Wednesday, January 31, 2007

Just Another Day in Paradise

I awoke at 4am (thank you, pregnant bladder) this morning from a somewhat disturbing dream of being trapped within the body of steel bleachers with a feeling of dread. Today is my surgery day, and I had a few big cases lined up. I chalked the portent of doom up to normal pre-surgery jitters. I should have listened to my gut. Shortly after arriving to the hospital, I started rounding on patients, one of whom was a patient that I believed was more of a "social admit." The patient was a 37 week pregnant woman that had presented the night before complaining of contractions. The triage nurse insisted that she had changed her cervix from 1 cm to 1 cm with "a little wiggle room." Since she lived rather far from the hospital and was to be a repeat C-section for delivery, I griped a little (good-naturedly, of course) that the nurse was killing me, but admitted her overnight for observation. Well, chalk up another for the nurse and her keen instinct, because the patient broke her water about 5 minutes prior to my arrival on the floor.

At first, she was only 2-3 cm dilated, so preparations were made for an ASAP C-section, and I went down to start my portion of a pelvic reconstruction surgery that I had co-ordinated with one of the urologists. He was still placing a sling, which was fortunate because I got a stat page that the nurse thought the C-section patient may be fully dilated! I broke scrub, ran upstairs, and checked to find the patient was about 7-8 cm. I spoke with the patient briefly about proceeding with a VBAC, to which she responded as though I had asked her to voluntarily cut off a limb. So, instead I ran back to the OR, asked them to prep for a stat section, and peeked into the room where the urologist was still working and asked him if he could stay busy for another 20 minutes so that I could deliver the baby. He happily agreed, and I bounced to the next OR and did a quick 20 minute skin-to-skin repeat C-section with tubal ligation with the scrub tech.

It was all of 9 am when I had re-scrubbed for the pelvic reconstruction case, and I was pretty much on an adrenaline rush for the remainder of the surgery. Luckily, this case went very smoothly (pelvic reconstruction is not one of my more favorite surgeries to do). After this case, I went to do a quick consult and pelvic on a young, uncooperative teenage girl, and back to the OB floor to complete rounds, check NSTs, and finish discharges. I had a minute to grab a bottle of water and half of a sandwich and it was time for the OR once again.

Next was a hysterectomy, and, unfortunately for me, I did not have another doc to first assist. While I am perfectly capable of doing the surgery on my own with a tech, it just goes so much more smoothly and quickly with two pairs of hands and eyes. I got into some pretty brisk bleeding on the right pelvic sidewall and got a little closer to the ureter than I liked, so back the urologist came to check out the plumbing. I just really have a phobia about occult bladder and ureter injury during hysterectomy. I saw a few in residency that had to go back to the OR after the defects were discovered in the post-operative period...it is just not pretty, and I get super paranoid about these things. I felt badly for bothering the urologist, but he assured me that he would rather have 30 intraoperative consults at the time of an original surgery than having to go back in days after the event. Fortunately, everything checked out ok, and while the patient lost a little more blood than I would have liked, she did very well throughout the surgery.

Then, it was back upstairs to review more NSTs and an ultrasound on one of my mild pre-ecclampsia patients (who also is a gestational diabetic). The doppler flow was worsening, as was her 24 hour urine protein level, so we made the decision for induction. Orders were written, post-op patients were checked, and my remaining surgeries proceeded without incident. I picked up CindyLou from daycare, we came home, ate dinner, she had a bath, a tantrum, and a bedtime story. Now she is tucked up in bed, I am tucked in on the couch (as yet unshowered, with a splitting headache, I might add) and I am praying for no more laboring patients tonight. Ah, just another lovely day in paradise. Isn't medicine fun and glamorous? Ha.

10 comments:

Redspiral said...

I realize how easy this is for me to say, all pre-med still and hopeful.. haha... but GOD I can't WAIT. I'm drooling over every word.... seriously. :D

rural_obgyn said...

Re your repeat C/S patient: I once had a patient who was scheduled for a repeat come in fully dilated, baby at +2 station. She adamantly refused to push, demanded another section. So we did one. Anything to please the customer??
Hope your induction did not result in a 3am c/s especially if your roads are icy.

Jawndoejah said...

Praying you get rest...

Was wondering what it was like for a pregnant OB as mine had her baby last summer. Now I know, I feel so sorry for her. I recall at my 1 year check we talked. Her baby was about 3 months old and she was feeling guilty as she couldn't nurse (she was nursing over lunch, and pumping besides). Her milk was running out with this life. I told her I thought it was great how she tried so hard, and I am sure she was doing well with her child. I told her she was a good mom and three months is pretty good for such a busy schedule. She said, "coming from an experienced mom of five, that means alot." I didn't want her to feel bad (I know, I nurse forever...but I stay home). Formula isn't better than breastmilk in most cases, but it's certainly a life saver and makes it possible for women to do what they have to do. I coudn't imagine working, pumping, and nursing over my lunch break. You should see how skinny this woman is anyway, her body really would have had to dig for reserves.

You take care of yourself.

Lioness said...

It felt a bit daft to just leave the one comment in an old post so am saying Hi once more here. I have read all of your blog and alas, no more. I shall now be forced to go back to all the different ways one can house calves and other related issues, which is exactly as interesting as it sounds.

[The only bits I enjoyed while studying for Reproduction & Obstoetrics were dystocia and neonatal care and some of the pathologies, but the professor seems to be unduly in love with such things as what happens to P4 in the mare on the 3rd day of dioestrus, *yawn*. Not one interesting question to be seen at all - and I could have soared!]

Anonymous said...

You're doing a great job- you sound like a fabulous doctor and mom! Hang in there! :)

Bohemian Road Nurse... said...

Wow, that is some busy day! (I hope your headache goes away and you get some rest---for bad headaches I take Motrin and Tylenol together, works like a charm...)

Jawndoejah said...

Just took an hpt yesterday as I'm nursing and have had only one cycle 98 days ago. It was positive within a second, and dark on the lines. Well, of course, this morning, I spotted. I know, I know, spotting happens a lot in pregnancy. Still, I've had 3 miscarriages, and am not up for another one. I also wonder how far along I am, I know it's not just 4 weeks with such a fast positive...maybe as much as 7-8. A miscarriage at that stage is harder than at 5 weeks, this I know...

Anonymous said...

Ahhh...I can soooo relate...in general people have absolutely no idea what our "jobs" really consist of..one lady asked me how often a week do I golf!!!

dr. whoo? said...

redspiral~ Yup, you may be just psychotic enough to be an OB. Seriously though, you have to love it to put up with the lifestyle (or, more precisely, lack thereof). ;)

rural ob_gyn~ People never cease to amaze me. At least she didn't make you sit around the hospital for 8 hours before refusing to push (see above post). Customer service at it's finest?

Luckily for me, that induction delivery happened at around 11am the following morning, complete with double nuchal cord *and* a true knot! Kiddo's legs looked like he had been breech for a significant amount of time, so there must have been some serious intrauterine gymnastics going on in there!

jawndoejah~ Aw, thanks for the prayers. At least I'm not working as many hours as I was in my previous pregnancy. I pumped and breastfed my daughter for about 8 months, and it was pretty difficult, especially on busy days, but worth it. My original goal was 6 months, then a year, but she self-weaned. The breast just wasn't portable enough for her! I do have plenty of, ahem, fat reserves though, so that was never an issue for me.

hi lioness and welcome! I'm glad you have enjoyed the blog so far, and hope that you've not given up on updates! Good luck in vet school, I think that it *does* sound fascinating. There will be plenty of reproductive related rants to come, promise. :)

hi anon~ Thank you so much for the compliments. Sometimes I'm not so sure my family would agree with you, but I am definitely trying. I appreciate your kind words and hope you keep reading!

bhr~ Thank you, mercifully it did finally abate. Thanks for the headache cure advice. I heart Motrin, but technically I'm not supposed to take it in pregnancy (although, I could probably safely take it until around the 26th week without serious repercussion.) When I get desperate, that is exactly what I take, too. :)

jawndoejah~ Eeek. Sending up prayers for you and fingers crossed for you. When can you get in for labs and an ultrasound? I hope you are doing ok.

anon~ I know, the public's perception of what physicians do is so incredibly warped by the media and shows like Gray's Anatomy. I mean, seriously, what surgical intern is out drinking in the bar one minute, and then called in to do emergency surgeries the next? Don't even get me started on how they are leisurely eating full breakfasts at home and then strolling into the hospital to start rounds when it is bright daylight (around 9 am, it seems?) Try 4 am, producers. Geez. (Don't get me wrong, I love the show, but the portrayal of medicine is spotty at best!)

Jawndoejah said...

So far so good. I got my labs on Saturday, and find out in the morning. I will get an u/s if my hgc is over 2000. Oh, I didn't explain that I had tested on this cycle twice before and it was negative, the last time being day 52 since the lmp. I began to think I was imagining the nausea! Ha!

I'm actually feeling much more optimistic since I haven't spotted all weekend. I just cannot wait to see how far along I am. With nursing messing with ovulation, I must have ovulated very late in the cycle (to test at day 52 and have a negative). With nausea, I believe I am farther than 5 weeks for sure, but less than 10 as I usually stop about that point. Really, I am excited at this point and the fear has been gone. Of course, that could all change with low progesterone or with a small fetus on sonogram for numbers...