Sunday, April 19, 2009

Revenge of the Pregnant Women

Oooooweeeeeeooooo. Scary, huh? Well, to a poor, unsuspecting, newly-recovered from the flu Ob/Gyn, it is the scariest prospect around. You see, for the first time (and I do mean, the very first time) in 4 years, I was oh-so-fortunate to have an entire 3 weekends off...in a ROW! The audacity! The outrage! Ohhhhh, and the payback. You see, 2 of those weekends were included on my vacation, which was less vacation, and more "how much activity can you cram into 10 days?" This was spent in the southerly regions and in Newville, the site of our pending relocation. The third weekend was Easter weekend, by some stroke of luck, I was able to convince OMFH to grant me the holiday off, to visit with Mr. Whoo's family in the Great White North. Easter weekend marked the beginning of the the Whoo Family's dalliance with "The Flu." It started with Bean, quickly moved to me, and took out CindyLou later on in the week. Mr. Whoo is the only one left standing, and he's starting to get that characteristic hacking cough. Surely, I thought in my fever-fogged brain, out of all that glorious time off, some of my patients would deliver in my absence. Much to their delight (and my relative dismay), they did not. Other Doc, throughout the whole of my vacation and time off, did not deliver a single patient of mine.


Instead, they all waited for me. So this week, between popping Day.Quil, Ny.Quil, and Mot.rin, I have been exceedingly busy. The day that I returned from vacation, I had an induction for post-dates (41 weeks and 6 days). She had received cervical ripening overnight and actually was really contracting well. About 5 minutes after I hit the floor, she SROM'd the thickest meconium fluid I had ever seen, this was followed by a 10 minute trip to the 60s for the fetal heart rate. I checked for a cord, couldn't find one, tried everything possible to get the kiddo to recover, and eventually went down for an emergent cesarean. The baby was out in less than a minute, and needed a little transition time, but ended up doing very well. Not the best way to start the morning. After finishing up the paper work and talking to the family, I saw a familiar patient roll up to the nurse's station...in obvious distress. She was supposed to have a repeat C-section later that week, but, she was in labor today. Back we went to the OR, where I delivered a 9.5 pound baby boy. I finally made it to the office that day around 3 o'clock.

The rest of the week continued in a similar fashion. There was a severe IUGR baby, born to a couple that struggled with fertility for a very long time. She was only 37 weeks, but the baby was measuring 32 weeks. We had watched the growth for the last few weeks, and it had steadily plateaued. The patient received only cerv.idil, but quickly labored and delivered a healthy, 5 pound baby girl. The placenta was incredibly calcified and quite small, so I felt confident the correct decision to deliver had been made. Unfortunately, there were a few inductions, one for preeclampsia and one for post dates that ended in late night cesarean sections. Both moms and babies did well, but I hate to have failed inductions. It makes me feel as if I have failed those patients.

Oh, and then the "weekend" came. My first weekend back since vacation, and, let's face it, I was already dragging from a busy week and a lingering illness, and OtherDoc had a similarly bad week. There were a million patients to round on, and about half a million circs (my favorite! Not.) I got the first call a little after midnight about patient at term with SROM. I had a little hope, as she did not want an epidural (score 1) and was only 2 cm when she was admitted (score 2!) Between my sick kids and being paged every hour from patients and from labor and delivery, very little rest was had between her admission and the call telling me that she was 8 cm at 4:00am. I arrived at the hospital right as she was beginning to push. Blessedly, it was a very nice, smooth delivery. No tears and a healthy baby. I'm sure my patients didn't appreciate being rounded on at 5 am, but I certainly wasn't coming back later! I did my umpteen circs, rounds, discharges, and spent the rest of the day trying, unsuccessfully to catch up on rest.

In the late afternoon, another "rule out labor" came in to triage. She had not changed her cervix, but she was post dates, and I decided to keep her for observation. I communicated several times with the nursing staff before I went to bed, and was assured she was "doing nothing." I took a Ny.Quil and was in bed no later than 10:30. Imagine my surprise when I received a page at 3:30 am telling me she was completely dilated. It was an all-too-familiar dash to the hospital in the middle of the night. I arrived, broke the bag of water, and she pushed out a beautiful 8.5 pound boy over an intact perineum. Once again, it was circs at 4:30 am, and rounds at 5 am. I have spent the rest of the day trying to recover. I am just now starting to feel human again. I really can't keep up this pace. I hope that I have done sufficient penance for my time off, and that the pregnant ladies are merciful tonight!

11 comments:

Ciarin said...

Don't you know - your patients will hold their babies in until they know you are available. It's funny because many of my personal patients will go into labor when I am on call. Or maybe I just spend a lot of time on call....hmm, hadn't thought of that!

Anyway, it's the whole thing about how cats and other animals can control the catecholamines until they feel they can safely labor.

Ethel said...

You may be tired but you rock!

Anonymous said...

I've always wondered-why do the OB's do the circs and not the peds?
-lpnmon

Lizard said...

I love your labor stories. I am a midwife doing out of hospital births, and I spend a lot of time talking to woman about how docs and hospitals are NOT evil, and how they really want the same things we all do-- smooth normal labors (with or without pain meds, whatever the mom prefers) with healthy moms and babies at the end of the day.

I read your stories and how you cheer the women who have normal births-- and how I completely agree with all of your inductions and sections-- and I wish your Newville was Here, because I would love to be able to refer women to you when they need more than I can do.

thanks for being such a wonderful doc! Your patients are lucky to have you.

Mama to Monkeys said...

I don't know how you do all those circs. I would certainly lose my mind. I know it's part of the job...but geez...I just don't think I could bring myself to do them.

Hope you are all feeling better!

Joy said...

I echo the sentiments of "Ethel"! You rock, Doc!

mamadoc said...

Mercy! And now, you are asking yourself, WHY did I take that time off? Ah, the bitter harvest of time away. Hope it's better tonight.

ER's Mom said...

Oh, the pain of the post-vacation week...

Tigermom said...

Welcome back. I love reading your stories. I hope your move to Newville goes smoothly.

Anonymous said...

I like reading about the births and I think you would be a great Dr. to have a baby with.

But the circs? ouch!
I just brought home my 5th intact son and I thought it was interesting how every single dr & nurse thanked me for leaving him whole. One of the Ob's in the practice told me the latest studies are just the "last stand" of circ in the US and are already being disproven & in a decade it should be gone from the newborn scene like it is now in Australia, the UK & Canada.

Have you read "Women's Bodies, Women's Wisdom" by Dr. Christiane Northrup? She has some excellent thoughts on performing circs.
-Claire

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