Catching Babies

A Novel

Birth, and death. Two ends of the same spectrum. And sometimes the only person standing between is a tired, overworked resident with personal problems of her own.

Welcome to the world of Catching Babies. In the halls of a busy metropolitan teaching hospital, a group of OB/GYN doctors complete their residencies and embark on ambitious careers, all while trying to hold their lives together at the seams. Jay is running from a life he’s tried to leave behind, while Katie sacrifices everything she has to serve an endless parade of needy patients. Anna is out trying to save the world, while Tracy is trying to save twins dying in utero. Based on true stories from delivery rooms and labor decks, Catching Babies spins the doctors’ stories into a gripping mosaic of the obsessions, the anxieties, and the heroism of doctors who have chosen to preside over life’s greatest medical drama—high-risk childbirth.

The birthing of a new baby is one of life’s great medical and human dramas. When it goes well, it is a loud and joyful mess. But when it goes badly, it is a travesty, devastating not only to hopeful mothers, but also to their doctors regardless of how well they have learned to anticipate and navigate the myriad hazards of obstetric medicine.

Catching Babies charts the professional and personal struggles of those doctors, following a group of OB/GYNs as they complete their residency in a busy urban teaching hospital, embark on ambitious careers, and try to mend personal relationships neglected through years of training and sacrifice.

Catching Babies is the general public’s first hard look behind the medical curtain into the practice, politics, and often bizarre culture of obstetrics and gynecology, as smashed together into a single specialty and “organized” in the most disorganized health care system in the world. It explores the broader landscape surrounding obstetric medicine and women’s health:

  • • the culture clash of religion, reproductive rights, and medical technology
  • • the emotional brutality of residency training
  • • the complex turf war between most (but not all) OB/GYNs and the growing and diverse ranks of midwives
  • • the truimphs of many women to get and stay pregnant against the medical and technical odds
  • • America’s ongoing civil war over abortion rights

In obstetric medicine and women’s health, both the courage and callowness we have come to expect of our individual physicians find some of their most dramatic expressions. Catching Babies spins their stories into a gripping mosaic of the obsessions, grandiosity, anxieties and heroism of doctors who have chosen to preside over the joyful messes and heart-breaking travesties in our hospitals’ delivery rooms.

Catching Babies is an inside look at the industry that brings our babies into this world. It’s a harsh world for doctors who work to make sure that every baby has a soft landing. Insightful. Gripping. Wonderful. – Lisa Sanders, MD, Author, “Diagnosis” Column for The New York Times Magazine & Every Patient Tells a Story

A most remarkable aspect of birth is how this normal and simple act is frequently neither. In Catching Babies, Kleinke powerfully demonstrates how birth, despite advanced technologies and medical interventions, remains the center of our common human experience – usually the greatest of joys yet also tainted with occasions of unavoidable loss and misery. If ignorance is bliss, then how are young physicians molded by the realities of daily struggles to avert life’s ultimate cruelties?  As someone who has lived this life for twenty years, I wept often at how accurately Catching Babies portrays the elations and internal private fears shared by the women and men who dedicate their lives to serving women’s health, with complex motivations, variable results and often at high cost to themselves and their families. Catching Babies also exposes the current complexities that hinder bringing balance back to a birth experience that is too often polarized. For those who want safer and more satisfying health for women, this book is a must read. – James Byrne, MD, OB/GYN Chair, Santa Clara Valley Medical Center & Clinical Associate Professor, Maternal Fetal Medicine, Stanford University School of Medicine

If you think Grey’s Anatomy is shallow, House ridiculous, and you can’t keep track of who’s doing whom on Private Practice, you should read Catching Babies. J.D. Kleinke has done one of the hardest things imaginable – taken a swath of health policy, medical care issues, and ethics – and surrounded it in a novel I could not put down. On the other hand, if you love those TV medical dramas, read Catching Babies now so you can complain knowingly to your friends when Hollywood messes up the characters and the medicine in the inevitable-to-come TV series. – Matthew Holt, Co-Founder, Health 2.0 & Founder, The Health Care Blog

Noted health care economist J.D. Kleinke uses the vehicle of a riveting novel to nail the American health care mess. Deeply flawed but compelling medical figures rip raw the deeply flawed American social construct, the deeply flawed medical profession, and the deeply flawed health care system through the unforgiving prism of that most elemental human activity: sexual reproduction. – George D Lundberg, MD, Editor-in-Chief, Journal of the American Medical Association (JAMA), 1982-1999

Combining romance with political intrigue and sharp insights into healthcare delivery, economist-turned-novelist Kleinke has created a page-turner that defines what it means to live the life of a young urban doctor. – Peter Frishauf, Founder, Medscape

The academic medical center is the largest, most complicated stage in our health care system, and Kleinke is its master dramatist. Catching Babies humanizes the manic energy and impenetrable culture of our teaching hospitals, showing us the best and worst of how we are training the next generation of specialist-physicians, often within the same few breaths. This may be the great American medical novel. – George D. Pillari, Co-Founder, Solucient

J.D. Kleinke is a medical economist, health care policy expert, and advocate for patient access to medical care. He has helped create four health care information organizations, served as a health care business columnist for the Wall Street Journal, and advised both sides of the political aisle on health policy and legislation.

His first book, Bleeding Edge: The Business of Health Care in the New Century (Aspen, 1998) was a foundational textbook for many physician-executive MBA programs and health administration graduate programs in the U.S. His follow-up, Oxymorons: The Myth of a US Health Care System (Wiley, 2001), was a scathing and oft-cited criticism of what is wrong with the health insurance industry, and one of the earliest calls for systemic health care reform.

Though it’s my third book about health care, Catching Babies is my first published novel.

I started researching and writing Catching Babies in 2003 as a non-fiction expose of the messy and often fierce technical, moral, and cultural conflicts at the heart of women’s health. My earlier study of the clinical practice patterns of childbirth and gynecologic surgery, combined with fortuitous friendships with physicians and midwives at critical moments in their training, coalesced in a stark idea I had yet to encounter in the health services literature: obstetrics and gynecology stand at ground zero of a broader health care system pulled apart by polarizing forces that often have little to do with medicine, ethics, or patients’ real needs.

Our nation’s permanent civil war over abortion rights – electrified with religious passion, political hypocrisy, and gruesome rhetoric scarcely related to the clinical and behavioral realities of abortion – is the most glaring example of how America’s philosophical and psychological conundra play themselves out in our health care system.

The political, financial, and legal fights over the way we care for women and deliver their babies are the super-charged versions of this spillover effect, of America’s most intractable conflicts always finding their angriest voices in arguments about health care. For clearest proof, one look no further than the often bizarre rhetoric spewed during the 2009-2010 debate about the Affordable Care Act – and the jarring fact that passage of the entire legislation hinged, in the 11th hour, on the funding of abortion.

Catching Babies was originally intended as a clinically detailed study of how these wildly problematic and deeply misunderstood medical subjects play out in the real world. It was conceived as the general public’s first hard look behind the medical curtain into the practice, politics, and often bizarre culture of obstetrics and gynecology, as smashed together into a single specialty and “organized” in the most disorganized health care system in the world. It would also map out the complex turf war between most (but not all) OB/GYNs and the growing and diverse ranks of midwives.

As I dug more deeply into these cases and their often unlikely outcomes, I noticed the recurrence of an odd phenomenon that has confounded health researchers for decades: medical decisions and outcomes often have less to do with what the patient needs or where public health analysis would lead, and more to do with what’s eating at the doctor, what’s making the patient act out, or what’s wrong back at either one’s home.

Fast-forward through a few rough drafts and a few rough years, and suddenly the medical cases I had assembled to illustrate some of health care’s thornier problems struck me as far more interesting than the problems themselves. Many of those cases began and ended not with medical facts, economic or public health prerogatives, or philosophical positioning, but with the full spectrum of human impulses: fear, control, compassion, repression, projection, self-hatred, self-aggrandizement, the search for meaning, the leap of faith. The human compulsions at work in these cases begged questions not only about a unique patient’s irrational response to her medical situation, but also about the pathological drives of her caregiver.

Who exactly are these physicians, midwives and nurses all thrown – as forcefully as their pregnant patients – into a maddening system not of their own design and often in conflict with their most deeply held values? The systematic brutalization of these caregivers, in particular OB/GYNs during their long and difficult training, has turned many into heroes, some into detached technicians, and a few into white-coated monsters – each, of course, in his or her own exquisite way. The closer I looked for patterns, the more elusive such patterning became, until I had crossed, perhaps inevitably, into the realm of narrative fiction. Fast-forward through a few more years and my own terrifying encounter with the realities of the health care system, and these “medical cases” had metamorphosed into human stories.

Catching Babies still seeks to tell the larger story of how and why we deliver most babies and care for most women in the odd and often maddening ways we do. But somewhere in the long process of research, composition, revision and reflection – which stretched out, off and on, for seven years – I discovered that the real story is best told through the myriad fractures and fissures of the human drama: through the doctors, nurses, midwives, patients, family members and others struggling inside the system as they have found it.

There is nothing that simultaneously combines so much wonder, terror, and joy than childbirth. People who witness it for the first time so often refer to it in starkly religious terms, because it really is the miracle of life, unfolding before our very eyes, every single time.

J.D. Kleinke

Portland, Oregon, 2011

Coming soon: an interview with J.D. Kleinke, the author of Catching Babies as it enters development as a television series!

From “Three Perfect Babies,” in the university hospital

Rebekah had begun to appreciate the complexity of the problem all the way back when she was eleven, when she watched wide-eyed and open-mouthed as her mother delivered her baby brother; she had held him when he was five minutes old, still damp and musky and bright red.

A year later, her mother had been pregnant again, but so sick she could not get out of bed, until the night Rebekah awoke to flashing lights and her mother disappearing into the back of an ambulance, coming home two days later from the hospital no longer pregnant. Rebekah’s father, a biologist who worked for a drug company, had tried to explain it to her, but his soft gray-blue eyes would go wet, and then blank, and he would pull at his beard and think of something else to talk about.

One year after that, she finally put the two pieces of it together, in Hebrew school, when she was studying for her bat mitzvah. They were reading from the Torah as a group, each boy and girl in the circle taking a turn with a verse from the Book of Genesis. When it came around to Rebekah, there were those ancient, awful words she would never forget; depending on what she chose to believe, which varied every few years, those words had either fallen randomly from the turn of the universe, or had emerged after their three thousand year wait for her on that very day: And to the woman God said, ‘I will make most severe your pangs in childbearing; in pain shall you bear children.’ Seeing those words for the first time, she understood what had happened to her mother, even if she would never understand why.

This was the rock bottom of it, Rebekah thought as she walked around the back of the hospital and past the empty ambulance bay, stepping with care on the icy sidewalk. Nothing could make the reality of what they were doing go away; but they could lessen its ferocity, the same way they could finally now contain and control, if never really cure, most kinds of cancer. There were new medicines for everything, journals piling up to the ceiling with new ideas, billions in research spending every year; there simply had to be new and better ways to lessen the pain of bearing children. Maybe then, they would be able to restore some of its magic.

Thanks to Katie’s always vigilant presence up and down the labor deck all night –

and with Katie’s knowledge and permission, if not encouragement – Rebekah had been able to simulate an at-home childbirth in the hospital with Tara: no drugs, no nurses, no stirrups, no lights, just the three of them becoming the four of them.  She had walked in and shut the door behind her, leaving the room dark but for the soft nighttime glow of the city through the big picture window.

Tara was laying on her side, her sweaty black hair splayed out on bleached sheets of the still flat delivery bed, her top leg half open as the baby worked its way down the birth canal. Rebekah placed a gloved hand on her upturned knee, ready to check on the progress of the baby again, and Tara started to roll over onto her back but Rebekah told her, with her eyes, it’s okay, I can check you this way.

Tara’s skinny, bearded husband looked up at Rebekah, asking with his eyes, Should I get up? and Rebekah shook her head, No, it’s okay. He curled up tighter around Tara, caressing her, stroking her hair.

Tara let out an animal yelp as another contraction slammed through her, and Rebekah felt the baby’s head bulge forward, a perfect occipital anterior.

“Ok, now,” she said, her voice soft, quiet, caressing. “How about a little push.”

Tara sucked in her breath and pushed, and her husband sucked in his breath with her, holding her as the baby bulged its way downward. The contraction subsided, and she sucked at the air, and her husband stroked her forehead. Then another contraction, another animal yelp, and Rebekah saw the top of the baby’s head pop out, a wet pink grapefruit.

She slipped her fingers in around its head, felt chin and free shoulder and no cord, told Tara to take a short breath, and then another “push.”

And in one long wet gush, the baby slipped out into Rebekah’s hands and up into the cradle of her right arm, a girl, no more startled than as if she had been lifted from a warm bath into the chilly air; her tiny eye-slits opening halfway, two blue slivers of light, glinting with the first rays of sun breaking through the window.


From “Ice Storms,” in a residency loft apartment

When Jay got up to their loft, he found Tracy by the washing machine, lifting a wrinkled pair of scrubs from the dryer and slipping them on. She shot him a hot, sharp dart of a look, and brushed by into the living room section of their loft.

“What’s up?” he asked. He followed her and crumpled onto the old couch at one end of the big, mostly empty space. They hadn’t had any time or urge to decorate since moving in together the previous summer; their apartment was just a place to sleep, eat, shower, and, if their call schedules accidentally coincided, have sex in between the days, nights, and weeks on end at the hospital a few blocks away. The open floor plan didn’t encourage much decorating, especially because they didn’t have any money to decorate with. Voices bounced around in the space like an empty theater, and they would be moving out when residency finished anyway.

“I have to head in,” she said, her voice tinged with anger. “They’re getting slammed.”

“Yeah, I know,” he said, twisting himself free of his overcoat.

He stood and watched her tie the bottoms of her scrubs, pulling the knot too tight, frowning down at it, and re-tying it. Even when she was angry with him, which was more frequent these days, Tracy glowed with a raw sensuality accentuated by her tomboy disinterest in her own appearance. She had pale, freckled skin unadorned by any make-up, high small breasts, and a mass of unkempt brown hair. Her belly bulged slightly over the drawstring of her scrubs, thrust outward by a long curving lower back that flared into the sway hips of a woman unashamed of her womanhood. Jay knew that patients felt comfortable with Tracy because she looked comfortable with herself, her scrubs hanging on her hips the way old sweatpants hung on their own hips during their days off.

“Wild night, huh,” Tracy said, still not looking at him.

“Yeah.”

She pulled on her labcoat, with its overstuffed pockets, then walked into the kitchen area, opened the fridge, closed it again. Jay crawled to his feet, nearly falling over from the dizziness, and squirmed out of his own labcoat and scrubs. They were crusted and stiff from the gush of Jill’s blood.

Tracy poured coffee into a travel mug for her midnight walk to the hospital.

“A little too wild,” he said, shivering in the cold loft. He walked over toward their bedroom area, fished a sweatshirt from the pile of dirty laundry along one wall, tossed the bloody scrubs onto the same pile, and pulled the comforter off their unmade bed. “You’re not going to believe what—”

“I don’t have to believe,” she cut him off from the other end of the loft, looking at him for the first time. Her eyes were green or gray or blue, depending on the light in the room; and when she turned her head, the color changed. In the center of her eyes, however, were small black hard dots that did not change. They stared out at the world, from within the soft changing colors of her pupils, always from far away, farthest of all when she got angry. “Katie called and told me about the hairball with the rupture.”

“Yeah, well,” he said, walking back to the couch, his thoughts gone, his mind turned to mush. “It was a—”

“So hairball,” she cut him off  “you thought you’d snake it from me, huh?”

Jay was snapped awake. “What?”

“I’m on backup call. I should have gone out with those units for that lady, not you.”

“I thought you could use the night off,” he said, collapsing onto the couch. “You’re in the middle of gyn-onck, for Christ’s sake!  I thought I was doing you a favor.”

“Ho-ney,” she said with the scolding tone he resented more than anything else she ever said or did. “Don’t give me that.”

“But—”

“I have to go,” she said, coming back out from the kitchen area, pulling her winter coat over her labcoat.

Jay rubbed his eyes. “No, wait a minute. I need you to understand.”

“Understand what?”

“That I was trying to cut you a break.”

She picked up her coffee and started for the door.

“Ask Katie,” he said. “I was—”

“All I understand,” she said, opening the door, “is that you snaked a bitchin’ case from me.”

And she was gone.