The Ditchdigger's Daughters

by Dr. Yvonne S. Thornton

  “You ready to get up?” Daddy demanded, looming over Alfred as he writhed on the ground. “No? Then I got only one thing to say to you: don’t you ever steal from me again. And just to make sure you don’t, I’m throwin’ you and your things outta my house.”

  It was the first and only time Daddy used his fists rather than his mind to best someone else.

  Daddy hated to talk about Alfred after the boy was gone, but once when we were sitting at the roundtable having a cup of coffee together, he admitted: “Maybe God was trying to tell me something when he sent me all girls because if Tass and I had had a son, he would probably have ended up just like Alfred. That would have been my own son I hit out there because I wouldn’t have been strict with him like I was with you girls and he would’ve gone bad.” Daddy took a long reflective sip of his coffee and sighed. “I blew it. I wanted a son so bad, I really blew it.”

  It was a lesson in how to raise children that I took very seriously. If I’d been inclined to spoil Woody and Kimmie—and I was tempted to because I loved them so dearly—I had only to compare how we girls had turned out with the mess Alfred was making of his life to realize that the way to express love is not by giving children whatever they want but by giving them values and structure and lively explanations of the difference between needs and wants. When one of our children really needs something, Shearwood and I do everything we can to provide it. But when the material thing is merely wanted, then we consider it is time for a clear talk about purposes and meaning.

  But all that was still in the future because Kimmie had just been born. I had told Dr. Knab that, with the baby due June 7, I would be back to work when my vacation was up at the end of June. However, with Kimmie having waited so long in the wings, I decided to take the full six weeks’’ maternity leave the military allows and use the extra time to study for my last hurdle: the oral examination and defense of my thesis that was to take place in Chicago in December. After I reported back to duty in August, Dr. Knab put me on-call immediately, but whenever I had an evening off, Shearwood baby-sat so I could study.

  Because the military paid the board-certification fees, I traveled to Chicago in uniform, which fortunately fit nicely again because I’d eaten carefully while pregnant, not wanting to gain sixty pounds as I had with Woody. Actually, on a Weight Watchers diet, I had gained exactly three-quarters of a pound, and that plus another twenty dropped off soon after Kimmie was born. Flying to Chicago, I felt trim and confident I wasn’t pregnant, I didn’t have the flu. The only worry I had concerned which examiners I would get because the grapevine had it that there was one examiner who was exceedingly tough, another who never passed anybody, and a third who was only interested in esoterica.

  When I was introduced to the panel, I recognized the name of one examiner to be that of the tough fellow, but I had escaped the other two, which I was glad of. The tough one proved to be fair as the panel posed such problems as: “Give the mechanism of calcium metabolism in a hyperparathyroid mother. Tell how you would treat her.” The trick, I knew, was to discuss the case dynamically, talking to the examiners as I would to an attending physician when I was called in as a consultant on a case.

  When I had done that, the tough examiner went on to question me about my thesis: “This part here, what methods did you employ for your statistical analysis? How did you analyze these data? How did you arrive at that?” When he was satisfied that I really had done the work and written the thesis, not had someone else do it for me, he returned to case problems.

  “Your next patient comes in with a family history of Tay-Sachs disease. Her cousin has Tay-Sachs disease and her husband is a carrier. How do you counsel her about her risk of having a child with the disease?” I constructed a family pedigree, went through all the calculations, and he nodded, satisfied.

  The next question concerned the mechanism of drugs that cause birth defects in humans, with specific reference to thalidomide. After discussing at which point during a pregnancy the drug has to be ingested for it to cause birth defects specifically, twenty-one to forty days after conception—I referred to the fact that testing of the drug on laboratory rats had shown no adverse effects because thalidomide itself is not toxic; rather, the drug is converted in the liver to a chemical derivative called an arene oxide metabolite, and that is what causes the damage. This conversion, I said, takes place only in the livers of humans, rabbits, and monkeys, not in rats, which is why the problems with thalidomide had not been detected sooner.

  “Is that right?” the tough examiner said with some surprise.

  “Yes, it is, sir.”

  “Well, then, I’ve learned something.” He was extremely polite and thanked me as I left the examination room.

  Weeks later a guest lecturer speaking at the National Naval Medical Center remarked to Dr. Knab in front of all the attendings, “Hey, Doug, they tell me that one of your staff was terrific on the orals. The examiners couldn’t remember when they’d seen such a knowledgeable candidate.”

  “Oh, that must have been Bill O’Brien.” O’Brien was Dr. Knab’s fair-haired boy.

  “No, it was a woman, a Dr. Thornton.”

  Dr. Knab glared at him, ready to spit tacks because the visitor had mentioned this in front of the assembled staff. He had probably done it thinking that my performance was a credit to Dr. Knab, but Knab wanted no reflected glory from me, any more than he wished praise to come to me.

  I was double board-certified now, a specialist in obstetrics and gynecology with a subspecialty in maternal-fetal medicine, the first woman of my race to pass the boards in maternal-fetal medicine. I felt that I had paid my dues, and I had complete confidence in my skills and knowledge. People might not like me as a black woman but they had to respect my expertise. They had to listen when they came up against a problem and I, asked my advice, said, “This is what must be done.”

  All my life people have prejudged me. Before I open my mouth, they tell themselves that I should be in somebody’s kitchen doing the cooking and the cleaning. Since I know that I am very different from the person people assume I am based on my looks, I always wonder if that person I’m meeting might also look one way but be quite another, so I try not to make up my mind about a new acquaintance too quickly. I follow Daddy’s technique, which he said was to “throw out something and see how they respond.” If, for instance, someone says to me, “What do you think of women in medicine?” I answer noncommittally, ‘‘You know, they’re working hard,” and wait for the other person to reveal himself by the opinion he may then go on to express. Or, to take a specific example, when I was in medical school, I asked one fellow what he thought about a woman’s keeping her own name after she married. “Oh, no,” he said. “Any woman who marries me is going to have to take my name.” Shearwood’s answer to the same question was, “I think she should. Her parents have put a lot of time in on her.” The contrasting answers told me almost everything I needed to know about the two men.

  This way of being noncommittal until the other person reveals himself has stood me in good stead in the male-dominated medical profession. A woman physician needs to protect herself because many men deliberately try to make her look bad. I honestly believe that I have had more problems because I’m a woman than because I’m black. Male doctors would rather deal with a black male than with a woman of any color. If they have an antipathy toward blacks, they tend to keep their feelings well concealed because they know blacks have been oppressed and they are sympathetic, but it is somehow socially acceptable to be scornful of women.

  Male or female, an obstetrician, particularly one in private practice, needs stamina, the ability to just plain keep going through the long hours until the baby is delivered. It can be trial by fire, and you have to dig down deep into your reserves of strength and endurance. Oddly enough, the time when I had to dig deepest came not in civilian life but in the military where, theoretically, there should be quite enough staff on hand to help out. But one time there wasn’t, and I went fif
ty-two hours without sleep.

  A call came in from the naval base at Beaufort, South Carolina, that one of the two obstetricians on the base was out with appendicitis and they needed the loan of an obstetrician to cover for him. The base was next to the marine training center at Parris Island, which was under the umbrella of the Navy, and I quickly gained the impression that Parris Island was a rabbit hutch, so numerous were the pregnant wives. It was February 1981, Kimmie was seven months old, when I was ordered down there to help out. When people heard where I was going, they told me to take my tennis racket along because the beautiful resort of Hilton Head was nearby.

  “Sounds great,” said I, and threw my suitcase and racquet in the trunk of the car and started out. A day later, when I pulled into the hospital parking lot in South Carolina, a nurse came running to the car. “We thought you’d never get here! Are you Dr. Thornton? Oh, please, God, you’ve got to be Dr. Thornton!”

  “I am indeed,” I said as she pulled at me to drag me from the car. “What’s going on here?”

  “We’ve got a patient ready to deliver and there’s no obstetrician!”

  “How come? I was told there was a Dr. Peterson here.”

  “He fell out of a tree and broke his arm.”

  “What!”

  “The cat went up a tree. His daughter went up after the cat. He went up after his daughter. His daughter and the cat got down all right, but he fell out of the tree and broke his arm. Oh, please hurry!”

  I didn’t stop to take my suitcase from the car, just raced into the hospital after the nurse and delivered the baby. And another baby. And another. I did a forceps delivery. I did C-sections. I manned the clinic, the Emergency Room, and the operating room. Day became night. Night became day. I can’t remember eating or going to the bathroom. After forty-eight hours I was moving in a surrealistic world, putting one foot in from of the other as though I were walking underwater. “I can’t function,” I finally said. “This is no good for the patients. Get me a telephone.” I called Dr. Knab.

  “Where’s Dr. Peterson?” he demanded.

  “He fell out of a tree. I’m here alone and these marine wives are having babies like you wouldn’t believe.”

  “Why didn’t you call me sooner?”

  “Sooner? I couldn’t even get to the bathroom, let alone to a phone.”

  “Oh, Yvonne…” For the first time, I detected a human warmth in his voice, as though he might just have been concerned about me. “I’ll call Charleston,” he said. “They’ll have to send somebody there immediately.”

  At the fiftieth hour a nurse hauled me into the delivery room. “The mother’s fully dilated but the baby’s head won’t come down.” The patient’s feet were in the stirrups, her knees up. As I moved toward her, the baby’s head popped out. It was enormous. I started to say, “If this is the head, imagine what the shoulders are like,” when I saw the baby’s head begin to turn blue. His head was wedged; the circulation to it was being cut off. Even though I’d witnessed the situation only once before, I recognized the problem immediately—shoulder dystocia. I had observed it as a resident when I was assisting an attending physician who went crazy trying to get the baby out before it strangled to death. That’s what happens: the head is out but the shoulder is wedged, and before you can free it, the baby dies.

  “Get me a pair of scissors!” I yelled at the nurse. I did an instant large episiotomy, cutting all the way down into the rectum and opening it up so I could try to maneuver the baby’s shoulders. The mother’s knees were flexed near her shoulders. I was attempting to corkscrew the baby’s head with my hand. The nurses were on the mother’s lower abdomen pushing, pushing, pushing, trying to press the baby’s shoulders out from under the pubic bone where they were hooked. The mother was fully conscious and I was shouting at her, “Push! Push!”

  Suddenly the baby came free. It was out. It started to cry. It was alive! I looked to the heavens and breathed, “Thank you, Jesus.” A living baby. A ten-pound, twelve-ounce baby. Now I had to make repairs to the poor mother. Just as I finished stitching her up, the obstetrician sent from Charleston arrived and someone led me to a bed. I collapsed and slept for twenty-four hours. The new doctor began calling after fifteen hours because by then he felt he had to have help, but I didn’t even hear the phone ring. Eventually, he became so worried that he sent a nurse down to see if I could be roused.

  He and I were the only obstetricians on duty for the next two weeks, and I never set foot outside the hospital. Someone fetched my suitcase from the car, but the tennis racquet stayed in the trunk and to this day I have never laid eyes on Hilton Head.

  This episode and another made me argue with Shearwood against reenlisting when our three-year tour of duty was drawing to a close. The tune in the department had changed considerably by then. Now it was: “Dr. Thornton, everybody loves you. You’re such a marvelous obstetrician, such a caring doctor. You can’t leave us now.” Oh, yes, I can, if the Navy is threatening to send me to the Persian Gulf.

  The hostage crisis was on in Iran, and I received word that I had been assigned to the Surgery II team. “But I’m an obstetrician,” I protested.

  “Doesn’t matter. You’re a surgeon, and we can teach you gut surgery in twenty-four hours.”

  “I don’t want to do gut surgery, and I’ve got two little children.”

  “Sorry. Surgery I team is over there now on a hospital ship, and Surgery II is the backup.”

  That night I fumed at Shearwood, “Why don’t they take you?” “I suppose because I went to Okinawa.”

  ‘‘You weren’t being shot at in Okinawa! You weren’t on a ship that could get bombed!”

  Luckily the hostages were released, things quieted down in the Middle East, and I didn’t have to learn gut surgery. But I no longer wanted to be in a position where a snap of the fingers could send me thousands of miles across the world from my children. “Okay,” Shearwood agreed, “we’re outta here,” and we wrote letters resigning our commissions, giving as the explanation that “the vicissitudes of military life do not permit us to provide a stable environment for our children.”

  Our resignations were accepted, but everyone predicted, ‘‘You’ll be back because it’s tough out there in civilian life.” I was well aware that it is difficult to establish a private practice, particularly if you’re black and not part of an old-boy network that will refer patients to you. You’re beating the bushes, you’re taking Medicaid patients, you’re doing anything to get a patient in your office who will pay even a few dollars. And if you’re an obstetrician, you’re working all hours. You tell your child, “Of course, I’ll come to see you in the school play, dear,” only to have to say later, “Gee, honey, I’m sorry but I had a delivery.” That was one reason I had taken so much advanced training: so that my expertise would qualify me to serve as a consultant in an academic setting where I would have a base salary and relatively regular hours and wouldn’t have to neglect my children.

  One of the places I applied when I knew we would be leaving the military was The New York Hospital/Cornell Medical Center in New York City. I sent them my curriculum vitae, which was an absolutely neutral document as far as my race was concerned—I didn’t attend Howard or Meharry; I wasn’t a member of the National Medical Association—and when the people at Cornell called my former professors and mentors at Columbia and Roosevelt for references, no one apparently thought to mention that I was black, only that I was a hard worker and a good one. Dr. Roy Petrie at Columbia teased me by telling me: “I had this guy from Cornell really drilling me about you so I told him you were a terrible person and hated your patients.”

  Whatever he told the people at Cornell, it was enough to persuade them to hire me sight unseen, and when I showed up, they were dumbfounded. As a member of a minority, you become adept at reading nonverbal communication: the slackness around the mouth that indicates the jaw is on the verge of dropping, the furrow between the brows, the tilt of the body as though the person is
instinctively about to back away. Then comes the hesitant question: “Are you … Dr. Thornton?”

  “Yes,” I said to the department head at Cornell, “I’m Dr. Thornton. Is there a problem?”

  “Oh, no. No, there’s no problem. Well, there is the problem that we’ve run out of space on the B level where the faculty offices are, so we’ll have to put you on the subbasement level, which will be convenient to the clinic.”

  “The clinic?”

  “The clinic director has left, so you’ll be taking her place.”

  “But I am a maternal-fetal medicine specialist.”

  “Well, yes, but that’s the only opening we have for you right now.”

  How would Daddy handle this? He’d say, “Kill ‘em with a smile, Cookie.”

  “Clinic director?” I said. “Fine. Subbasement? Fine.”

  A few more surprises were delivered by the other maternal- fetal medicine specialist on staff. He said, “You’re going to have to conduct a private practice, you know.”

  “No, I didn’t know. I was under the impression that maternal-fetal medicine specialists were consultants to other obstetricians and that’s how we acquire patients and generate revenue for the department.”

  “Oh, no, you need to have a private practice. You have to see patients and deliver babies.”

  “I don’t mind delivering babies, but I don’t want to have a one-on-one practice as though I were an obstetrician when what I am is a perinatologist.”

  “That’s the way it is here at Cornell. You get paid a third of your salary and the rest of it you have to generate yourself from your practice, with all income over that going to the OB/GYN department.”