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Click here to order the 2010 Physician Directory
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Marin Medicine
By Colleen Foy Sterling, MD
 Birth Day, by Mark Sloan, MD, 384 pages, Ballantine, $25. Birth Day: A Pediatrician Explores the Science, the History, and the Wonder of Childbirth is difficult to categorize despite its clear subtitle. It is, simply put, a great book, but it could be shelved almost anywhere in a bookstore, making it hard to locate. I hope physicians will avoid this pitfall by ripping out this page and taking it directly to your favorite local bookstore and asking where Birth Day is located, be it in the “Parenting and Childbirth” section, or “History,” or “Memoirs.” Find this book you must, for it will enlighten you and make you smile at the same time. Birth Day is by Mark Sloan, MD, a pediatrician at Kaiser Santa Rosa with over 30 years of experience in his field, including attending more than 3,000 births. With its title and endearing cover with tiny baby feet, Birth Day may look and sound like a book for people expecting babies, but it is also precisely for physicians. On one level, it is a memoir of a long medical career. Mark’s memoir begins with his obstetrics rotation as a third-year medical student at the University of Illinois in Chicago. The rotation, although staggeringly revealing and intense, actually steered him away from assisting with the process of birth and toward waiting in the wings to accept the pass, as the on-call pediatrician, to assess and resuscitate the newly birthed. What better place to observe the process of birth, with mind clear and hands waiting? The opening chapter, titled “Twenty Babies,” is amusing and exciting, and at the same time answers the question, “Why should we listen to this guy anyway?” The premise of the book is set here. Mark recalls these births as he experienced them, at a stage of his own lifecycle that he describes as “hardly more than a baby myself.” He is a baby, innocent and ignorant, at the beginning of his training, an overwhelmed medical student on his first OB rotation. In a later chapter, “An Alternate Route,” Mark becomes a new father himself and muses on the ease with which his son is born by cesarean to his wife Elisabeth, the miracle that this is, and the history of cesarean birth (including germ theory, perinatal death, and a mysterious cross-dresser who played a major role in developing the cesarean section as we know it today). Mark and I both work for Kaiser Santa Rosa, yet I do not know him well. Pediatricians and family physicians are separated by campus location, so I was surprised to run into him one day during the fall of 2007 at the coffee cart near my office on Bicentennial Way. He told me he was taking time off to write a book that he had been thinking about for some time. He had been working with a writing group, and had already written for several newspapers and journals, including Sonoma Medicine. He approached the writing of this book like a scientist, gathering data, thinking about what he wanted. He did his market research and discovered that very little had been written by physicians about the history of birth in the Western world. Most books with pediatrician authors were “advice books” à la Barry Brazelton, and most of the birth books were guides written by midwives. The memoirs were written by mothers. But there was nothing out there quite like what Mark was proposing: a book in which “a pediatrician explores the science, the history and the wonder of childbirth.” The scientific approach worked. Mark sent out a dozen book proposals and received five acceptances. “I have been told my case is definitely atypical,” he recently recalled. About the time I ran into him at the coffee cart, he took two months unpaid leave. I think it is hard for physicians to imagine taking time off like this, and I asked him later how he did it. What were the steps he took to make time for this project? He answered, “It was the first time I did not have a daily schedule, I think in my life. I would get up early around 5:30 (I’m a morning person) and start working, then get the kids to school, and then would go to A’Roma Roasters [a coffee shop in Santa Rosa] and write for a while, and then to the JC library to do research. I would come home and edit a lot. My evenings were for my family. The key was that I created a rhythm of writing, and after two months, I went back to work, but I was able to keep a similar rhythm.” By March 2008 he had finished the book, and then even more amazingly, “I sent my manuscript in to my editor, and I did not receive anything back from her. I kept waiting for the other shoe to drop. Finally I received my manuscript back.” “Was it covered with red ink?” I asked. “No, faint pencil marks, actually. The executive editor of Ballantine Books asked for one paragraph to be removed.” In each chapter of his book/memoir, Mark segues into bits of fascinating history and biology. Some of it is stuff we learned in medical school, but at a level of detail and frankly beautiful writing, that brings it to life. I would often read Mark’s book at lunch, outside by the fountain, and laugh, and then gasp in admiration and surprise. It really is a miracle that we survive birth, not just as babies, but as mothers and parents. This excerpt from the opening chapter almost made me snort my sandwich out of my nose: Things had not started well, in addition to Tonya’s delivery and the Chicken Little thing, I was something of a klutz in that first week or two. One night I tripped on a bedrail and ripped a phone out of the wall as I went down, waking the dozen women sleeping on one wing of the postpartum ward. Later that same night, I destroyed the blood samples I had painstakingly collected from them when I failed to secure the tiny sample tubes properly in the lab centrifuge. Five minutes later I opened the lid to find a paste of blood and pulverized glass splattered all over the inside of the machine. A centrifuge, I learned, is not an easy thing to clean. I have to admit that I cried when I read the heartbreaking chapter “The First Five Minutes.” With my heart, soul and cerebrum thus squishy with sentiment, my intellect literally sucked up the tandem information blithely tucked in with the baby blanket, so to speak, about the absolutely amazing microbiological and physiological transition from fetus to baby that occurs within the first few moments of birth. How I read and reread that same information from textbooks during medical school! I spent weeks watching the internal development of a chick fetus under a microscope, drawing each day with colored pencils in my lab notebook for my developmental physiology course. Mark captures all of that here, intermingled with the dramatic personal story of baby Sean O’Connor. The science and the historical facts just slide into your awareness without a struggle, with a smile of awe and recognition. Why couldn’t Mark’s book have been around when I was studying this stuff with absolutely nothing to hang it on? While reading Birth Day, I coincidentally started to receive an onslaught of “cc’d charts” in our electronic medical record system regarding a pregnant patient of mine. The ultrasound suggested some fetal developmental abnormalities. We strive for continuity of care in family medicine, but with the fractionation of the actual patient experience, we have less connection with patients who are in difficult circumstances. One specialist does the ultrasound, another delivers the news, another delivers the baby, a pediatrician attends the birth and resuscitates the child, who then is immediately referred to subspecialists in “the city.” Because of my experience with Mark’s book, I suddenly reverberated with the need for continuity of care. I was like those people on the TV allergy commercials who have a foggy film lifted from their lives. As I scanned the various reports of this family’s child, the anguish and insecurity they were most assuredly experiencing became almost painfully obvious. I picked up the phone and called the mother to check in before I had even met the baby at the first newborn visit, probably for the first time since I had started at Kaiser, and the mom’s relief and comfort literally hummed through the phone line. My experience is just one of many reasons that physicians will find Birth Day valuable. Mark is one of us, and he has published an excellent book. He is a role model, even if, in his own words, he is “not a typical case.” Reprinted from Sonoma Medicine by permission of the Sonoma County Medical Association. E-mail: foysterling@comcast.net Dr. Foy Sterling is a family physician in La Clinica Santa Rosa at Kaiser Santa Rosa. |
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