It's hard to resist a book whose protagonist opens with the line, "I am going to make this medical student cry."
Written from the perspective of a jaded senior resident in obstetrics/gynecology, "" is billed as fiction but contains quite a bit of truth taken from her training, co-author , an obstetrician/gynecologist in northern Florida, told 番茄社区.
Take the scene in which a resident who develops complications from her own pregnancy is targeted by colleagues who believe she is trying to get out of work. True, said Stoddard. "I haven't spoken with my former co-residents since."
The scene in which an attending hurriedly leaves part of a placenta inside a patient so he can be on time to a Broadway show? "Absolutely not representative of my colleagues!" Stoddard said.
Pseudonymous co-author is also known for her "fiction" about the grueling medical training process. Her first book, "," is loosely based on her first month of intern year with a masochistic senior resident.
番茄社区 talked to Stoddard about her motivations for writing about the grittier aspects of medical training and exactly where she drew the line between fiction and reality.
MPT: Why did you decide this was a story you wanted to tell?
Stoddard: I love to write, I love my field, and embrace the opportunity to intertwine those worlds whenever possible.
I think for this book, the stage in training was key. Sort of a "not a girl, not yet a woman" stage. In residency, you start out as an intern, knowing very little about how the real world works in practice. As a senior, you are focusing on your future, looking for a post-residency job, and you should know how things are done and have the tools you need to practice on your own. In the intervening 2 years, an enormous learning curve is foisted upon you -- you have to undergo an extreme transformation from ignorant newbie to confident, competent, and independent practitioner. Scary, and pretty darn compelling stuff.
MPT: And why was fiction the way to go?
Stoddard: Fiction writing in the medical field is far less ethically complicated, although no less compelling. It allows one to draw on real-life experiences and then embellish or alter the outcomes for dramatic or desired effects.
MPT: You're a practicing obstetrician/gynecologist. I have to ask: how much of this book is true to your experiences?
Stoddard: This was my primary role in co-writing this book with Freida -- keeping the novel as close to true to life ob/gyn experience as possible. Now, of course, certain aspects have been exaggerated for entertainment purposes, and certain things like the attending that compromises a patient's care so that he can get to a previous engagement is absolutely not representative of my colleagues!
However, it is important to remember that physicians are also regular people that can make the wrong choices and have the pressures of everyday life on them, like everyone else. They are not just surgery-performing, question-answering, live-at-the-hospital automatons that some people believe they are.
MPT: As you mentioned, there's a point in the book where an attending's behavior puts a patient in a dangerous situation. In response, the residency administration puts intense pressure on the residents to keep the incident discreet. How real is that type of tension between attendings and residents?
Stoddard: I finished residency in 2005, so it has been a while. But yes, there are tensions between residents and attendings. Some are small, and occasionally there are some severe issues.
In many programs, you learn from several different attendings, as well as from your books. If you are progressing, you take what you learn and make it your own. There are times when what you feel is the best plan as a resident will not be your attending's plan for your patient. Since your attending is the patient's physician ultimately responsible for their care, you should defer.
There are, of course, fail-safes in place if one feels as if patient safety is compromised. Then it can be reported and remedied. But most of the time it is just different approaches to the same problem.
MPT: There's also a point in the book where a pregnant resident who needs to work fewer hours is targeted by her colleagues who have to work three times as much as she does. Is there a stigma to being pregnant while in residency?
Stoddard: This is actually loosely based on my own personal experience in residency. When I developed pregnancy complications (pre-term contractions) and was recommended fewer work hours by my physician and attending, my senior resident actually called the attending and questioned her clinical decision!
This made [the senior resident] so upset she completely took me out of work until a certain point and then returned me back to "1/2 time" at 40 hours a week at 36 weeks. I was made a complete pariah in my residency. They acted like I did it on purpose to "get out of work." I was a very hard worker in residency and not a slacker at all. My so-called friends in my residency actually canceled my baby shower when I was out of work because they "wouldn't want me to go into labor."
I was devastated and so depressed. I could not believe how unsupportive my co-residents and so-called friends were. Fortunately for me, after a bout with pre-eclampsia, my baby was born term, healthy, and happy. She is now 11. I haven't spoken with my former co-residents since.
MPT: Wow. It must be ironic when it's an ob/gyn residency.
Stoddard: I found it incredibly ironic in some ways but not in others. This profession burns you out. No one likes for their workload to increase, and in our program there were only three residents per year. When you are already working 80 hours a week, even a little bit more work can really push you over the edge. (Obviously.)
MPT: You collaborated with the pseudonymous Freida McFadden for this book. She has a popular blog poking fun of the personalities in medicine, and this will be her third book to do the same. How did you meet, and how was the joint writing process?
Stoddard: Freida and I both wrote for a blog called , and I blogged for a time at under the pseudonym of Dr. Whoo.
She had already written "" and had been somewhat inspired by the stories on my blog to write about ob/gyn residency. Thus, "Baby City" was born. Truly, my contribution is very second fiddle -- mostly technical consultant, nuts and bolts, bread and butter ob/gyn scenarios, and medicine. Freida is the creative one that weaves the story and brings the characters to life around the framework of a medical setting.
MPT: It's hard to miss "" vibe from your writing. There's a focus on the stresses of those in training, their relationships, and the sometimes unsavory attitudes towards peers and patients. Was your writing influenced by any particular authors or stories?
Stoddard: Anyone who goes through medical training and does not develop a modicum of "House of God" perspective is a better person than I! When you are so tired and burnt out, you get to the point in your job where your patients are a barrier to your basic human needs: food, sleep, even going to the bathroom, and, yes, you start to really, really resent them for it. If you are lucky, you get through it and find a job where you can find a better life/work balance and start to care again. Compassion fatigue is real. I can't say that my writing style is cognizantly influenced by anyone, but I love to read, so Crichton, Koontz, Cornwell, Patterson, to name just a few off the top of my brain.
MPT: What were your own best and worst moments during residency?
Stoddard: Some of the best moments in residency came from learning my path, doing my first c-section, delivering my first set of twins, doing a complicated breech delivery that came in from an outlying midwife that didn't know the baby was breech until the baby crowned(!), learning how to do hysterectomies, and following a patient from the beginning to the end of her pregnancy. The very best part was when it was over!
The worst moments -- definitely the situation outlined above. It showed me a side of my colleagues I don't think I would have ever seen otherwise. A real eye-opening experience.