Q&A with Chavi Eve Karkowsky

Chavi Eve Karkowsky, M.D., is the author of the new book High Risk: Stories of Pregnancy, Birth, and the Unexpected. Her work has appeared in a variety of publications, including Slate and The Washington Post. She is a maternal-fetal medicine specialist in New York City.

Q: You write, "I wrote this book because I think I have the most interesting work in the world." Why did you become a maternal-fetal medicine doctor, and at what point did you decide to write the book?

A: I graduated residency, and was working as an OBGYN in a smaller hospital; over the course of that time, I realized that I didn't like transferring away the sickest patients or sending them to other doctors - I wanted to take care of them! That led me to Maternal Fetal Medicine. 

I was at the beginning of my training in MFM - I had a toddler, and a demanding work schedule - and all of a sudden, I realized I needed to write. I had written intermittently for years, but all of a sudden, it became something I had to find time to do, every so often, despite everything else. 

I very slowly began - first a blog, then a Medscape blog, and finally I pitched some ideas to outlets like Slate.

Ultimately, my editor at Slate asked me whether I had ever thought of writing a book. I had never harbored any ambition to do so - but as soon as she asked me, I realized that yep, I'd really love the opportunity to explore ideas in a longer way. It took years to get a proposal and then a book together, but here we are!

Q: How did you choose the patients' stories to include in the book? 

A: I've been doing this work for a very long time, which means that there are so many stories I am privileged to be in the room for. Many of them stick with me - not usually because of the clinical situation, but because the way a patient said something, or asked me to think of something in a way that clarified an idea that I didn't even realize I had.

I hope that's what the stories do in my  book - all of them are important, and compelling in and of themselves; but in addition, they make larger truths apparent to us. 

Q: In the book, you state, "Nobody--not regular people, not all doctors, certainly not many of our policy makers--seems to understand what happens in our clinics and hospitals." What are some of the main lessons you hope readers take away from the book?

A: Some of the lessons from the book: 

- Pregnancy and reproductive life can be so much harder and require so much more bravery than anyone ever tells us

- Sometimes women and families need to make decisions that other people would find unthinkable; but these situations are not rare, and they have or will happen to someone we know and love.

- People who want to legislate those decisions need to come to work with me to understand what is truly at stake. 

- Even so: everything is almost always ok (yes, really). 

- And finally, the medical system is a world unto itself; understanding it (and knowing how to advocate within it!) is probably the most important medical skill any of us will ever learn, as doctors or as patients. 

Q: What do you see looking ahead when it comes to advances in maternal-fetal medicine?

A: MFMs around the world are working on some of the most urgent and interesting questions in the world! More and more attention is being turned to maternal mortality and racial and ethnic discrepancies in care, which is a national emergency and is being treated as such.

There is research all the time in preterm birth, pre-eclampsia, the most effective surgical techniques, telemedicine, genetics  - anything you can think of. I read enormous amounts in order to stay current, but the blessing of this prolific age is that it's a challenge!

Q: What are you working on now? 

A: I just wrote a piece about how we don't think widely enough about what kills mothers - and how that's going to limit our ability to fix the problem. I do find that I am thinking more about how our larger lives intersect with my small part of the world.

Another example of that is that lately, I've been playing with a lot of thoughts about the role of religion and faith, and how they intersect in such an interesting way in childbirth, even in medical settings.

So I think you could say that I'm slowly trying to think about what my next book or long-form piece might be about. I'll take suggestions about my next topic - coming up with a cogent idea is often the hardest part for me!

Q: Anything else we should know? 

A: Nothing comes to mind, but if anyone wants to tweet at me, I'm @ChaviKar and I usually answer!

--Interview with Deborah Kalb