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.