My 2011 medical novel, Catching Babies -- re-released in 2022 in the wake of a TV development deal with Warner Brothers -- was the result of more than two decades working in the US health care system as a data science and technology entrepreneur and executive. Though it's my third book about health care, Catching Babies is my first published novel. (Yes, I have a college-era novel that will never see the light of the day...)
I started researching and writing Catching Babies as a non-fiction expose of the messy and often fierce technical, moral, and cultural conflicts at the heart of high-risk obstetric medicine and 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.
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 what the public health demands, 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 personal 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 the cases began and ended not with medical facts, economic 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 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 deeply affecting 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, 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.
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BIO NOTE: Alongside a long career in health information technology, I've also written extensively on health policy and medical economics and innovation. I have been a regular contributor to the policy journal, Health Affairs and The Wall Street Journal. My work has also appeared in JAMA, Barron's, the British Medical Journal, Modern Healthcare, and numerous other publications. My 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. My 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.
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