Friday, May 17, 2013

Being the Biggest Person

It probably would surprise most people to know that there are very few actual rules in medicine.  Being a doctor is a whole lot more art than science.  But still, there are a few rules, which often seem quite arbitrary but are actually based on science.

Today I was trying to decide on when to induce one of my patients, and I was struck by a dilemma resulting from one of those rules.  We followed some rules and settled months ago on May 30 for this patient's due date (OK, so maybe this story is about two rules).  She and I both want to induce her labor because she lives quite far from the hospital and is worried about delivering on the side of the road, but this kind of induction is essentially elective, which means that we can only do it a week before her due date.  This rule is one of the biggies.  Choose to deliver a baby too early, and you risk delivering one who isn't ready to breathe on its own, among other things.  Frustratingly, I am on call the day before we are clear to induce her and then have a  lot going on the rest of the week, so for convenience reasons, I would really like to fudge things a bit.  In fact, the patient and her husband both thought her due date was the 29th.  Oh, how I wish that were written in her chart!

Here's where it gets even stickier: I am the sole OB/GYN on a committee that reviews cases at our hospital.  Recently several cases came up for review for patients who were electively delivered a day or two before the 39-week mark.  All of my colleagues on the committee were irritated: how much difference could one or two days make?  I found myself defending my department and my specialty.  Yes, a day or two probably doesn't make a difference most of the time, but we've got to draw the line somewhere; it's a slippery slope between one or two days and four or five days or more, and there are few errors worse than delivering a baby who isn't ready for life on the outside without a really good reason.

As thoughts about fudging things entered my mind, I thought back to my role on the committee and my whole-hearted belief that people need to stick to the rules.  Most rules are there for a reason.  And so, with a somewhat heavy heart, I stuck with the patient's established due date and scheduled her induction for a day that is super inconvenient for me.

As a mother of an almost-two-year-old, I find myself internally debating this same issue all the time.  We set rules for our kids for one reason or another--I generally try to limit myself to those with a real purpose--but often enforcing them becomes a burden.  Just this evening, I was trying to get Asher to help me feed the dog, which is one of his "chores," and he was totally unreceptive.  I was too tired to fight that battle any longer and decided to do it alone.  His father was annoyed that I had caved like that, and I knew he was right.  Kids need us to be consistent with our rules.

Now that I have some time to contemplate my day, I have a couple of thoughts.

The first is that as parents we need to be the biggest person by setting a good example for our children.  This includes sticking to our own rules.  At work, that means not breaking a rule just because we know it doesn't really make a difference.  At home that means being consistent with our rules for our children and the consequences of breaking them.  It also means living by certain principles ourselves.  If you don't want your kid eating junk food, you need to stop eating all those cookies and chips and learn to love your veggies.

The second thought is that none of us is perfect.  I feel somewhat guilty for even having thoughts about breaking the rules at work, and I feel even worse that I let Asher slack off on his chores tonight.  In both cases, the offense is miniscule, but the slippery slope lies ahead.   Consistency with rules, which sometimes means being the bad guy, is my weakest point as a parent.  I always feel the pull to be lenient "just this once," but how many "just this once" incidents are too many?  I will always have days when I just can't summon the energy to fight the battle, but hopefully by reminding myself of the importance of consistency, I will be more mindful, and the battle won't seem quite so challenging.

Doing the right thing can be a challenge, but as parents, it is our duty.  The great thing about parenthood is the opportunity to grow along with our children.

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