Interdisciplinary Dialogue

Statistically speaking, when Crohn's Disease patients get pregnant, 1/3 experience a marked improvement in their symptoms, 1/3 stay the same, and 1/3 get worse. Want to guess which category I fall into?

For the first 20 weeks or so of this pregnancy, I enjoyed remarkably and uncharacteristically good health. The day after I congratulated myself on dodging the Crohn's bullet, however, I came out of remission. My G.I. doctor at Penn immediately added a few medications to the arsenal, but in her haste (she was leaving for vacation the day I went to see her), she forgot to write a prescription request for the most important one.

Since I am at the hospital every week for one thing or another, I told my OB doctor (who is quite possibly the nicest person on earth) about the oversight and asked him if he could write me a prescription. Even though the GI and high-risk OB clinics are within spitting distance of one another, my OB said that he would have to "call over" and make sure that I really needed a prescription-strength anti-diarhetic, and wasn't planning on constipating myself "just for fun." While the doctor made the call, I slowly but surely made myself sick by spinning myself around on the swivel chair in his office.

Since my GI doctor was out of town, my OB had to speak with the GI resident on call. I love residents for many reasons, but mostly because they are obsessed with protocol. Since I am too, we usually get along really well.

"This is Dr. X from Maternal Fetal Medicine calling about patient Jana Mathews. She is requesting X medicine and I wanted to clear it with your office before I write a prescription."

The GI resident on the other line clearly was skeptical of my story. I would be too; after all, there is a HUGE black market for constipators. Before he would agree to authorize the prescription, the resident needed to know a little bit more about my specific symptoms.

I answered truthfully. The OB doctor dutifully dictated my answers over the phone to the resident, and as he did, his face turned bright red. It was then that I (and the nurse standing next to me) realized that the OB doctor was not familiar with the vocabulary of the GI clinic and was more than a little embarrassed by it.

As a committed interdisciplinarian (I'm not sure exactly what this is, but in order to make it through graduate school you have to be one of them), I felt that it was my obligation and duty to help two doctors of different fields talk across disciplines and bridge the divide between the uterus and intestines; the organs are neighbors after all and it is a shame that their caregivers aren't better friends.

I sought to remedy the situation by telling my OB doctor that the initial list of symptoms that I gave him was not comprehensive and that I wanted to add a few more. With assistance of the nurse, I listed on a piece of paper all of my favorite phrases contained in the educational pamphlets that are littered around the GI waiting room. Included among the treasures are "fistulating ulcers;" "rectal fissures;" "bloody stool;" "anal contusions;" and "perianal abscess."

My OB was too engrossed in his phone call with the GI resident to notice that the nurse and I were twitching with glee as we watched him verbalize these phrases. It was only after he hung up the phone that the poor doctor began to suspect that I didn't have all of the symptoms that I was claiming.

"What is this?" the doctor asked me accusingly, pointing at my GI vocab list.
I turned into a thirteen year-old boy. "I don't know," I responded.
"Here's your prescription, Mrs. Mathews," the doctor said, and flung a piece of paper at me. "See you next week."
"It's Dr. Mathews," I corrected him.

Sometimes I hear voices, but this time I'm pretty sure that I really did hear the good doctor mutter "whatever" under his breath after I rounded the corner.

P.S. Lest you think that my OB and I are not on good terms, I want to clarify that we are. He called me this morning to give me some lab results and and said he would think seriously about my suggestion of organizing a symposium or conference aimed at promoting "interdisciplinary collaboration" between the GI and OB departments at Penn. I asked if I could be the keynote speaker and he said that he would have to think about it, but probably not.