A physician’s passion for obstetrics-gynecology [PODCAST]

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“As trainees, we have unpredictable schedules. Sometimes we work days; others, we work long nights. As the weekends come by, my best friend inevitably asks me: “Who’s showing up this week at work, Batman or Bruce Wayne? This week Batman is showing up to catch babies. And frankly, there’s nothing else I’d rather be doing at 3 a.m.”

Jacques Balayla is an obstetrics-gynecology physician.

He shares his story and discusses his KevinMD article, “Batman catching babies.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Rate and review at KevinMD.com/rate. Subscribe at KevinMD.com/podcast. Let’s get into the show. We have Jacques Balayla. He’s an obstetrics-gynecology physician. His KevinMD article is titled “Batman catching babies.” Jacques, welcome to the show.

Jacques Balayla: Thank you so much, Dr. Pho. How are you?

Kevin Pho: Good. We’ll get to the article in a little bit. First off, briefly share your story and journey to where you are today.

Jacques Balayla: Certainly. I am currently based out of Montreal, Canada. I was actually born in Venezuela, though; I immigrated to Canada back in 2002. Medicine was not really something that I ever envisioned, but unfortunately, my mother got sick, and I was sort of thrown into this caregiving role that I was not necessarily ready for, nor was expecting. But ultimately, I fell in love with the person behind that caregiving role, being my mother. It really solidified the notions about the role of the woman in the family and in society, and it made me really fall in love with the field of women’s health in general.

I decided then to pursue my studies in medicine, in academic medicine at that. I ended up going through medical school here at McGill University and then graduated as an OB/GYN. I have a master’s degree in public health as well, and I am currently a clinical investigator at the Lady Davis Institute here at the Jewish General Hospital in Montreal.

Kevin Pho: All right. So tell me about some of the challenges today practicing obstetrics and gynecology in Canada.

Jacques Balayla: Some of the challenges that we faced quite recently, in fact, were related primarily to the pandemic. As you know, pregnant women, for example, are somewhat immunosuppressed during pregnancy, and they are at slightly higher risk of getting severe COVID. So we certainly had several admissions in the ICU and several really difficult cases in terms of management, multidisciplinary management in pregnant patients, caring for both mother and baby, obviously. So that was certainly a new challenge that we had to adapt to very quickly.

More generally, though, in Canada, because we have socialized health care, access to care is somewhat easier, and public health is actually quite present in our country. We had to do a lot of telemedicine, speaking to patients over the phone and doing online consultations. As you can imagine, for an obstetrician-gynecologist who sometimes needs to examine areas that are a bit more private, that’s obviously impossible to do online. So sometimes you have to weigh the risk of bringing a patient into the clinic to be able to examine them and see them in person with the risk of them getting COVID, particularly if they’re pregnant. So that was a challenge that we had to adapt to, and as we slowly exit the pandemic, we’re only now realizing, “Wow, that was really quite an experience that we had as obstetrician-gynecologists.”

Kevin Pho: Now, for those medical students who may be listening to you on this podcast, what are some reasons they should consider obstetrics and gynecology as a career?

Jacques Balayla: My answer for this is always the same, and it’s actually quite related to the article that we’ll talk about in a moment. It is that in a world that otherwise seems so ugly, so sad, so stressful, and sometimes so hyperactive in many respects, the one guaranteed grain of beauty that you can always count on is a new baby coming into the world. It is an extremely fulfilling practice and career. And yes, it comes with its challenges, certainly in terms of scheduling and in terms of training, but the payout, I think, even on a human and a personal level, is so tremendous that anybody who’s even remotely curious about that experience, I encourage them to at least try to have an elective in obstetrics as a medical student. Really enjoy your clerkship and your medical school years, because it is a very special specialty, unlike many others.

To the degree that I can tell you, think of it like this: How many doctors can say that most of their patients aren’t even sick? Family physicians, general practitioners at that, who do primary care will oftentimes see complications probably at rates higher than obstetricians. And that’s not to say that things cannot go bad in pregnancy. Obviously, they can. But as a general rule, it’s such a joy to work with this population, particularly in times of societal difficulties like we’re living through at the moment. It puts such a sharp contrast between what is really real and raw and valuable and virtuous and the noise that we create as a society, with changing times and increasing challenges.

So that, to me, is really the reason why I went into obstetrics. Obviously, my mother played a big role in being the female lead in the family, the nuclear family, and that was inspiring to me personally. But I encourage everybody to at least dip your fingers into it. I guarantee you’ll fall in love.

Kevin Pho: All right, let’s talk about your KevinMD article, “Batman catching babies.” Now, give us a sense: Why did you write this article?

Jacques Balayla: Yeah. It doesn’t come as a surprise that a lot of the times when we have deeper thoughts in our lives are times when we don’t explicitly expect it. You could be in the shower, you could be driving, or sometimes, like in my case, you could be awake at 3 o’clock in the morning about to deliver a baby, and these thoughts come into your head about the things that you’re living at the moment.

For me, it was a huge realization. It was a night, probably six or seven months ago, when a baby was being born. It was probably 3 o’clock in the morning, and I’m thinking to myself, “What am I doing here at 3 a.m.? How did life bring me to a position, to a place where I can actually make a difference in this person’s life and create memories that they literally cherish for the rest of their lives?” I felt very privileged, I felt very emotional, I felt very humbled, and I felt very inspired.

One of the realizations that I got, not that day, but essentially a realization that I’ve had really throughout my studies, is that when you scan a mother, you see that the baby looks similar to any other baby that you’ve scanned. You’re looking for the same organs, the same features, and the same anatomical landmarks. And then somehow you see them after birth, and they look entirely different. It’s really reinforced the idea that there’s some kind of common denominator among all of us, and it puts into perspective all of the challenges that we’re facing, all of the sectarian partisanship, not only politically but even from a religious perspective or a social perspective, which is probably, again, more of that noise I was talking about than the actual reality.

I think we have more in common with one another than we let on. I think if we were really cognizant of this fact, we’d be much better providers as a general community, and we would probably have less backlash than we often get, especially in times of controversy, with things like COVID, for example, that really brought a lot of the skepticism, I guess, out of individuals into more of a public forum.

Kevin Pho: Now, even in Canada, there are so many obstacles, right, that interfere with that doctor-patient relationship. Now, absolutely, you have a very idealized notion of obstetrics and gynecology, and I love hearing that. I love hearing that. So I guess the question is, how do you maintain that focus when there’s, like I said, so much noise around you, so much bureaucracy, so much interference between that doctor and patient? How do you maintain that idealized notion?

Jacques Balayla: You’re absolutely correct, and you’re right that this was a single event that inspired me to write the article, but there are times, essentially, when you do ask yourself questions, and you tell yourself, “Well, is this worth all of the sweat and the sleepless nights?” All the bureaucracy, the difficulty with insurance, the difficulty, for example, accessing care, the times, rare as they may be, that are catastrophic for a pregnant woman or her baby, what we’re talking about in the U.S. now, removing a woman’s ability to choose over her own autonomy: These are things that essentially shake you, and that could very well, if you’re not conscious of the fact, change your mindset about what it is that you do and why it is that you went into it in the first place.

For me, I think it was such a personal reason. I have very fond memories of my mother, who’s passed on now. She’s really what keeps my life going. I also happen to be a father, and I have kids, and I look at them and I can only imagine the joy that other parents are feeling when they look at their own kids. That motivates me to try to provide the best care and make sure the experience that couples can have, at least to the degree that biology allows it, is a good one. That is really my main source of motivation.

But I hear what you’re saying, and this is in fact an issue. I cannot tell you how many colleagues of mine are either burned out or on the way to being burned out, and I don’t blame them, because the world can be so overwhelming that you can sometimes lose sight of why you’re doing what it is that you’re doing in the first place. And it’s tricky, because it can be quite inconspicuous. It can just come on at any point.

Kevin Pho: Yeah. When you hear these stories from your colleagues, and I’m sure in Canada and the States, burnout is a common topic, or an increasingly frequent topic, what goes through your mind when you hear your colleagues talking about burnout?

Jacques Balayla: It saddens me, because my colleagues are phenomenal human beings, and I know that the desire that they have is to help. It is to be of service. It is to make sure, not only in obstetrics and gynecology but, I think, generally speaking, in all of medicine, to do well by your patients. I think we all swear an oath to that. So it saddens me that there are factors outside of that relationship between the patient and the physician that sometimes interfere.

It saddens me even more when those misconceptions or those difficulties arise as the consequence of some kind of controversial notion, or some kind of poor messaging on behalf of a public health agency, for example, during COVID, or some kind of government entity that comes out and says something. Then all of a sudden, because somebody else said something about a vaccine and you represent the medical system, you’re the enemy and not an ally anymore. For me, it’s really sad, but I understand. I understand because I’ve been on the receiving end of that criticism at times as well, and it isn’t fun. And when you don’t have it.

Kevin Pho: Give us an example of that, from patients, or, for example, from politicians. So give us the example.

Jacques Balayla: I’ll give you the perfect example right now. The government, at least here where I live, is trying to bring back some kind of normalcy to our lives, and obviously we appreciate that as a society. But a lot of people are still, I think, reasonably and rationally concerned about the risk of COVID. There are new variants that are coming on, and the winter months are coming as well. But the government, for example, is discouraging physicians from entertaining consultations again at a distance, online, telemedicine, which was actually a big help. Because it’s true that while some patients do need to be seen in person, there are many things that we can fix at a distance. There are many things that we can do for them even if they’re at a distance that the government is now trying to discourage us from doing.

What that ends up actually translating to clinically is that the patient then maybe won’t show up, and that barrier to care should not be there, or at least, in my view, there’s no valid reason why it should be there. It makes it difficult for us to be able to access the care that the patient needs. And then, obviously and understandably, I think, the patient may be upset or underwhelmed with the care that they have received, not understanding that it’s not that we want to put them at risk, but there are sometimes protocols in place that we ourselves are bound by.

So we don’t always have control of that patient-physician relationship, and neither does the patient, and so all of a sudden you start entering into third parties. I know that, for example, in the U.S., this is an issue with insurance companies, government, hospital boards, and even local governments, where the decisions, particularly for women, are being taken out of the confines of the clinical encounter.

Kevin Pho: Now, if you were to redo your entire medical career again, is there anything that you would do differently?

Jacques Balayla: I don’t think so. I think for all the difficulties that I may have lived in my personal life, and all the challenges that residency in obstetrics and gynecology and being an attending in medicine, generally speaking, bring, it’s still been a solidly positive experience, an experience that I wish other people would have the privilege to experience, assuming that it’s something that interests them and it’s their passion.

I would tell you that there are some things that I’ve learned, however, that I wish I had perhaps applied sooner. One of the things that, even during the pandemic, became a lot more important for me was the fact of just sometimes listening, the power of the spoken word. We live in 2022. We have all these fancy tools and all these diagnostic technologies that allow us to treat and to really heal beyond anything we’ve ever done before, and that’s fantastic. But there’s still a human side to medicine that I think we sometimes shy away from. One of the things that I wish had been inculcated in me was the notion of that communication and how actually critical it is.

I always give the example that sometimes I can have somebody break down in front of me because of something that I said. I haven’t done anything. I haven’t said anything. I just told somebody, “Your test is normal,” or “Talk to me about how you’re feeling. How is this pandemic affecting you?” It’s scary to have a baby during a pandemic, where you’re not necessarily sure what the world holds and what world you’re bringing your baby into. Sometimes just listening makes such a big difference, more so than I had ever hoped.

I always assumed that you’re somebody they’re coming to for a service that you are providing, and then on to the next. And I think that the nature of medicine is that as much as it is scientific, it’s also an art, and there’s a human side that I think, if we were to exploit it a little bit more, if we were to explore, not exploit, explore is the right word, I think it would do us a lot of good.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Jacques Balayla: Yeah. I think that relates a little bit to your question before. To me, one of the take-home messages is that passion is important, but passions need to be fed. Passions need to be sustained and maintained. Passion is not something that you develop once and eventually just assume that it doesn’t fade, because it can sometimes fade. And sometimes when that passion, that light, dwindles, it’s not necessarily because of your own doing. Like we were saying, sometimes there are external agents and external factors.

But diversifying your scope of practice, understanding what it is that makes you tick, pursuing that, and keeping the perspective of why it is that you’re doing what you’re doing, without necessarily listening to that noise, is what I would recommend, not only to current colleagues, and I try to do that as often as I can, but also to incoming students. They will have a whole host of potential disciplines that they can choose from, but they hear things, or they’re scared, or they love something but they’ve been told that the lifestyle is not great, or “You’re a woman. How are you going to get married and have babies if you’re a surgeon?” or “Why do you want to see people with mental illness all day? You’re going to get tired.” All of these nonsensical things, at the end of the day, say nothing about how you feel about a certain discipline or a certain specialty.

So my advice would be also to follow your passion, but to keep on feeding your passion, because passions sometimes do fade. And again, that is not necessarily a consequence of your own behavior or your own thoughts; sometimes it can be from external factors.

Kevin Pho: Jacques, thank you so much for sharing your time and insight, and thanks again for being on the show.

Jacques Balayla: My pleasure. Thank you so much.

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