necessary ingredients in a successful visit with a doctor, regardless of your sex, age, or locale. When a doctor lacks one (or all) it creates an atmosphere of fear and distrust.  With fear and distrust come disempowerment and a loss of confidence.  Add in pregnancy hormones and a strong personality, and creates an explosive keg that could go off at any moment.

I exploded yesterday.

It took many interviews, but I am extremely lucky to have found an ob/gyn that I have connected with.  It’s probably not surprising that she’s female, a mother of young children, on the younger side, and far more likely to regard me as a peer.  That my last OB also fit this loose description is also unsurprising.  I have grown to trust both of my OB’s because I have never felt belittled, disrespected, or unsafe in their offices.

The person who took (and deserved) the full force of my explosive temper was a sonographer.

Not because the appointment started over 30 minutes late. 

The reality of doctor’s offices (regardless of specialty) is that over the course of the day you can run later and later especially if you are giving each patient the care they need instead of the care you can fit into a tight slot.  I’m sure I’ve been the cause of many a delayed appointment in my time, and while it is boring, it is understandable.

I was not thrilled when the doctor didn’t bother to introduce himself.

I will admit that I was put off by a doctor not bothering to introduce himself.  It’s not exactly empowering to be laying on a bed with part of your body exposed.  It is further less than empowering for someone who is supposed to perform a procedure to just walk in and not bother introducing themselves.  I felt small.  I felt dehumanized…that I was perceived as less than deserving of a minimum courtesy, like “Hi, I’m Dr. X,” before you start squeezing ultrasound gel on my exposed skin.

By itself, it’s a turn off, but this was a one-time appointment and I was willing to shrug it off.

I was a little upset when I was greeted with “Third Baby, Congratulations.”

Let me be clear here, just as I was clear with every doctor that has ever asked me a question relating to my fertility.  This is my third pregnancy.  My first ended in a miscarriage of a child, Hope, that was planned for and very much wanted.  Whom our family still mourns the loss of.  My second pregnancy resulted in Elanor’s birth.  I am optimistic that this pregnancy will end in our SECOND live birth.  A third pregnancy doesn’t equal a third child.

Perhaps I am a bit over sensitive on this topic.  I have two close friends and know several more through friends of friends and via blog that have struggled with infertility, with repeated miscarriage, and who have had a far rougher road to travel to parenthood than I have.

The assumption that pregnancy always equals the birth of a child was the myth that kicked my ass and sent me into a month-long depression after I lost Hope’s pregnancy.  It took Elanor’s birth for me to fully accept that my body wasn’t defective.  That I wasn’t defective.  That assumption is part of the reason there is a culture of silence on the subject of miscarriage…particularly given that miscarriage is incredibly common in the first 10-12 weeks of pregnancy…between 25 and 30% of all pregnancies end in miscarriage, some before the woman realizes she’s missed a period, many in the early weeks of pregnancy as the fertilized egg tries to multiply itself and carry out the genetic coding.  Coding that sometimes has a bug in it.  The process of turning one cell into a fully formed human is not easy…it’s almost surprising that miscarriage isn’t even more common than it already is.  As a culture we don’t talk about it, though.  I have a lot of anger about this silence.  I also have a lot of anger that because I suffered one miscarriage, I’ve never really trusted my body again.  I spent all of Elanor’s pregnancy expecting her die in utero…my anxiety was so high that I went into counseling to deal with it.  I’ve done better with this pregnancy, but I’d be lying if I didn’t confess to nightmares, to fear, and to the truth that I hold my breath every time I go into my OB’s office and don’t let it out until I hear that reassuring “whoosha-whoosha” sound of the baby’s heart beating healthily.

I also reacted to what I perceived as a tone not unlike the one used on prize showdogs when they’re about to whelp another high priced set of puppies.

With all of that baggage, coupled with a first show of proof that this doctor wasn’t reading my chart all that carefully, I replied testily that it was potentially my second live birth, not my third child.

However, I realize that this baggage is also intensely personal and probably could have let it go, had the rest of the appointment gone differently.

I most definitely was grinding my teeth every time Dr. X called me “my darling.”

Here ‘s where things began to go off the rails.

I am 32 years old.  I am a fully functional, intelligent adult.  I do not take well to strange men referring to me as “my darling,” or any other condescending pet name to which they feel entitled to crown me.

I realize that there are generational differences.  I realize that there are cultural differences in play.  None of that entitles an older man, in a professional setting, to call me a pet name rather than “Crystal” (which I’m fine with, and generally prefer) or “Mrs. N—” (if they want to be more formal).  My experience in Singapore has largely been that a doctor will introduce themselves to me and then ask me what I prefer to be called.  I would roll my eyes but likely take this sort of pet name calling from a much older man in a casual setting, and it doesn’t bother me when taxi uncles address my 2 1/2 year old with little pet names like that.  Those are moments where setting implies a level of informality that make it if not okay, at least understandable within the context of age/culture. It is never acceptable to refer to a medical patient whom you’ve never met by a pet name, especially when you haven’t bothered to tell them yours.  Period.  Full stop.

I remember looking at Ravi, who was sitting next to me and shooting him a glance that said “Did you just hear what I heard?”  I seem to remember him giving me his look that’s equivalent to an eye roll, as if to say “what an ass.”

Had he been competent, I would still be pissed about this, but I wouldn’t have ended the appointment.

The final straw, however, was when we couldn’t agree on the purpose of my visit

You want to have a lousy bedside manner?  Fine, not everyone cares about that.

You want to talk to me like I’m no older or worldly than my 2 year old?  Pisses me off, but some women feel codded and safe when older men do that, and you don’t know how to read your audience (and ugh! to those women), especially when it’s a first visit.

But when we can’t even agree what job I’m there for you to do?  Then we have an issue that isn’t going to slide and isn’t going end well.

After not introducing himself and talking to me like I was a cross between his pet hamster and my two year old, Dr. X launched into a lecture about the timing of my ultrasound.  I’m told that I’m both too late and too early for my ultrasound.  Which would be true if I were there for the nuchal fold/quad screen (12-14 weeks) or the echocardiogram (22-24 weeks) but is absolutely incorrect given that I was there for my level 2 ultrasound, which measures vital organs and is done between 18 and 22 weeks.  I am 19 weeks pregnant on Wednesday, so this is actually exactly the right time for this assessment.  Has this guy read my chart?  Or is that just what he does…comes in, calls the random woman on the table my darling and does whatever the hell he wants?

Instead of trying to have good communication and clarification, I’m told that I’m wrong, that it’s too late to do the level 2 ultrasound and that he’s the doctor, not me.  I’m also called “my darling” several times during the exchange.

The frustration that began with his lack of respect at not introducing himself, that had grown with every patronizing “my darling,” finally exploded.

Close to shaking with my rage, I sit up, wipe off the gel from my stomach, pull up the maternity band on my shorts and pull down my top.  “We’re done here.”

He begins to argue with me, every word dripping with condescension, and just as I could have predicted, it was yet another round of  being called “my darling” that blew my temper.

This is when I decide to set him straight, “Look, let’s get one thing clear.  I’m NOT your darling.”  We start to argue, him telling me to get back on the table and that he’ll do my scan, me telling him no way in hell and that I have a master’s degree–he needs to stop calling me his goddamn darling (looking back, I’m not sure what having a master’s has to do with anything, but at the time it seemed to be a valid part of my argument that I was far past an appropriate point in my life to be called something as degrading as “my darling” by a complete stranger).

I walked out.

Dr. X tries to reason with Ravi (who is 100% behind my decision) who tells him that we’re done.

I’m in tears by the elevator.

I felt small.  I felt belittled.  I felt rage.  I was devastated that the day I’d been looking forward to had been ruined by a jackass.  I knew that I’d done the right thing, but was also terrified that by walking out I’d missed out on an important piece of information.  I was worried about the baby.  I did not feel safe.

Coming on the heels of Saturday’s tour and my finally coming to terms with the idea of delivering in Singapore, this felt like a far greater setback than it was.  When I got home, I spent the next two hours before my OB appointment alternating between crying jags and searching for flights back home to Boston, where I felt safe.  Where I understood the care I could expect to receive.  Where, although there are certainly asshole doctors, I at least have the option of reporting unprofessional behavior to their hospital.

Yes, there were cultural issues that were being negotiated, perhaps poorly by both of us.  However, I just don’t see any possible excuse for the kind of behavior that went on, cultural differences or not.

Later in the day, I saw my OB, who promised another opportunity with someone who has a better bedside manner.  She said she’d take a look, and things looked good.  The baby’s heartbeat was good, and she saw a few of the vital organs.

We also tried to sneak a peek at the sex of the baby.  The baby wasn’t in an optimal position, and there was no clear view.  Based on what was seen/wasn’t seen, the OB felt 75%-80% sure that the baby is a girl.  However, I’m not entirely convinced and want another look before I start seriously thinking about names and clothes and all of that.

Filed under: medical, Pregnant Expat, Singapore | 17 Comments »

On Saturday, before we did Pink Dot, Ravi and I had a private tour of the maternity stuff at Gleneagles Hospital. Normally they do group tours, but I needed to talk to the NICU nurses and such, so they decided to give us a private tour.

From start to finish I was really impressed by the tour, the staff and the hospital.  In Boston you wouldn’t get a private tour unless you were married to a Red Sox player or maybe if you’re Tom Brady’s wife.  Much less one that lasts 90 minutes.

This is the second hospital I’d toured for maternity reasons in Singapore.  The first was Thomson Hospital, which caters exclusively to pregnant women.  Which is nice, except that they’re not necessarily equipped to handle high risk cases.  The NICU is a super small room with no way to isolate a baby who needs it…if a baby is that sick, they’re moved to KK Women’s and Childrens (assuming there’s room in their NICU).  Obviously we hope that this baby will not need any of the sort of care that Elanor did, but after going through everything with E, I want to make sure that wherever I deliver is up to the challenge of a sick baby.

Most of what I saw was fairly standard.  Birthing room with uncomfortable sleep chair for a partner/friend, check.  Hospital room was nice…they (like most private hospitals) are trying for more of a “hotel” vibe than a hospital vibe (something that BI can’t be accused of….BI is nice, but it’s very much a hospital set up).  There’s a tv and dvd player in every room (which is nice, but I’ll have my laptop assuming I’m THAT bored in the 2 day stay and want to do something other than be on FB).  I asked about a fridge and was told that they could get one, no problem (most likely for a fee, but whatever).

The NICU was large.  Rather than set up for private rooms, it’s one big open room with one private room off to the side should a child be ill enough to need “droplet” precautions (which I’m familiar with as E needed that at one point in her hospital stay).  The nurses were very nice and talked me through visitation procedures, IV procedures (especially as it’s the belief of the Infectious Disease team that E’s illness was caused when a bacteria met one of her wounds from taking out her own IV’s…I’m terrified of them now–for my kids, not so much for me), and so forth.  I’m likely to be on the same floor as the NICU as well, so that would be more conveinent than the two floor journey I made in Boston to get to Ellie.

I also got to look in the window of an OR and talk to an OR nurse about C section procedures.  Asian sizing caused its usual issues when I couldn’t get the XL top over my chest…which for the record, isn’t actually that big and they found me men’s scrubs instead (which did fit, thankfully).

I walked away feeling like while Gleneagles isn’t the rival of a top notch Boston hospital (which has the full funding of Harvard Med or Tufts or whatever behind it), it’s probably the equal to any “good” hospital in the US and better than the more rural hospital I was born in.

The thing that struck me again and again is how fundamentally different Singaporean and US approaches are to birth/post partum.  In the US, the hospital sets the policy and the doctors all follow it.  Here, the hospital doesn’t really have a ton of policies, and it’s largely about your doctor’s policies on immediate breastfeeding, partner involvement in the room, etc.  The most common question I was asked was “who’s your doctor” and then the nurses would answer based on that because every doctor has different policies.  The major benefit, of course, is that you can find a doctor who works with YOUR approach to birthing/post-partum and then go from there instead of being subjected to hospital dictates.  Of course, I probably think it’s more of a positive because it’s working to my benefit in this case.

I still have not made a definitive decision about where I’m giving birth, but I *am* leaning towards Singapore.  I need a little more time to make sure of how I feel, but with the combination of a good doctor and the ability to pay for things I care about like a fridge coupled with a hospital that’s very user friendly (they’re willing to make plenty of accomodations…things like if I have a C section and the baby is ready to go to the room before I am, that they’ll let Ravi take the baby to the room and cuddle him/her, they’re willing to work with me to have my pre-pumped colostrum ready if the baby needs some extra nutrients rather than go straight to formula, etc).

Filed under: medical, Pregnant Expat, Singapore | Leave a Comment »