Wednesday is my surgery day, a day to be in the OR and out of the clinic, and, therefore, it is a day to which I look forward every week. I had particularly high hopes for this Wednesday because my large and rather complicated surgery had to be postponed, shortening my day considerably. Alas, this day, while not particularly awful, did not go as planned. I was awakened at 3:45 this morning to my daughter in the midst of a nightmare. Her whimpers subsided within a minute, and no move from the bed was needed, but I spent the next 45 minutes worrying about her. Needless to say, I made up for that lost sleep by hitting the snooze a few too many times, and that resulted in not having enough time to shower. I also noticed, as I hastened to get ready, that my ring finger looked particularly swollen. The rest of my fingers were fine, so I slammed a bottle of water, iced the finger on the way to work, and prayed that I would be able to get my rings off in time for surgery. The swelling had not decreased by OR time, and I practically had to flay the skin off of my finger to remove my wedding band. The cause of the swelling appeared to be a tiny bug bite on the knuckle. It still has not decreased, though I wouldn't be surprised if I had additionally damaged the finger by forcing the ring over already swollen tissue. This was a most inauspicious beginning, and it was barely 8 AM.
The first surgery was a repeat section. It was complicated by masses of scar tissue, a new scrub tech who was not fabulous at first assisting, and difficulty delivering the baby's head. I am short, and I always have to have a standing stool for the OR. When delivering a baby by C-section, you have to give fundal pressure to deliver the head. When you are short, it is difficult to get a good angle and give enough pressure to bring the presenting part to the incision. I nearly had to use a vacuum to deliver, but I was finally (after what seemed like an eternity, but in reality was probably less than a minute) able to deliver the baby's head without assitance. The second case was a Hysteroscopy and D&C on a woman with post-menopausal bleeding. She also happened to weigh in the upper 300 pound range and was in possession of the longest vagina I have ever seen. I am not kidding. There were no speculums available that could adequately expose her cervix. I had to improvise with two different speculums to even visualize the cervix. The whole case was a struggle, and while I was able to see a couple of endometrial polyps, I was unable to completely resesct them. I didn't have instruments that were long enough to reach to her uterine fundus. I did the best that I could do, got an adequate specimen for pathology, and got the heck out of dodge. I really hope that she doesn't have cancer. We shall see.
Next, I headed to the office to dig out from beneath the mountains of charts that covered the expanse of my desk and filing cabinet. On Monday and Tuesday combined, I saw a total of 90 patients. I charted on about 15 of those 90 during clinic because I was so slammed, and I think it rather rude to be writing the chart while the patient is speaking. I may have to rethink this strategy. It took me no less than 4 hours to complete the charting, sign off the gazillion labs that needed checking, and complete several different types of bureauacratic paperwork (FMLA papers, prescription approvals, etc. etc.). I still have more discharge summaries to dictate. How do you physicians out there keep up with all of the paperwork? I feel as if I am drowning in forms and papers.
Then, tonight, strangest of the strange, my little one, my baby that has been sleeping in her own bed through the night since 3 months of age (no throwing stones, please?), did not want to go bed. She acted as if she were afraid. I thought back to this morning's bad dream, wondering if this could be the cause. She didn't want me to leave, so I lay on the floor next to her crib, holding her hand for about 20 minutes. Finally, I turned on a night light in the bathroom adjoining her room, and left the door open. She whined a little bit when I got up to go, but settled down quickly. I hope that this is just a fluke and not the beginning of a phobia of the dark or of bed. I did rock her in the chair tonight, and her body is so long! I can't believe how much she has grown. I can't believe I'm crazy enough to contemplate starting all over again. I can't believe that it is almost 10 pm and I still haven't showered! ICK! Off to de-grunge.