A letter

There's a particular kind of quiet that happens when a woman decides not to ask her second question.

The emergency department, over and over. A woman would tell me the thing she came in for. Sometimes she'd add a second, smaller one, almost apologising for it. Almost never a third. And in the chair beside the exam table there'd be a husband, or a mother, or a friend, prompting her — working down a list she wouldn't read out herself. She'd wave it off. No, no, he's busy. Not because she thought the rest of it didn't matter. Because that was what she was used to.

I trained to do this work properly, and for a long time I did it the way it is usually done.

I trained at the University of Oklahoma, medical school and residency both, and worked with the hospitalist group throughout. Four years of residency and nearly four since — all of it hospital-employed, all of it obstetrics, which is how I came to be in the emergency department so often. At least twenty deliveries a month, usually more. Which means I have delivered a great many babies for women I met that night.

thrē is smaller on purpose. Four hundred people, a day that isn't overbooked, and the same face every time you come in. None of that is innovative. It's just what the work looks like when nothing else is pulling at it.

What I will miss is the particular satisfaction of a hard night going right. You are the only doctor there, it asks more of you than you thought you had, and you find a way, and it works — and you can be unrushed with her, for once, and leave the room glad of what you gave. I don't think this practice can reproduce that. Something has to be going wrong for a night like that to exist, and I have built a place where the entire point is that nothing is.

I grew up in a house of women, so the room always felt familiar. I came close to trauma surgery and stepped away — the losses there sat heavier on me than I could carry well. And my wife pointed out that I had never been happier on any rotation than this one. I'm glad I listened to her.

I can't promise you outcomes. Nobody honest can. What I can promise is that when you sit down, I will not be somewhere else — and that you'll get through every question you wrote down.

A Sunday here is a long walk with Suki, a cappuccino I am always too impatient to let cool and always burn my tongue on, pancakes I slightly burn as well, and children who are not fully dressed until two in the afternoon.