Catching Up

Sorry to disappear from the blogosphere for such a long time. I've just been a wee bit busy here. When I posted last, my partner was off on vacation, I was on call, and my blood pressure was teetering on the borderline. I made it through the first week of OtherDoc's vacation relatively unscathed. I had lots of clinic patients, but the deliveries remained somewhat manageable. I, on the other hand, was feeling pretty drug out and worn down. (Wonder why?) At my 38 week appointment, my OB was on vacation as well, so I saw another physician in the practice. My pressure was 148/89, my cervix was closed (surprise) and my NST looked great. I got the lecture about taking it easy (yeah, right) and I had to repeat the dreaded labs and 24 hour urine protein. I saved that joy for the weekend. I collected on Saturday and turned it in on Sunday when I went in to round on patients.

I'm not sure if this is a coincidence or not, but on Sunday I admitted and delivered a severe HELLP patient of mine. She had no preeclampsia, only HELLP, and she got really sick really fast. She came in complaining of upper abdominal pain. Her labs were just mildly bumped at that time, but she was term with a favorable cervix, so we began Mag Sulfate and started the induction immediately. Luckily she delivered within a couple of hours. Then the fun with labs started, her liver enzymes soared as her platelets plummeted. The platelet count nadir was around 40,000, just shy of needing a platelet transfusion. Luckily, with the help of Dexamethasone, she turned the corner and recovered very quickly. She was able to go home on her 3rd day post-partum. Later that day I checked my own labs. No signs of HELLP, but my 24 hour urine protein was solidly in the mild preeclampsia range. Knowing that my time was limited, and in anticipation of having the smackdown at my Wednesday afternoon appointment, I attempted to stack my schedule for Monday, Tuesday, and Wednesday morning.

Monday was an absolute blur, lots of clinic patients, charts, and 3 inductions, not to mention my sick HELLP patient. I was waiting on a delivery (around 5:30) when I got a phone call from my physician at labor and delivery. Uh-oh. It turns out that he had been looking for my labs, and when he saw the 24 hour urine protein, he was compelled to find me and tell me to stop working...pronto, and to pick a day for induction. Eeek. I immediately flashed on how sick my patient had gotten in such a short time, and I knew that it was time to start taking care of me. He sounded like he meant business, so I immediately called the back up covering physician, who was wonderful and told me not to worry about him covering my patients, even though I had stacked inductions and sections for the next few days. I then made out an extensive check out list and did the final delivery ( a rather difficult vacuum, at that). Then I went to see my patients that I had scheduled for induction and explained that I had been pulled from work by my own physician and would not be attending their deliveries. Then I cried, in front of the patients, and felt like an idiot. Both women were very understanding. I finally got home around 11pm, cried some more, and felt like the weight of the world had finally been removed from my shoulders. Tuesday I did absolutely nothing but sit and catch up on my patients via computer. Wednesday I (finally) packed my hospital bag and prepared to go to my appointment. Little did I know how important that would be....

To be continued...