“High Risk Pregnancies: Telling Important Stories” – with Dr. Chavi Eve Karkowsky

In this episode, Dr. Fox interviews Dr. Chavi Eve Karkowsky, who is a maternal fetal medicine specialist and author of “High Risk: Stories of Pregnancy, Birth, and the Unexpected.”  

Treating High Risk Pregnancies 

On treating women with high-risk pregnancies, Dr. Karkowsky says “I loved that I was present for the best day of people’s lives or the worst days of people’s lives,” explaining that she enjoys sharing happy moments and comforting or guiding patients through difficult times. Dr. Karkowsky explains that in many ways, OB/GYNs and MFM specialists must serve as advocates for their patients, advising other medical care providers as necessary.  

Dr. Karkowsky also emphasizes the importance of communicating effectively with patients, and the connections this has with storytelling. Dr. Fox adds that physicians have conflict between being paternalistic, telling their patients what to do, and giving patients autonomy. Dr. Karkowsky explains that the doctor’s role is in “curating information, giving the patients enough information but not too much,” and says this is “really the art of what we do.”  

Similarly, Dr. Karkowsky gives the example of allowing a patient to “tell her own story” when dealing with a peri-viable pregnancy. She explains that in these situations, medical care could differ depending on whether the mother wants or believes is the right choice for her, and that “the story is either of miscarriage or of preterm birth.” Dr. Karkowsky explains that “what we’re really trying to guide them in is: tell your story, because if you don’t the story will be told for you. However horrible it is to have to make choices, having choices made for you is intolerable.” 

Writing About High Risk Pregnancies 

When asked why she chose to write this book, Dr. Karkowsky says “writers gotta write!” As an attending, she took a writing class, but didn’t pursue it much. After feeling a creative urge years later, she started writing stories and blogs, including pieces for her institution and Medscape. Dr. Karkowsky explains that she saw these stories as a “precious and hidden” thing. While she finds academic writing to be a challenge, “layperson writing is a joy for me.”  

In writing the book, Dr. Karkowsky found an “ethically complex” problem in telling patients’ stories, and says it was difficult to navigate consent and HIPAA. She changed identifiers beyond what HIPAA requires, with the goal that a woman in the story wouldn’t be able to identify herself. “I would prefer these women to tell their own stories, but to tell their own stories was not the choice before me,” she explained. Dr. Karkowsky also decided that it was “only fair to put myself on the same playing field” and share stories from her own experiences as well.  

On writing, Dr. Karkowsky says the process has helped her “unpack the emotional landscape of a room” and acknowledge the emotional, beautiful, and difficult contexts of her experiences as a physician. She adds that “if I don’t write, I don’t feel well,” and says that coming to understand herself as both a scientist and an artist “has been a little bit of an identity shift.”