My intense reaction to the novel-turned-television show Fleishman Is in Trouble began when I saw my last name in the book’s title. When I bought it, I did not know its two protagonists shared iterations of my name: Rachel Fleishman and her ex-husband, Dr. Fleishman. As I read it, I saw through both characters’ human failings and found strands of my own identity in each of them. Watching it now, four years later, I am struck anew by how Rachel’s traumatic birth left the Fleishmans in trouble. Her birth story helped me realize how much my own traumatic birth transformed me as a doctor.
Like Rachel Fleishman, I did not have a simple delivery. My birth story is the story of an emergency Cesarian section, of hearing the obstetrician call for another surgeon, of a faceless voice yelling at the blood bank, of me screaming and trying to climb off my own operating table. I was trying to save my son, as I would save my own patients, because he was born silent and stunned.
I am a doctor who cares for sick babies: a neonatologist. I witness childbirth endlessly, but only when babies are born early, born distressed, born emergently, born ill. My distorted view of deliveries means I am continually humbled that any human being ever came safely into this world.
I always thought it was because of my job that birth stories find me. They find me over wine when a close friend confides how she felt the day her 7-year-old son was born 9 weeks premature. They find me in text messages when a colleague goes into preterm labor with twins. They find me in between sobs at 11 o’clock at night when I am rounding in my NICU. They creep into my dreams after I run to the emergency department when a pregnant woman was in a car accident. They reframe the way I use gendered language when I care for a baby whose transgender parent safely delivered their second child. Most often, though, they dribble out gradually from my patients’ mothers who I chat with day after day after day while their sons and daughters are in my NICU.
I have a front row seat to childbirth gone awry, and my only therapeutic instrument is my willingness to make time to listen to these stories.
Much of my responsibility outside the delivery room entails supporting my newborn patients so they may grow and thrive despite the NICU. Much of my training was grounded in textbook understanding of organs and ongoing interpretation of medical journals. Like the Dr. Fleishman in Fleishman Is in Trouble, who is enamored with the magic that is the regenerative liver inside his patients’ bodies, I am continually amazed at how time and growth can help so many babies recover from the struggles of prematurity or sickness at birth.
But I am also continually supporting newly postpartum parents in the aftermath of births that did not go as envisioned. I am not their doctor; I am their children’s doctor. It is possible that I could keep sending testing and assigning diagnoses for their babies and simply shut down their stories about all they endured with a succinct pronouncement. Talk to your own doctor about that. But I have a front row seat to childbirth gone awry, and my only therapeutic instrument is my willingness to make time to listen to these stories.
As I collect these birth stories, I am mindful that my own empathic presence may be inadequate. Many NICU parents have post-partum mental health struggles related to their deliveries and the unnatural parenting environment of the NICU. Because neonatologists lack training as mental health providers, I commonly refer parents for professional help from social workers, psychologists, psychiatrists or parent support groups.
When we watched the character Rachel Fleishman’s labor and delivery, we understand that she endured healthcare devoid of compassion, devoid of dignity.
How the character Rachel Fleishman found her own support for postpartum depression and PTSD is an astounding revelation in Fleishman Is in Trouble. But I am also mindful that not every birth story, despite unexpected turns in its arc or unmet expectations by its narrator, requires a therapist. So many birthing people simply need someone to listen to them, to hold their truth. Even if just for a moment.
When we watched the character Rachel Fleishman’s labor and delivery, we understand that she endured healthcare devoid of compassion, devoid of dignity. Her male obstetrician did not respect her bodily autonomy and disregarded the power differentials at stake when pregnant people labor and submit themselves to genital examination. Her care was perhaps intellectually, technically, medicolegally correct. It matters that her life and her child’s life were indeed safe and saved.
To talk about childbirth is to say again and again that for some pregnant people, basic life-sustaining healthcare is unavailable. The Commonwealth Fund affirmed again last month that the U.S. maternal mortality crisis continues to worsen. And it worsens inequitably. Black and Indigenous women are far more likely to die of complications related to pregnancy and childbirth than women like Rachel Fleishman.
But, as Fleishman Is in Trouble illustrates so well, being alive should not be the only goal.
The show helps us feel the absurdity in insinuating that Rachel could have moved on from her delivery simply and gracefully, content to be alive and physically unscathed, perhaps attending therapy to help her cope. Brodesser-Akner shrewdly summed this all up when she wrote, Rachel “was what this doctor thought she was. She was nothing. She was just a woman.”
As viewers, we are left with Rachel’s birth story, a story of a wealthy white woman, to help us make sense of why America remains uncommitted to women’s health, even though 85 percent of women give birth in their childbearing years.
Recent data reveals that access to maternal healthcare is constricting, the preterm birth rate is rising, and women and birthing people continue to die in overwhelming numbers simply trying to become parents. These starting revelations impact millions of people, yet they garnered few if any headlines. The news cycles remain fixated on stories of male impunity, and pregnancy as a binary choice.
Advocates for healthier childbirth call for better birthing experiences, safer birthing experiences and dignified birthing experiences. They work to address structural racism, to reimagine American healthcare for birthing people. To save women’s lives, to center dignity and compassion in healthcare.
One realistic portrayal of an imperfect childbirth is an incredible feat for Fleishman Is in Trouble. But there are more stories to tell.
I hold birth stories from women who sacrificed every cent and their own safety so their child could be born an American citizen. I hold birth stories from women who struggled with opiate use disorder but transitioned to prescribed maintenance medication during pregnancy to diminish the likelihood of overdose and increase the likelihood of safe a healthy pregnancy. I hold birth stories from so many Black women I care for in North Philadelphia who delivered early due to preeclampsia.
Watching Rachel’s story, and thinking about my own, helped me realize I don’t hold these stories simply because my work is proximate to their staging. I hold these stories because of how it felt when I finally began to share my own birth story. A story of my son’s successful resuscitation. A story that sometimes bubbles up when I stand aside waiting during emergency Cesarian deliveries.
As I watch the book’s TV adaptation, I am continually caught off-guard by the bizarre experience of hearing my name, Dr. Fleishman, on television. But the Dr. Fleishman in Fleishman is in Trouble is a man. The female physician in Fleishman Is in Trouble, Joanie, is never referred as to “Dr.” Like many other female physicians (who tend to be better doctors and practice medicine with more empathy than their male colleagues), she remained just “Joanie.”
As I watch, I realize that the reason I hear “Dr. Fleishman” said so frequently is because the character himself begs for everyone to recognize that he is a doctor, as if the respect conferred by his honorific can compensate for his internal suffering. I pay no attention to the “Ms.,” or “Ma’am,” or “Young lady,” or even the “Rachel” I get at work. My title feels less important than the actual care I provide as a woman in medicine.
Fleishman Is in Trouble taught me by understanding the world through which I work and walk as a woman, by entwining my lived experiences with my professional presence, by being Dr. Rachel Fleishman, there are so many lives I can touch.
Strange disclosure: Since the book came out in 2019 and I wrote a piece for a medical journal about reading the book, Taffy Brodesser-Akner and I have become friendly, not the least of which has to do with the fact that I write in an area that is of interest to her and that I share the name of a major character in her book.
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