I've been cleaning my office this week, going through files that include cards and photos from patients as far back as 1988. I was really touched by the sentiments patients expressed in some of these cards. No one expects a thank-you card for just doing her job, but I must admit that it's nice to feel appreciated. I'm not the right doctor for every patient, and sometimes things don't go well in the "doctor-patient interaction." But going through these cards reminded me of the times things did work well, when I did a really good job.

Sometimes taking care of a pregnant woman presents "teachable moments" where a brief intervention -- how to quit smoking, or what to do for heartburn -- can have a big impact. Labor, too, is a crisis point, even when everything goes well, and it means a lot to find kindness and reassurance (and a familiar face). I have the same fond feelings about the OB who took care of me when I had my son.

But any OB can look like a hero when all goes well. The cards that touched me the most were from moms who had difficult experiences: the photo of the baby who was found unexpectedly to have a major cleft lip; the mom who gave birth to triplets after months of bed rest and then months in the newborn ICU; the miscarriage at 18 weeks from birth defects and chromosome abnormalities.

It's harder to come through in terrible times, and if I can have a good impact then, I feel like I've really accomplished something. It's nice to deliver healthy babies, don't get me wrong -- but when you can really meet someone's needs in bad times, to the point where they feel the urge to reach back and say thanks, that's a real doctoring accomplishment.

Many days I look back and see what I could have done better. I bet you do that too. But today I'm just going to remember and appreciate the times when I made a difference, and give myself a little pat on the back.

Now ... back to work.