Medicine from the heart . . . Kerian Service

June 30, 2011

Each Thursday, the Daily Voice showcases selected Thursday Morning Memos, reflective essays about clinical experiences written by faculty, alumni, residents and students of the Department of Family Medicine & Community Health and, occasionally, contributors from other departments. Thursday Morning Memos is UMass Medical School’s homegrown version of narrative medicine, in which the authors process their experiences through writing. To learn more, visit:

Kerian Service, MD, a new graduate of the Family Health Center of Worcester residency program, reminds us how far our graduating residents have come over the past three years as they experience becoming their patients’ true doctor. It is a great feeling—one that is coupled with pride and fear. –Hugh Silk, MD. 

Service, Kerian 

Becoming her doctor 

She told me she stayed in the sofa all weekend, with legs closed, because she was afraid her water would break while I was away. A big smile quickly swept across my face. During our routine prenatal visit a week earlier, I told N.C. that I would be going home to NYC for the weekend, and there was a possibility I would miss the delivery if she delivered during that time. Needless to say, she was happy to see me in clinic again, baby still in utero. 

The next time we met was in Room 91, on the Labor and Delivery ward. A decision was made to induce her as she was past her estimated due date. Dr. K. was the attending on that night, which I was happy about, because Dr. K. spoke N.C.’s native tongue (though N.C. speaks fluent English also). I thought to myself, “This will be great, as there will be an instant connection between N.C. and Dr. K as they both share a common language.” There was some conversation in her native tongue, but very minimal. It quickly reverted to English, as N.C. answered mainly in English. As Dr. K reiterated to her the process of induction, N.C. quickly stole glances at me, as if looking for confirmation from me that what Dr. K was saying was correct. Another thought crept into my mind. “I wonder if N.C. realizes that Dr. K is the supervising doc and she has a lot more experience in maternity care than I do?” 

I saw N.C. early the next morning when she was fully dilated and about to begin pushing. Her husband, who I had met a few times before, was there and trying to be as nurturing as possible to a woman pushing out an almost-seven-pound baby. As if irritated by his gesture, she pushed his hand away when he tried to pat her face with a cool damp cloth. He tried helping out in another way by counting while she was pushing: “One, two, three . . .” This too did not go well with N.C. She angrily told her husband not to count, as she wanted the doctor to do it instead. I smiled under my blue mask; I quickly surveyed the room to also see smiling faces from Dr. O. (the new attending on), the nurses, as well as N.C.’s husband. N.C. was pushing extremely well for a first timer in labor, though she didn’t believe it, as she occasionally would say “Service, do something!” or, “Take the baby out!” Her beautiful baby girl arrived after less than 30 minutes of pushing. 

A couple of days after birth, N.C.’s baby had to spend some time in the Neonatal Intensive Care Unit (NICU). The neonatologists needed to do imaging studies on her for further workup. N.C. sought my advice first before giving the NICU doctors the green light to proceed with the head ultrasound of the baby. 

Each experience with N.C. described above continued to put me in awe of how highly she valued me as her physician. I have viewed myself as a lowly resident doctor, albeit trying to take the best care of my patients, with support from attendings. But then, here was N.C. who viewed me as her doctor. It is a satisfying, yet daunting feeling; but one that I cherish. 

I continue to see N.C. and her family regularly when they bring the baby in for well child checks, all of whom are doing great.