Saturday, July 22, 2006

Call Me Blade

I'm starting to wonder if I am going to attend a natural delivery ever again. This month I have staffed 15 deliveries, 7 were c-sections. Granted, 3 were emergent, 1 was repeat, and 1 was breech presentation, leaving only 2 for failure to dilate/descend, but come on! In the last 2 weeks that I have been covering myself and OtherDoc I've had 2 completely spontaneous vaginal deliveries, one vacuum-assisted delivery, and, count 'em, 6 cesarean deliveries. I have another one of OtherDoc's patients, a potential cesarean for breech, lurking about on labor and delivery, trying to become pre-ecclamptic on me. Don't get me wrong, I love to operate, but there is something so satisfying about a completely spontaneous and natural birth.

Unnecessary induction of labor can be blamed for this rise in cesarean births, and it is definitely true that in a small community hospital that one is much more likely to deliver a baby by cesarean for an ugly fetal heart tracing. I did a research study in residency that did reveal a correlation with purely elective induction of labor and subsequent cesarean birth. Some physicians will induce patients for their convenience. I try not to induce without medical reason, pre-ecclampsia, post-dates, LGA, SGA, etc. In this day and age, it is the patients that are the ones demanding the scheduled deliveries; even if they may end up with a c-section, even if their bodies aren't ready.

This is frustrating to me. Labor is so much faster and easier if it happens on its own time schedule. We humans are such control freaks. I cannot tell you how many times I am asked to predict the time of arrival of a precious newborn. It is probably my number one most asked question. My reply is always the same, "If I could predict *that*, then I wouldn't need to work because I'd be a self-made millionaire." Inside, I'm saying, "whenever it damn-well happens!" Color me bitter. Grumble, grumble.

Friday, July 21, 2006


It's been a rough 2 weeks. I can't wait for OtherDoc to come back from vacation and for mine to start. Yesterday was one of the more scary cases that I have had since residency. I had just gotten home from the hospital after transferring one of my 32 week patients to the University hospital for pre-term labor (4 cm dilated!!) and sectioning my 2 day LGA induction (who happened to weigh over 300lbs, herself) when I got a stat call from the triage nurse. "The baby's heart rate is in the 90s and it isn't coming up!" A routine NST of OtherDoc's had a baby that was in distress, and I was at home, 20 minutes away. I drove as quickly as I could, avoided accidents in rush hour traffic, and made it to the patient's bedside, where the fetal heart rate was indeed in the low 100s to 90s (normal heart rate is usually 110-160!) It was my call, and we went stat to the OR. The baby was out in less than 2 minutes, and, after the pediatricians worked on her for an anxious minute or two, she was pink and screaming. I think that I started breathing at that moment, as well. Now, I've done several emergent sections in residency, but I was always in-house when the emergency happened. Never have I been so scared that a baby would die before I could get it out. I am thanking God today that I got there in time and the baby, though tiny, is perfectly fine. I am so grateful to be able to do this for a living, I just hope that my nerves can take it! Vacation with Florida Friends starts in 2 days! I *can't* wait!

Wednesday, July 19, 2006

Ob/Gyn Kenobi, and life post-residency

I realize that the title of this forum seems to suggest that I am some sort of OB guru. That is definitely not true. I just finished residency 1 year ago, and have been in private practice for 10 months. I named the forum Ob/Gyn Kenobi because someone mistakenly called me this, and it was hilarious. I trained at a small, close-knit, community-based University hospital. For those of you who are confused by the above statement, let me elaborate. The program was in a University hospital, but the residency program was primarily staffed by private physicians. There were only 12 total residents, 3 per year. Our teams were then supplemented with Family Medicine residents and students. I attended medical school in a large city in a very academic/University setting, and I most definitely wanted the opposite for my residency training. I thought it would be somehow "less malignant." Unfortunately, while academics were questionably less rigorous, familiarity breeds contempt. I had no idea how bad residency truly was until I got out! The worst thing about my program, looking back now, was the people and how they treated me and one another. Ironic, since I ranked the program first because everyone seemed "so close." I experienced exile and ridicule rivaling the most extreme of middle school cliques when I dared to get pregnant in residency, and, horror of horrors, have a complicated pregnancy! I had hyperemesis (vomiting every day until 37 weeks), pre-term contractions, and pre-ecclampsia (pregnancy induced hypertension). My OB took me out of work when I started contracting at 32 weeks, and my "friends" and fellow residents accused me of TRYING TO GET OUT OF WORK! Residency truly warps your brain. These trained OB residents, who would pull their patients from their 40-hour-a-week jobs for less than what I endured, had no empathy for me. I was the pariah who didn't want to work. Even my "dear" friend, BH (see 1st post). My friendship with her did not survive my pregnancy. I was likely clinically depressed for the majority of the remainder of my residency.

Let me encourage anyone who is in residency at this moment and feeling as though they cannot possibly continue, life after residency is SO WORTH IT. I came out of residency training into a hospital-employed practice. They paid 200K of my student loans, and they pay my malpractice. They hire and fire office staff, and take care of billing. I get to take care of patients. I have office 2 half days and 2 full days a week. I have surgery one day a week. I have no one telling me what I have to do. I can round on my patients at nine, noon, or five if I choose. If I have complicated patients, there is a large University hospital 30 minutes north (with residents, heh heh) to which to send them. I'm still working on the call sharing, this is my only complaint. I see my family almost every night. Nurses handle the majority of normal laboring patients, I need only show up when the baby is ready to be delivered. ( I LOVE MY NURSES!!! NURSES ROCK!) No more q 2 hour labor notes. No more 4 hour magnesium notes. No staffing triage for every woman who decides she wants ultrasound pictures of her baby at 3 am. I handle most orders from home. I am so glad that I went through the hell of residency, so that I can appreciate how good life in the private sector truly is. Now if we could just work on the patients calling at 12 am to tell me that they started their period (!) life would be perfect.

Sunday, July 16, 2006

The Weight Perception Paradox

Like many American women, I am overweight. I have not always been overweight. In high school and even college I was a normal weight for my height (5'2"). I have never been "skinny" in the true sense of the word, but definitely healthy and fit. My husband and I have both gained since meeting and marrying; I think that this is pretty routine. When we were married, I was probably 10-15 lbs over my "goal weight." In residency, land of constant stress, little sleep, and paradoxically unhealthy hospital food, I ballooned. My first two years of residency, the now mandatory 80-hour work week was but a dream. I worked 110-120 hour weeks as an intern and second year resident. I ate grilled cheese and French fries at 4 in the morning because, dammit, I *deserved* them after the hell I was going through. I did little more than collapse onto my bed or couch once I finally darkened the door of my house. Exercise? Yeah, right. Once the 80 hour work week kicked in, I did start going to the gym every morning before 6:30 rounds. Then I got pregnant. Long story short, I've gained 50 pounds (!) in five years. Since I started private practice, I've lost 15 of those 50. I still struggle with food every day.

What's bizarre is that when I was younger and fit, I was thoroughly convinced that I was, in fact, obese. I obsessed over each pound on the scale. When I gained weight in college, drinking and midnight fried food runs, I punished myself in the gym and went every single day, skipped dessert, and ate salads. I was wearing a size 6 and berating myself for not being a 4 or a 2. I wasn't even close to fat, but I thought I was huge. Now that I am indeed overweight, I find myself looking in the mirror and thinking that I look pretty okay, a little chubby, but okay. I don't perceive myself to be overweight, even though I am *very* overweight. The only time I realize how bad it has gotten is when I look at pictures of myself. There is no denying the extra pounds in photographs. My husband relates much of the same feelings about his self perception, so we have entitled our mutual folly the "Weight Perception Paradox" and today, for the 347,000th time, we are vowing to "get back on track." As a physician, I know what it takes to lose weight and keep it off. I have just chosen not to follow. Now we have a daughter, my blood pressure is borderline, and both of our cholesterol levels are higher than they need to be. It's time to take responsibility for ourselves and our health, if not for our sake, then for the sake of our little girl. Perhaps by putting myself on the spot by journaling in cyberspace, I can start to become accountable for controlling my weight. It is definitely worth a try.

Saturday, July 15, 2006

We're people too, y'all

Let me begin my rambling with a disclaimer...I feel very blessed and fortunate to be able to do what I do for a living. It is truly a privilege, and most days I love it to pieces. This morning, however, I am baffled by people. When I say people, I mean patients in general, and I mean OtherDoc's patients in particular. OtherDoc is out of town on a much needed and deserved vacation. I am covering him and his patients as well as my own, solo, for the entirety of his (rather long) hiatus. There is no way for me to describe accurately what it is like to be tethered to the hospital for 24 hours a day, 7 days a week via the electronic leash, AKA, the pager, but it is a little like home arrest. I really can't venture any farther than 30 miles from the hospital, lest an emergency or imminent delivery arise. I definitely can't be drinking alcoholic beverages for fear of aforesaid emergencies, and generally, there is just this nagging feeling of discomfort that at any minute my placid little home life is going to be rudely interrupted by a mad dash to the hospital.

Now let's factor in the patients. I know that the climate of medicine has changed a lot in the past 20 years. Patients are generally more savvy about their care, and tend to like to collaborate with their physicians on the plans for their healthcare. I think this is a good thing. Doctors are no longer revered or really even valued. We are often regarded with suspicion and plied with lawsuits for looking sideways at a patient. What I absolutely cannot understand is why patients, who definitely don't view physicians as authority figures any longer, think that it is okay to call, nay, have the hospital page their physician, at home, IN THE MIDDLE OF THE NIGHT, to ask what cold medicine they can take when they are breastfeeding, or ask said physician to diagnose some rash they have on their left shoulder OVER THE PHONE! This blows my mind. I doubt I would page a physician at home if my fingers and toes were falling off, I'd just wrap them up and get to the ER. I don't get why patients can show up in my office with sheaves of papers printed from the internet detailing their (self-determined) diagnosis, and the treatment that they wish for me to administer, yet feel the need to call me about an OTC medicine that they can look up on the internet with ease (in the middle of the night)!

Perhaps patients think that when a physician is "on call", they are supposed to be up all night, just waiting for their calls; their own personal medical encyclopedia, if you will. I know that people get scared and nervous and want immediate reassurance, but physicians are people, too. We have lives and families and the desire, to just maybe, get more than-2 hours of uninterrupted sleep in a row without getting a page so inane that we can't go back to sleep because it makes us so angry. That is all...for now.

Friday, July 14, 2006

Ob/Gyns of America: We're people pulling people out of people.

This is my favorite description of my profession. Simple and silly, but it sums it up rather well. I first saw this posted on the refrigerator door of a once-dear-friend-now-turned-backstabbing-harpy, or BH, and it is one of the better memories that I have taken from our short friendship. I'm sure this is probably going to be one of those projects that I start, grow bored with, and leave to hang out in cyberspace. This is my third attempt to do a web-blog. The first came about when I was in medical school, living alone, and attempting desperately to connect with the world outside of the god-forsaken city in which I completed my medical school training. The second was a foray into the world of myspace, which is still on life-support, but too many people that know me can read things there, and it makes me uncomfortable to talk about them there.

I have no idea why anyone would care to hear my ramblings on starting out in private practice, pretty fresh out of residency, in a small mountain town. Most likely would not. (that is definitely a sentence fragment!) I just like to play online and vent. Maybe it will be read and maybe it won't. Right now, I'm not sure that I want anyone to read it! Navigating a new town and a new hospital and a new profession, *without* the prospect of many new friends ('cause let's face it, what woman wants to hang out and have drinks with their hoohah doctor?) is daunting. This seems like a nice place to b*tch about it. So there.