Thursday, February 05, 2009

Is Mercury in Retrograde or Something?

Hello all, what a crappy week it has been. Is anyone else having "issues" this week? My week actually started out on a pretty good note. One of my patients, pregnant with twins, began to develop preeclampsia. We made the decision to augment labor (she was already contracting and 3 cm), and late in the evening I got to do my first vaginal twin delivery since residency. I was nervous because I am used to doing twin deliveries in the OR as a "double set up," just in case there is a need to emergently deliver the second twin by C-section. In Whoo Hospital, there are no ORs on the L&D floor, so the deliveries are done in the room, and, should an emergency arise, you have to go down several stories to the OR. In a situation where minutes and seconds are precious, this is a daunting thing, especially as the night wore on and I realized that she would deliver in the dead middle of the night (aka skeleton crew time). Luckily, it was the smoothest twin delivery I'd had or seen in a long time. The first baby had no complications on delivery, the second baby stayed vertex, we broke the second bag of water, and baby number two was born about 5 contractions and 2 pushes later. Both babies and mom did wonderfully well. It was truly an amazing experience, and I was happy to be a part of that.

After that, though, it all went downhill fast. Of course, due to the middle of the night delivery, I got very little sleep. Therefore I overslept, and was later than I wanted to be getting to the hospital. Waiting for me there was a consult for the ever dreaded "pelvic pain." Before I get roasted about pelvic pain, let me emphasize that yes, it exists. Yes, there are gynecologic causes. Yes, it is not always supratentorial (all in the patient's head). But this patient definitely had supratentorial pelvic pain. She was already on a cocktail of narcotics and benzodiazepenes, and she spoke of severe excruciating pain in the calmest of voices, her pulse at 60, blood pressure at 90/60. Her exam was completely normal, as were her labs and imaging studies. She blithely asked me to "go ahead and do a hysterectomy while she was "here" (IE admitted to the hospital for pneumonia)." I blithely declined, set a follow up appointment in the office, offered medical suppression for her cycles (got denied), and asked her to sign a medical record release to obtain information from her prior ("out of state") physician.

Already in a *fantastic* mood by this point, I proceeded to the office. Where my right hand woman, SuperNurse, had slipped on the ice in the parking lot and (unknown at the time)broken her leg. For a while she tried to walk on it, but we all finally convinced her to go get xrays. So then, I was stuck with NotSoSuper medical assistant, who may well be the laziest person on the face of the earth. Any one who has worked in an office knows that the nurse who assists you can make or break the flow of your day. This day was definitely broken. The afternoon dragged on with the most draining kinds of patients around including such hits as "every organ system bothers me, can't you just wave a wand and fix it?" and, after a "routine" annual, a 20 minute nervous breakdown over the (unfounded) perception that her female anatomy was somehow horribly disfigured, and she wanted vaginal reconstructive surgery, not one but two Op.rah inspired "natural hormones" consults, and, last, but certainly not least, a patient with known cancer, sent to me by her radiation oncologist for a "skin tag" removal, that I am almost 100% certain is a vulvar carcinoma. Good times, good times.

Then, after a long, hard day already at 5pm, I log on to the internet to learn that one of my friends that I knew from middle school, high school, and college had taken their own life, and leaves behind a small child. I was shocked, then dismayed, and am still very sad over the whole thing. Just terrible news. Mr. Whoo had his community service club meeting, so I kid wrangled alone for bedtime and bath time. Exhausting. To top all of the rest of the day off, after being unnecessarily snarky when I had meant to be funny, I had a misunderstanding with one of my friends, feelings were hurt (I believe on both sides), and now I am getting the technologic freeze out which isn't very pleasant, either.

I am still struggling with the license application for obtaining my medical license in New State. So far I am out almost $1000 in various fees and I haven't even submitted the application proper (which will be $5000 +). We haven't sold our house yet, we haven't begun packing, I'm still over weight and not losing, despite my best efforts, and for extra fun, I have decided to cut all alcohol consumption for the month of February. Oh yes, and I am on call this week and all weekend long. So yeah, my week has pretty much sucked! How about you all? Am I the only one?

16 comments:

Rebecca said...

Hang in there, Doc! Too bad you picked February to go alcohol-free, but at least it's a short month. :) Hope it gets better.

mamadoc said...

Probably the Dementors are breeding. It's the only explanation that makes sense. Maybe you should re-think the no alcholol thing till next month. Our mothers (for the most part, because they couldn't begine to imagine what our lives would be like) didn't tell us there'd be days like THIS. Hang in there...

Mr. Whoo said...

You are still Superwoman to me.

Anonymous said...

These are minor though highly annoying problems. The twins...what a nice delivery. As long as you have no term IUFD's and no moms in the ICU, you are golden. Enjoy your blessings! Rural ObGyn

Theresa said...

Hang in there..it will get better. Hope SuperNurse will be ok and will be back soon.

Anonymous said...

My week has stunk too. I have a case right now that will either drive me to a heart attack or alcoholism :) I am the guardian on the case which basically means it is on my shoulders to recommend what happens to the kids and in this situation it is no exaggeration to say many lives will be altered as a result. Various parties on the case call me no less than five times per day, every single day. On the bright side: tomorrow is Friday, we are getting together with a good friend for dinner, and the most stressful thing on my agenda is working on Valentine's for the two older children's parties next week. Hope the call gods are kind to you. And that is wonderful about your twin delivery!
-Amy in OH

THAT GIRL said...

Lets see... not sure I can top yours but I am close...

Full time employer started mandating overtime, after I signed up for 2 noc shifts at the PRN hospital... resulting in just now finishing up five consecutive noc shifts between two hospitals...

Two fourth degree lacerations, both with no epidural (one was out of control and one was LGA)

One unexplained demise, couldn't find heart tones at 0530... Pogi, full term who came in labor

One IOL with a beautiful strip delivered a beautiful baby, HR 130s for an hour with no respiratory effort... lost him 2 hours and 40 minutes later... undiagnosed diaphragmatic hernia (devastating)

Many teenagers delivered... one of which laughed like a goat and wanted to breast feed cause it was "funny" (my back hurts!)

Went two days without seeing my children at all

But... I DO love my job... promise!!!

Here's to a better week for both of us!!!!

Fizzlemed said...

Hang in there, Lady. Life can be a stinking pile. It does keep it pretty exciting when all of the bad stuff compounds into a string of seriously crappy days. Here's to things looking up soon.... Best wishes to SuperNurse too. I think you should call her that to her face, by the way.

Laura said...

Do not even get me started on the weird crap going on in our OB dept. I'm glad to hear that we're not the only ones.....sorry for you though. Hope things look bright and shiny for you soon!

Prisca said...

Yeah, whatever this funk is it is catching! Things suck here on my OB unit as well--hang in there! :)

Ethel said...

Geez, just the vulvular cancer would have done the day in for me if I were the physician! For us the whole month of January was sucky, so was last year - but at least we have money to pay for our needs and a home to live in (or two, we need to sell the 1st...)

Sigh. It will get better, it always does - or at least we get to a point where we are able to deal with it better. Peace to you!

Anonymous said...

Hang in there! I've had a horrid week. I'm a social worker. Recommended to remove a child from a home this week. Got denied and chewed out for recommending it. Thrown under the bus by the DCS worker while meeting with her super. Got a new referral client. Client is 8 mos. Reported as being seen in ER for RSV. Dr called DCS reporting client was extensively and severely bruised on buttocks and legs. Mother is 18 and is referred for "in home parenting ed and anger mgmt". WTF. Maybe our weeks will be better next week!

Jenny said...

I had a root canal (with IV, good) and my first case of food poisoning on Thursday. Thursday was definitely a crappy day. Ha ha, no pun intended. :-p

Fizzy said...

I'm applying for a license in a new state now and I *thought* it was "only" going to cost me $1000. Now you've got me worried there's some $5000 fee I didn't notice. Why does it cost so much?

Fordo said...

I'm sorry your day was so bad, Lady. Things will get better, I promise.

wife.mom.nurse said...

Thank goodness for anonymity ")