"My ego won out over my sense."

Darcy Forbes is in a group practice of OB/GYN in Denver, Colorado. She is 40 years old and married without children.

I went to medical school to become an obstetrician/gynecologist because, having worked at labor and delivery, my fantasy was to do a "kind" delivery. This was nearly twenty years ago and I was going to bring the kindness and caring of nursing to the cure orientation of medicine. My fantasy was to do home deliveries. I was going to be the ultimate nurse/doula/deliverer all rolled into one.

As a nurse I had a holistic approach. As an obstetrician I learned what can go wrong. As a nurse I could tell right away who needed a C-section. As an obstetrician it's much harder. You're the one who cuts the lady. If the womb falls apart, if she gets an infection or a blood clot, you have to take care of the complications.

Another thing I've learned over the years is that a certain amount of intervention is in a woman's best interest. If she's going to labor for 72 hours, that's no blessing. Labor and delivery are not the endpoint. The endpoint is a good mom and a good baby. If you want anesthesia, have anesthesia. You didn't get pregnant for the maternity experience; you got pregnant for the baby.

Over the years I've intervened more. I use Pitocin more easily. Yes, she'd be fine but it would take her another twelve hours. Another twelve hours is a long time to labor. Another ten minutes is too long. I use much more anesthesia than I ever thought I would, but I take care of the carriage trade. They want it.

Over the years my C-section rates have gone down, because as my experience has gone up I don't get scared. I am also very patient because I've seen everything a million times. When I was a nurse I didn't have that kind of life experience. Experience is a great teacher. As a nurse you work a shift and you're done. The first year or two in practice, when it was just me and my partner working, every other night you could work a long, long haul. No one relieved me at the end of eight hours. Now I've worked it with my partners that we do relieve each other because this can grind you into the ground.

Really bad things happen in obstetrics. Not often. My group does 500 deliveries a year, and once or twice a year there's something terrible--a terrible hemorrhage, a horrible infection, terrible fetal distress where the baby is truly in danger, a maternal laceration that's a nightmare to repair--something that splits the vagina up through the urethra, through the clitoris, something you can't repair at home. There's no blood bank in the patient's kitchen.

Doing a home delivery is a foolish fantasy. Am I really willing to lose one or two patients a year and one or two babies a year, just for the setting? I'm not. One of the reasons I picked the hospital I work at is because they do a great job of in labor and delivery. All the equipment is behind cabinets, but it's still a hospital, not home.

I'm only going to do obstetrics for a few more years because it is grueling. My manic energy is going to have to go somewhere. Yesterday I gave some thought to reordering my priorities. I like reordering my priorities. My current fantasy is that I'd like to teach and maybe do some more clinical research. I am currently engaged in a self PAP smear study. My patients are good sports and like to help me.


When it was time to go to college, in my family you had a choice: you could become a teacher or a nurse. My mother was a teacher, so my sister Ruth and I became nurses. The first two years undergraduate I did at Temple University and lived at home. Then I went to Cornell's New York Hospital for two years and got a B.S.N.

My idea was to work my way around the country. One thing I loved about nursing, you could get a job anyplace. When I got out of the baccalaureate program in '76, I wasn't very well prepared clinically. The Medical College of Virginia had a one-year nursing internship program where you could work in three areas with extra support and teaching. I loved it because I worked in labor-delivery. I worked on the complicated antepartum unit and in an OB/GYN ER and wound up as head nurse there. After a couple of years I got bored and worked in all the different areas--ICU, the OR--trying to keep myself stimulated. But when I felt a mastery of the situation, after a few months, the boredom would set in.

Meanwhile I had met David. On the first date I think I knew I was going to marry this incredible man. Since he was in medical school, I had to wait for him. So my grand plans to work my way around the country didn't get far. What I had decided was that I would be a nurse/midwife. David thought that was hilarious. He said, "You're going to work for a doctor? I doubt it."

My supportive spouse said, "Midwifery school is three years and medical school is four. Why don't you just go to medical school?" I wondered if I was smart enough. I had had a boyfriend in New York, a very smart man, who undermined me. In nursing school I had talked about maybe what I really wanted was to be a doctor, not a nurse. And he said, "You're too undisciplined." When you're twenty, you believe people like that.

I'm a night person. I would work nights as a nurse and in the morning I would take a course. The first semester I took chemistry and the second I took physics. It took me two years to get the prerequisites. When I aced the three courses I needed, I thought, I'll just take the MCATs and see how I do. Then I applied to medical school, but I didn't tell anybody. What if I didn't get in?

I got in everywhere. I didn't think they'd be receptive to a nurse, but they were incredibly receptive. University of Pennsylvania, my dream school, wanted me, so David, who's a westerner and wanted to come back out west to do his residency, made a move to Philly.

Medical school was the happiest time of my whole life. I loved it. The University of Pennsylvania is an extraordinarily wonderful place to study medicine. I felt cared for. Penn was unique. I had fascinating classmates--people who had run businesses, an architect, a man who had played the piano in the Van Cliburn competition. Only a third of the class was the twenty-two year old pre-meds from Princeton. The rest had life experience. There was even another nurse in my class.

The first semester was hard for me because I didn't really understand how to study. When I sat down to take the biochemistry midterm I suddenly realized they had wanted you to memorize all the cycles. I couldn't imagine someone would want you to memorize that. It's in every book. I wound up with a zero.

There was a guy in my part of the alphabet who was very smart, a little wonder from Harvard. He and I started a study group together. He's a teacher by nature and I got a perfect score on the biochemistry final. They let me pass. We continued to study together the next year with two other men who were really smart--they were like one, two, three in my class--and there was me.

What I brought to the group was a practical approach none of them had experienced. When it was time to learn how to do IVs, we practiced on each other because I knew how. When it was time to pass nasogastric tubes, we passed them on each other. I wasn't afraid of the clinical stuff. They did their first pelvic exams on me. I knew how to examine people who were naked and in pain. When someone is naked, you make them feel less embarrassed by being matter of fact.

Medicine is a new language. Coming from nursing I was pretty fluent. When you sit down to read a medical for the first time, what does 29yo G2P3 VDx2 mean? I was the translator. My spouse was a radiology resident. When we did radiology he would bring slides and films home. We learned to read X-rays from David.

I was older, I was married. David and I had a home. These were all single guys, and I used to feed them. They were young, they didn't know if they were coming or going. Discussions about their girlfriends all took place in my living room. We took good care of each other. It was a very happy time.

A lot of medical school is bullshit, and when you're a nurse you have already started to learn to select what's bullshit and what's necessary. People with no background can't tell what's important and what's not, so they learn everything. I was resistant to learning things I interpreted as bullshit. That was a bit of a disadvantage. On the other hand, I was able to learn things I knew I would use. Pharmacology--I wanted to ingest the text because I knew I'd be a clinical doc. But the neuro pathways did not seem relevant.

During medical school I would find myself seduced at different times by different fields. For example, I spent eight weeks with the most wonderful general surgery professor at Pennsylvania Hospital on my first surgery rotation. I loved David Paskin and I loved general surgery. I would get caught up by the force of the teacher. Later I'd think, I don't want to be a general surgeon, all those gallbladders and colon patients. Yuck. One of my professors, Alan Wein, was a wonderful urologist. I talked to him about doing urology. He said, "If you're planning to do transplants and pediatrics, this will work very well, but if you're planning to do general urology, you're going to starve." He was practical even if I wasn't.

David and I had now been in Philadelphia for four years and he really wanted to come back out west. But my husband is very, very smart. The University of Pennsylvania had the first clinical magnet in this country and he was offered the first clinical fellowship, a one-year opportunity to do research on MRI. But my commitment in OB/GYN was going to be for four years. He couldn't resist the opportunity to be Penn's fellow, so he took that job for a year, which tied me to Philadelphia, which was fine. I'm from Philadelphia, all my friends and family are there.

One of the residencies I was interested in was the University of Pennsylvania and the other was at Pennsylvania Hospital. I would have been happy at Pennsylvania Hospital: It was near where I lived, it's an historic hospital, I had good friends and professors and teachers there. But my ego won out over my sense. Why pick that if you can get into THE University of Pennsylvania? So I went to THE University of Pennsylvania and I was miserable for four years.

It was a really bad choice--four years of every other night. It's grueling, it's unkind, the people are assholes. The patients are the poorest of the poor. Over the four years I started to see the patients as the enemy. Half the patients who showed up in labor and delivery had no prenatal care. They were dirty. They did drugs. On any given day in my clinic ten percent of the women had gonorrhea. If you wanted people to come back you had to give them carfare. You cared much more about the outcomes of the pregnancies than they did.

It was a terrible experience. I think I spent a year or two in a real clinical depression. In retrospect I'm even angrier at my professors, because how come nobody noticed? When I finished the residency I was so burned out and so angry and so used up, I decided I wasn't going to be a doctor. Pretty bold, huh? I thought, Well, I can always work as a nurse.

But this was the time when my desire to be a writer resurfaced. So I thought, I'm going to write a novel. And my wonderful spouse said, "Do whatever you need to get healthy." I took half a year and wrote a novel. I couldn't get an agent. I couldn't get a publisher to read it. But I learned a lot. It's a science fiction murder story. Who could kill women better than a gynecologist, exploding people with laparoscopic gases? It was very therapeutic. I got a lot of the poison out of my system, but I wasn't recovered from the residency.

The second half of that year I went to England and did a fellowship in gyn urology. I'd always loved urology, so I thought I'd do a tiny area of gynecology and stay as far away as I could from malignant obstetrical patients. The training in England was a wonderful experience.

David unfortunately was going crazy. He was a westerner living in the heart of Philadelphia, and there was a garbage strike, and there was a bag lady on our steps. He'd taken a series of fellowships and finally a job because he'd been waiting for five years. He didn't like the job at Penn because they had trained him. They never saw his transition to his medical adulthood.

So I said , "Any place you want to go is fine," and he chose a job in Denver. He became the vice chairman of the department of radiology and head of ultrasound. I came here thinking I'd take an academic job, but the chairman in OB/GYN was an asshole. He offered me $35,000 a year. I pointed out I had made more than this as a fellow. He told me I didn't need more because my husband was going to be at associate professor level.

I said to myself, this is crazy. Where was I going to work? This was the only university in town. Through a series of friends and connections I ended up with a doc in private practice, a middle-aged male obstetrician. I love Ted. We've been in partnership seven years. The group went from the two of us to six partners. I have great patients who care as much as I care. It's about half obstetrics, half gynecology.

A lot of it is temperament and nature, but the women physicians in my practice see fewer patients each day than the men, because they spend longer with them. We all see the same number of patients but the women take longer hours. Ted will see all his patients in three days, whereas I need four days to see the same number of patients and give the education, the TLC, that I want to share.

This is not to say the guys don't do this, but when the patient wants to discuss her abnormal bleeding, she's likely to see Danny. If she wants to discuss her PMS, she's likely to see me. When it's time for estrogen replacement, they come to the women. Patients also tend to enter the practice via the women. Our guys are great and the patients grow fond of them, but the draw and the drive is the four women.

The guys do much more surgery than the women do. Danny teases me I have a fibroid farm. I don't have a farm, I have a plantation of fibroids. I don't operate on people unless they're symptomatic. The book says all these things that don't make any sense to me as a woman. I don't care if your fibroids are up to your navel, if they're not bothering you, why would I bother them? They are benign tumors. They will never turn to cancer.

If you bleed like crazy each month and your hematocrit is 30, if you don't feel good, you can't make love and you can't pee, that's a different story. I don't manipulate patients with fear, i.e. "This could be cancer." I have such a busy practice I don't need to. I don't like the idea of block time in the OR because if you have time, you fill it. I'm not sure that's good for your patients. If I have something, I schedule it.

I also think patients choose. There are people who want stuff done to them. If you want something done, it will get done to you. The women doctors are less likely to operate. I do a lot of second opinions and my second opinion is almost always, "Don't do it. Wait, it will get much worse. You'll appreciate the surgery more and if you have side-effects or a complication you won't be as angry, because you'll know you really needed it. On the other hand, when you reach menopause things may get better and you won't have to do anything." I probably represent the extreme of non-intervention.

I do like surgery. It's very satisfying. First of all you're in the operating room and nobody can bother you. In the office there are ten million interruptions--will you sign this, can you take a call. And you're usually seeing three patients at a time. You're holding everything in your head. The office is hectic.

The operating room is very calm, just me and the patient. I usually operate with my partner Susan because we have similar philosophies. We like the table at the same height. One of my partners, Martha, I adore her, but she's six-two. I have to stand on a stepstool for the table to be a good height for her. I tend to have an all-woman operating room. The women anesthesiologists like to operate with us. We don't throw things, we don't get upset, we don't frazzle, we don't fuss. We're also experienced.

The female residents love to come to us because we let them do the cases under supervision. It's amiable in our operating room. If the case is going well we talk about movies and books and fashions, and if the case isn't going well, we concentrate.

There's that satisfaction when it comes out perfect. In the operating room you're not finished until it's perfect. But I only do cases I'm very good at. I'm not a good cancer surgeon, so I don't do the cancer cases. But the bread and butter gynecology I'm good at. I feel safe in there. I don't like high drama. You go in a little humble because you can always get surprised. Danny says if you don't go into the OR humble after washing your hands, your ego's getting in the way of your good sense.

I spend fifty hours a week with patients. I'm endlessly impressed with how tough women can be, and how gentle they can be when they don't need to be tough. I wouldn't work with anybody else. Women are resilient. Whatever they want to do, they manage.


In Philadelphia when I was a resident, we used to go for all these twenty-four and twenty-five week babies. I would go for them because I didn't know the lady. I didn't know what she wanted. I have not had one single incident like that since I've been in practice because I know my people and we can talk about it in early pregnancy. What if something bad happens during the previable period? What are your feelings? How might we handle it together? They're smart and sensible, and they don't say, "Oh, I want everything done." You don't want everything done.

If you ask physicians, they're not going to do to themselves and their mothers what they do to other people's mothers. You do it to other people's mothers because the people have unresolved issues. Most doctors don't want to do too much. Most doctors are very ethical. They want to do what's right. They want to do what people want. There are a few arrogant fools, but most doctors are reasonable. About 5% assholes, is my calculation. A lot of them work at Penn.


Nursing is a very good job for a young woman, but the money never gets good. You never get any power and the truth is, the body of knowledge is limited. Even in the first few years I was a nurse I couldn't find a job that would hold my interest. Passing medications doesn't stimulate your brain. You have no autonomy and no power. You are following other people's orders. Depending on your nature, that may not sit well. A lot of smart women go into nursing and they can't remain stimulated. A lot of powerful women go into nursing and they need more autonomy. They need more knowledge. They need more power. They need to be in charge.

Patients tell you what to do. The doctors leave you "orders." Dietary calls up because you didn't clear the tables and they had no place to put the trays. Housekeeping calls to say someone is putting the linen in the wrong bag. Everybody thinks they're your boss.

I can remember being a nurse and thinking, I'm much smarter than these guys. I'm smarter, I'm nicer, I'm more skilled. I sew better. I could definitely do what these guys do. I kept changing positions at my hospital, looking for a place with autonomy. I found it in the OB/GYN ER. The residents hated it, so I had it to myself.

The year I ran the place, I did about sixteen deliveries. I would do the workup on the patients and if she looked infected, I'd send off cultures. I loved that. But even that pales. I wanted to take them to the OR. With a little training I felt I could do that. I love being a doctor. I have my days where I'm bored or where everybody gets on my nerves, but I like going to work. After a while with nursing it was hard to go to work.

People who went into medicine for the joie de vivre are still happy. All of medicine has its routines. What's a pleasure is the patients. I used to love great cases. Now I hate great cases. A great case is always bad for the patient. I've known my patients for years, we're old friends. I saw them for their pre-marital exam, I delivered their kids, I helped them find contraception. I don't want anything bad to happen to them. For the doctor who finds disease interesting, it pales over time. It's the patient who has to keep you interested. During my residency I was a disease doctor. Now I'm a people doctor. It's a lot more satisfying.

I wouldn't do it differently. I would still be a nurse first. Because if I hadn't been a nurse first, I wouldn't have known I wanted to be a doctor. You bring a lot of the caring of nursing with you. Medicine really is cure, and nursing really is care, and you can blend the two better.

When you start in medicine you're focused on the science, on the art of medicine. You don't come to the art of caring until later. Whereas in nursing it comes first. I don't find any of my partners are uncaring people; we care very much about our patients. They arrived at that point later in training because they came from a science background, not a nursing background. We wind up in the same place, or very close, depending on our natures. Doctors learn what nurses know, eventually. I'm very glad I became a nurse, and I'm very glad I became a doctor.