Assume the Position: Memoirs of an Obstetrician Gynecologist by Richard Houck MD Page A
Authors: Richard Houck MD
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syndrome baby before so I missed the diagnosis completely but had I made the diagnosis I would not have done anything differently. He put a name card on the baby’s bassinet and called it ‘baby Rick’ Smith, named by him after me. Each day on rounds for the next month he would begin the presentation of baby Smith with the same comment. “Rick saved this Mongol for the world”. And I did. He went home one month later.
The training program at Pennsylvania Hospital in general was excellent. Our Chief of Service, nationally renowned, had the highest standards and expected the same of each one of us. Every morning at 7:30 AM was ‘Morning Report,’ where all residents would gather and sit in silence as the Chief Resident of Obstetrics would discuss the statistics for births the prior day, indications for each Cesarean Section which had been performed, whether on the resident (public patients) or private (insured) attending physician service. The Chief Resident would usually come in around 6 am each day to get this information and review all the pertinent charts. Morning report was a learning experience for the whole resident staff, but no one other than the Chief Residents and the Chief of Service could speak. Among other things we would learn when Cesarean sections should, and should not, be done. The Chief Resident on the Gynecology service would present all cases scheduled for surgery in the operating room that day. If in the opinion of the Chief of Service a case had not been evaluated or selected properly for surgery the Chief of Service would just cancel the case and send the patient back to the clinic for further evaluation, even if the patient was in the pre op holding area. Often times the surgery was cancelled for something simple like not knowing what the patient’s blood count was before surgery; or an adequate medical trial of therapy hadn’t been tried before surgery was entertained, or the indications for the procedure were inadequate. Peer review happened every day under the Chief’s tutelage that served me well for my future endeavors. He set an example for us as to how correct medicine should be practiced. Nothing else was acceptable. It just became part of my mindset.
One night in the middle of the night I was performing a particularly difficult forceps delivery and rotation of the fetal head while still in the birth canal. I heard someone breathing over my shoulder. I looked around and there was the Chief of service who had appeared out of nowhere, inquiring if I had met all indications for applications of the forceps, why I was using this particular forceps as opposed to another. He checked the application of the forceps to the baby’s head himself, and then permitted me to continue as he watched the whole delivery, then quietly left the room, what I took to be silent approval. For me, I felt a sense of accomplishment and satisfaction that I had been silently observed, and passed with flying colors.
Multiple births were common at Pennsylvania hospital, particularly because there were world-renowned infertility specialists on staff. During one 48-hour period I had occasion as Chief resident to deliver triplets and sextuplets. The triplets were known and expected. The sextuplets were not. The mom had severe preeclampsia, a pregnancy induced syndrome that increased risk for both mother and baby, heading towards eclampsia with life threatening seizures and hypertension. We were trying to extract every hour possible out of her before delivering what we thought were her premature twins. It was a fine balance. When one baby suddenly died in utero and her blood pressure shot way up we had no choice but to proceed to immediate Cesarean Section, thinking we were going to get one dead and one living baby. Ultrasound was in its very infancy in 1977 such that the staff and residents were just learning how to use it and interpret
The training program at Pennsylvania Hospital in general was excellent. Our Chief of Service, nationally renowned, had the highest standards and expected the same of each one of us. Every morning at 7:30 AM was ‘Morning Report,’ where all residents would gather and sit in silence as the Chief Resident of Obstetrics would discuss the statistics for births the prior day, indications for each Cesarean Section which had been performed, whether on the resident (public patients) or private (insured) attending physician service. The Chief Resident would usually come in around 6 am each day to get this information and review all the pertinent charts. Morning report was a learning experience for the whole resident staff, but no one other than the Chief Residents and the Chief of Service could speak. Among other things we would learn when Cesarean sections should, and should not, be done. The Chief Resident on the Gynecology service would present all cases scheduled for surgery in the operating room that day. If in the opinion of the Chief of Service a case had not been evaluated or selected properly for surgery the Chief of Service would just cancel the case and send the patient back to the clinic for further evaluation, even if the patient was in the pre op holding area. Often times the surgery was cancelled for something simple like not knowing what the patient’s blood count was before surgery; or an adequate medical trial of therapy hadn’t been tried before surgery was entertained, or the indications for the procedure were inadequate. Peer review happened every day under the Chief’s tutelage that served me well for my future endeavors. He set an example for us as to how correct medicine should be practiced. Nothing else was acceptable. It just became part of my mindset.
One night in the middle of the night I was performing a particularly difficult forceps delivery and rotation of the fetal head while still in the birth canal. I heard someone breathing over my shoulder. I looked around and there was the Chief of service who had appeared out of nowhere, inquiring if I had met all indications for applications of the forceps, why I was using this particular forceps as opposed to another. He checked the application of the forceps to the baby’s head himself, and then permitted me to continue as he watched the whole delivery, then quietly left the room, what I took to be silent approval. For me, I felt a sense of accomplishment and satisfaction that I had been silently observed, and passed with flying colors.
Multiple births were common at Pennsylvania hospital, particularly because there were world-renowned infertility specialists on staff. During one 48-hour period I had occasion as Chief resident to deliver triplets and sextuplets. The triplets were known and expected. The sextuplets were not. The mom had severe preeclampsia, a pregnancy induced syndrome that increased risk for both mother and baby, heading towards eclampsia with life threatening seizures and hypertension. We were trying to extract every hour possible out of her before delivering what we thought were her premature twins. It was a fine balance. When one baby suddenly died in utero and her blood pressure shot way up we had no choice but to proceed to immediate Cesarean Section, thinking we were going to get one dead and one living baby. Ultrasound was in its very infancy in 1977 such that the staff and residents were just learning how to use it and interpret
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