Wednesday, August 30, 2006

"Ain't it funny how a melody can bring back a memory..."

"...take you to another place in time, completely change your state of mind." This Clint Black song was one of my "leaving high school, going to college" anthems. I would play it over and over again with my freshman roomate on our trips back and forth from home to college together. If you are a music lover, then you know of which I speak. We create the soundtracks of our lives, year by year, era by era, milestone by milestone. In my case, it was also roomate by roomate in college. I was pretty fortunate in the roomate department. My freshman roomie (FR) was a good friend from high school, and we still meet and speak periodically throughout the year. We can go months without speaking, but put us in the same room and it is like we've never skipped a beat. I love friendships like that, especially since I suck at keeping in close touch. Counting Crows, Gin Blossoms, Garth Brooks, Clint Black, and Reba are the artisits that immediately remind me of her.

My sophomore roomie (SR) was a sorority sister, and someone that, prior to living together, I barely knew. She was all sporty-cool and laid back, while I was still, admittedly, pretty uptight, prissy, and very shy. We shared an apartment with 2 other girls from a different sorority. One girl was awesome and one girl was psycho, but we had lots of fun. That year was soaked in alcohol, chips and salsa, forbidden cookie dough, and silly songs/sayings. (Also with bizarre Christmas tree decorations and a beer cap bulletin board.) SR introduced me to all forms of fabulous music, Dave Matthews, Hootie, Edwin McCain, Indigo Girls, and Billy Pilgrim. Sadly, midway through our college experience, she left for a boy and another college. A large part of my musical personality was shaped through SR, so I find myself smiling and thinking about her and college silliness whenever I listen to my favorite music.

My senior roomie, the infamous GuinnessGirl, and I were also in the same sorority and, at first, we had SR alone in common. Once we moved in, however, we were more alike than roomates probably should have been. You couldn't see the floor in our room because it was so sloppy and messy. Laziness and indulgence abounded. We drank contraband boxed wine on the balcony of the sorority house, beneath the sorority president's window, about whom we gossiped LOUDLY. GG introduced me to tarot cards and took me for my first reading. We would set up shop down at the bar down the street and try to drunk read tarot for all of the people walking past. She is truly the master of all musical, and rounded out my core repertoire of music love with Guster, Barenaked Ladies, Sarah McLaughlin, Cake, and Vertical Horizon.

Since I had an eight hour drive to the beach and back home, I willingly conjured up the ghosts of my musical past with my Counting Crows, Vertical Horizon, Billy Pilgrim, Edwin McCain, and Toad the Wet Sprocket CDs in my car stereo. It definitely worked to set the party mood, the primary reason for playing those songs, but it made me very nostalgic for my old roomates and the simpler life of a mere college student. The girly weekend was everything it was cracked up to be and more. We drank margaritas, we sang karaoke, we saw Edwin McCain and Angie Aparo in a little tiny bar, we soaked in the pool, and we hung out on the balcony overlooking the ocean. We ate too much and drank too much and talked more than anything. I am hoarse from all of the singing and talking and drinking. I miss having close girlfriends. I am going to have to make a better effort to keep in touch with the great women that have already shaped my life and who I am today. Luckily for me, a few of them read this blog, so that is a great start!

Wednesday, August 23, 2006

Boring Stories and Running Errands

Skip this post if you want medical-ese or fast paced birthing action. I have had no such action for the last five days, and won't for at least the next three! Ah vacation, how I love thee. Instead I am going to bitch about running errands and how much I hate to do so. So if you like whining and negativity, this is the post for you! I have managed, in my own slovenly way, to get my errands done. I braved the grocery store and bulk supply store with child in tow and cell phone in hand (thanks, Moof). Alas, it did not deter Patient'sMom from tapping me on the shoulder in the egg section. Luckily for me, she was ever-present at her daughter's pre-natal exams, so I remembered to whom she belonged. My patient delivered scarcely 7 weeks ago, yet her mother sighed at me, "She still has a little tummy on her." I dug deep and replied with the standard, "Well, it took nine months to gain that weight, so it isn't going to just fall off in a few weeks." What I *wanted* to say was that it had been over two years, and *my* "little tummy" (I wish) has yet to disappear. My patient is a single mom with enough on her plate already without needing the weight guilt-trip from her mother less than two months after delivery! Poor thing probably is going to have a terrible complex.

Today I got my oil changed and car inspected for the trip, dropped the kiddo off for tumbling class, and went to the mall. Did you know that very few stores in the mall open before 10 am? I, unfortunately, did not know this. Nevertheless, I found good, cheap beach clothes, most for half price. I hate trying on clothes, and that is all I am going to say about that. I have gone from being young and hip and belonging in the mall, to being frumpy and grumpy and abhorring the mall. Being in the mall reminds me why I love online shopping so much. The customer service is atrocious, and, when I could find salespeople, they were grossly uninformed. I nearly gave the poor makeup girl a heart attack when I asked her for makeup recommendations. She stammered, kept asking me what I wanted, and kept pulling out shades for me that were just dead wrong. Then, she admitted she had only been working there for six whole days. She hastened to add that she had been using that brand of makeup for seven years (probably since she turned 10), though, so she should be able to help. Judging by her (obviously) false eyelashes and bright violet eyeshadow, I was unconvinced. I finally found some basics and made a mental note to call the store in advance to speak to someone a little more experienced next time I wanted makeup advice. Mean, bitter hag = me.

The other thing that really made an impression upon me is the way that teenaged girls dress around here! They look like they just rolled out of bed, pulled their hair back on the top of their head, and wore their PJs to the mall. And the color combos! The worst one that I saw on this particular outing? Red and TURQUOISE. I may be a squat, fat frump, but at least I was wearing real clothes and making the effort to be clean and presentable in public. Shit, did that phrase just fly from my fingers? I am doomed to become my mother. I did see and speak with two of my patients at the mall (both of whom looked very cute and presentable), but I'm sure that I didn't see at least a dozen more as I barreled through the shops. I escaped with social pleasantries only and no va-jay-jay questions at all! As whiny and negative as this post is sounding, I really am in a fantastic mood. Enough whinging. I'm off to finish laundry and pack up the car. Sorry for boring you, and have a happy weekend!

Tuesday, August 22, 2006

Not much to say, too much to do

Greetings from Lazy Hollow. I am being very slug-like and feeling quite guilty about it all. I really don't know why I feel guilty about ceasing my perpetual motion for a few days. I feel uneasy inside about not doing *anything* when, truly, there is so much to do! My unorganized closet mocks me as I curl up on the couch under a blanket and watch the umpteenth Tivoed episode of my soap. (I need to catch up!) Obviously, I don't feel guilty enough *not* to be lazy, so we see which of my personality traits is the stronger. I am the procrastination princess. The to-do list is being tackled, albeit, slowly. I am actually showered and dressed before 9 today, and will see the light of day before noon! This is progress, folks.

On Thursday, I 'm heading to the beach for sun, sand, surf, and, well, lots of drinks and laughs with some of my girlfriends. These girls, um, women, are the wives/fiancees of my husband's good friends and core group from high school. These eight guys are friends the way that women are friends, and I mean that in a good way. They talk almost every day, travel to see each other, gossip like a bunch of old biddies, and they get together once a year for drunken debauchery, video games, fishing, playing Asshole(the card game, get your minds out of the gutter), and beer pong. As a defense mechanism, I think, we women have become very close. Through countless weddings, get togethers, and trips we ignore their general group weirdness and gossip, drink and laugh a lot together. This year, we women are going to have our first annual get away, leaving the boys at home with the various and sundry offspring. Most of all, we are doing it to hang out and get some girly time. Secondarily, I think, some of us are doing this to give the boys a taste of their own medicine. I don't include myself in this group, because Mr. Whoo does a whole lot of child care. He has to do this, as I am not always readily available, delivering babies and whatnot, but he does a really great job of parenting. I think he is better at parenting than I.

At any rate, sorry for the un-inspiring post, but it is reflecting my general mood at this moment in time! I'm off to shop for beach clothes, bottled water, gatorade, snacks, tequila, mixers, and (the all important) ibuprofen. I think I may actually be enjoying my lazy summer vacation.

Sunday, August 20, 2006


I am still recovering from my week-o-hell. I am trying to lay low for the first part of my vacation, as I am still in Hometown, but am not taking calls/seeing patients. This is difficult in a small town, for you are surely going to see someone you know or who knows you (which is more often the case for me) wherever you go. I can just picture, as I am trying to grocery shop or buy new (desperately needed) make up, "Oh! Dr. Whoo! I thought you were on vacation! I was going to call you about this rash (discharge, pain, etc.) I've been having for the last 2 years. While you're here....." Believe me, it has happened before. Unfortunately, I really do need to grocery shop, buy new makeup and clothes for the beach, get my hair done and my oil changed and everything else that I don't have time to do while I am working, so it is a risk I am going to have to run. My strategy is to either get out really early (which defeats the purpose of vacation, IMO) or right around dinnertime or later. We'll see how this pans out. I spent the entire day yesterday in pjs playing with my little one, watching movies, and reading, reading, reading blogs. It is so addictive! I find myself drawn to the infertility patient blogs (a professional interest of mine) and to the med student blogs. I know it has been a while since I was there, but reading the stories that these folks post brings me right back to that place in time. A while ago I compiled some musical quotes about my life and medical school that I am going to post in honor of all of you poor souls braving the wilds of medical school and residency. Hang in there!

"Another sleepless night, turn off my light, turn it on. Open my books, take in silence and wait for the dawn..." ~ billy pilgrim - "Try"

"How did I become a molecule in the concrete of this city? Indifferent to my endless motion in a space too small to see?" ~ Vertical Horizon - "Falling Down"

"But you will come to a place where the only thing you feel are loaded guns in your face, and you'll have to deal with pressure..." ~ Billy Joel - "Pressure"

"Finally get it together...where do you belong?" ~ Jackopierce - "Get it Together"

"Sleeping through classes, we'll make it up later. There's still so much time left to go. Misguided Roses, we bloom in October, emerging triumphant in time for the season's first snow" ~ Edwin McCain - "Rhythm of Life"

"People live below me and above me, to the side, and even if I wanted to, I've got no place good to hide. Concrete is my color and commerce, its my pride...Get me out of one should live like this" ~ billy pilgrim - "Get Me Out Of Here"

"Where does the time go? Spinning my wheels, standing still...just like running on ice. I only gain a little distance when I fall." ~ Vertical Horizon - "Falling Down"

"And the sky could open up, and what would we have to say? Something cute about burning out, it's better than fading away" ~ Edwin McCain - "Darwin's Children"

"I spent four years prostrate to the higher mind, got my paper and I was free" ~ Indigo Girls -"Closer to Fine"

Saturday, August 19, 2006

Eight babies, four days

I'm sorry that I have been away from the blogsphere for so long, but this week has been incredibly busy! I prognosticated that last weekend would be jam-packed with action due to the full moon. It turns out that I am a lousy fortune-teller. My weekend was relatively uneventful. It was the calm before the storm. Forewarning, this post maybe the longest I have written, so get comfy or be prepared to skim a lot.

Baby #1
I awoke later than normal on Monday, planning to go directly to the office. I was quite pleased that I didn't have to make the trek to the hospital, and was planning on a short day in which I could get laundry done. Ah, the best laid plans! Just as I was about to shower, the pager sounded. "Hi, we have Lady#1 here, she's 5-6 cm and posterior (this means high in the pelvis)." So much for not going into the hospital. I gave the standard admission orders, and figured that I had enough time for a shower before heading toward the hospital. Scarcely 10 minutes later, I had just gotten the conditioner halfway out of my hair, when the pager sounded again. Uh, oh. "We need you right now! She's about to deliver." Crap. Scrubs, car keys, frantic 15 minute race to the hospital. I roll into the room. Baby is out. The nurse says, "Sorry, I barely made it to the delivery and I was just at the nurse's station! Even if you hit the pavement when we called the first time, you couldn't have gotten here." Somehow, I didn't feel better about that. The patient was very understanding. She had waited several hours at home in labor because she had no ride to the hospital. I sewed up the laceration she had from having an unassisted, precipitous delivery, and we joked that she would have to move into the hospital prior to her next delivery in order to ensure she wouldn't deliver at home. After everything was repaired, I went back into the nursery to try to rinse the remaining conditioner out of my hair. Somehow, I wasn't too successful and spent the rest of the day looking like one of the chicks from the Robert Palmer video....except much, much fatter, with less (read, NO) makeup. Bad analogy.

Baby #2
Halfway through the morning in the office, the pager sounds again. I'm certain that it is a question related to my morning delivery or a non-stress test. Silly, naive me. "Lady #2 is here, she was here last night? Now she is 4 cm and hurting...What do you want us to do?" They know the answer to this question, but, like me, they like to prolong the inevitable. They are already short-staffed. I admit her and tell them to give her IV pain meds and let her walk. The office morning proceeds smoothly, and right around lunchtime, I am treated to a phone call from Lady #2's mother. I am going to kill my office staff for putting her through. She proceeds with a long, rambling diatribe on how her daughter has been laboring for a whole 24 hours, and how that was way too long, and how she had to be put on "patossium" for all of her labors. (I can only assume that she means pitocin, a synthetic form of oxytocin, which is used to initiate regular contractions, and not some strange new mineral.) Then I get treated to each agonizing detail of each of her deliveries, including food cravings and amount of weight gained before I can finally cut in and tell her that her daughter is contracting every 2-3 minutes without "patossium," she is in early labor, and she is doing just fine. I finish office and head to the hospital, where I break Lady #2's water, (meconium, great) and place internal monitors. She is 5 cm, hurting, and refusing both pain meds and an epidural. This is fine by me, as I like it when women are committed to natural labor (I prefer drugs/epidural for myself, but your body, your labor). Women tend to push better when they have that "primal urge." Unfortunately, the reason Lady #2 is not accepting pain medicine is not because she doesn't want it; it is because her mother has scared the bejeesus out of her that she will be paralyzed from an epidural, and that IV pain medicine will stress the baby. She is young and malleable, and I just keep my big mouth shut. Eventually, deep variable decels herald the baby's imminent arrival. Mom is writhing and rocking now, hysterical with pain. I check and find that she is completely dilated, but baby's presentation is transverse (the head is sideways). She is not pushing effectively because she is in too much pain to focus and stay in control. She refuses a pudendal block. Her exact words, "That big needle is not going in THERE!" The baby is not tolerating the pushing progress all that well, so I put on a vacuum extractor to rotate the head to an anterior presentation (this is much easier to deliver). The patient then decides that this is the moment to push herself away from me (and from the pain as the baby descends) the vacuum pops off. Shit. We coax her back down to the end of the bed, I injected a local anesthetic to try to give her some relief. No luck. The thing about operative deliveries is that the patient still has to push to get the baby out. You cannot drag the kid out by the head alone, it doesn't work that way. I re-apply the vacuum and get the baby to crown, cut an episiotomy, as mom refuses to push any more, and (finally) get the baby out. I reduce the nuchal cord, suction the meconium stained fluid, hand the floppy baby immediately to the nurse, and (after about a gallon of lidocaine) repair the 2nd degree episiotomy. Above me as I sew, Lady #2 and mom are congratulating themselves that she did this "all natural." Never mind that the baby was completely stressed and she wouldn't focus and push the baby out because she was in such pain. Never mind that the baby was floppy with no tone and poor color at delivery. I sew and keep my mouth shut, knowing that sometimes, a little pain relief can be the lesser of evils.

Baby # 3
Earlier, in the office, my nurse tells me that Lady #3 had called and was having a "few contractions." She is desiring to VBAC (vaginal birth after cesarean) so I tell my nurse to advise the patient to proceed to the hospital should the contractions persist. She presented to triage shortly before I delivered Baby #2, smiling and calm. "Surely she can't be in hard labor and look that comfortable," remarks the triage nurse. Wrong. She is 5-6 cm and contracting every minute....with a smile on her face! She is very surprised when we tell her she is going to stay. She gets an epidural right away, gets comfy, and I break her water and place internal monitors to monitor the intensity of her contractions. The danger of attempting a VBAC is uterine rupture (and subsequent fetal and/or maternal death) during labor. Fortunately, this happens only about 2% of the time, and upwards of 75% of woman can have a successful VBAC. Lady #3 is determined, focused, and confident that her body can do this. I regard her with hope and the smallest amount of doubt and fear of the worst outcome in the very back corner of my mind. She progresses normally to the point of pushing, we turn off the epidural to give her more of an urge to push. She pushes and pushes well for over an hour and a half when I notice that the uterine monitor is no longer registering at the proper level. The baby is not distressed, but I am. I check the position of the monitor, confer with the nurse, and worry that the drop in pressure is the sign of an impending uterine rupture. There is no loss of station, there is no fetal distress, mom feels no discomfort, but I am fearful. At last, the baby crowns, and the uterine monitor emerges, completely wrapped around the baby's body. It had been compressed by the weight of the baby as it descended through the canal. I delivered the (large) baby and placed the baby triumphantly on mom's belly. Everyone in the room is crying, including me. The baby is well over eight pounds. She has a 3rd degree laceration, but it is easy to repair. Her old uterine scar is intact, and we have achieved a successful VBAC. I arrive home sometime around 2 am, exhausted, but happy to end the night on a high note.

Baby #4
Lady #4 is a patient that transferred care to me early in her second trimester. I like her, she and her husband are very nice, and I even believe we could possibly hang out socially (if I would hang out with patients, that is). Obviously she feels the same way, as she insists on calling me by my first name. I always introduce myself as Dr. Whoo. I don't really like it when patients call me by my first name, as I always call them Ms. LastName and wish the same respect from them. I feel it keeps the professional boundaries in place. (It also irks me when we get mail addressed to Mr. and Mrs. Whoo from people who know that I am a physician. It's not that I am not a "Mrs." too, but I worked hard for that title, and I want to see it used in a formal manner.) I find that the more highly educated and the very poorly educated are the worst offenders when it comes to the first name basis. I do not correct them. I just grit my teeth and bear it. Despite the first name foible, I do like this patient, and brought her in for induction of labor for post dates. Apparently, her first delivery was horrible and miserable (see Lady #2) and she is expecting the worst. She has a fairly reasonable birthing plan. I encourage her to get her epidural early, break her water, and go into the office. The office is a madhouse on Tuesdays and Thursdays, and I find myself hoping to be called away early. For once, my prayers are answered. I get the call from labor and delivery that my patient is fully dilated, but comfortable with her epidural. I cancel the rest of the day (whoopee!) and zip to the hospital. Once I arrive, she begins to push and pushes for maybe 30 minutes until the baby crowns. I gown, glove, and deliver the baby. It is one of those deliveries that is just as smooth as silk. Controlled head delivery, stretching the perineum, no episiotomy, no tears, easy shoulders, slow body delivery, instantaneous cry, poignant music playing in the background, Daddy crying and cutting the cord and placing baby immediately on Mommy's bare belly. It is beautiful and I am happy, they are happy, and the baby is happy. Life is good, and I get to go home before 6 pm.

Baby #5
Lady #5 is a character in the true sense of the word. She is an immigrant from a South American country. Her father is an OB in her country, and I am going to be the first person besides her father to deliver one of her children. She is melodramatic, impatient, and a princess, but she complains with a smile. She is strong-willed, and highly annoyed that I will not take the baby before 1 week prior to her due date because she is "so fat she can't stand it." She weighs in the ballpark of 130-140 pounds at full term, and my lip is bleeding from being bitten so hard in the last few days. She is a third time repeat C-section, and is going to have her tubes tied, as well. She is a scheduled surgery, my second of four (scheduled) surgeries for the day. Her C-section is difficult. She has a lot of scar tissue from her previous surgeries that takes a lot of time to dissect. Her skin incision is not only tiny, but is also just one big cheloid (this scar tissue is not very pliable) that she would like removed. I can barely get the baby's head through the tiny skin incision, but I know she will be most displeased if I cut her one millimeter more than her previous incision. The baby is delivered and does well. I repair the uterus and tie and cut her tubes. She asks several times throughout the surgery if I have, indeed, cut and tied them. Once everything is repaired, I set about removing her old scar. She is so thin that she doesn't have a lot of extra skin or fat in this area, which makes removing the old scar rather difficult. I do my level best, but the incision ends up with a slight curve to it on the right side and I need to close it with both suture and staples to be certain that the tissue comes together correctly. It doesn't look perfect and I beat myself up. I know that she won't be thrilled, but surprisingly she is ok with it. We'll see how she feels when it heals completely.

Baby #6
Baby #6 was really supposed to be Baby #5. I brought Lady #6 in for induction the same day that I brought in Lady # 4. Her baby was consistently measuring above the 90th percentile for growth (LGA - large for gestational age) and her pregnancy was complicated by borderline gestational diabetes, elevated blood pressure, maternal obesity, and the fact that she works in the hospital. Physicians, physician's wives, nurses, and hospital personnel always seem to have complicated pregnancies, labors, and deliveries. I wish I knew why. We started her induction on Monday evening with a cervical ripening agent, followed by misoprostol, then by pitocin all day long on Tuesday. She never dilated more than 1 cm, so I rested her overnight on Tuesday evening, let her eat, and restarted another cervical ripening agent at midnight. When I arrived at the hospital early Wednesday morning (around 7 am), she was 2 cm dilated, and the baby had descended enough that I could break her water and place monitors. I started the pitocin again and went about my scheduled surgeries. I returned after the completion of all four scheduled surgeries at around 3pm to find her hurting, her epidural not working, and only dilated 4-5 cm, despite contracting well for every 1-2 minutes. Not very much progress in 8 hours. I gave her one more hour and re-checked again. She was still 4-5 cm and the baby was very high in the pelvis. At this point, she was exhausted and just ready to have a baby, so we proceed to C-section for failure to progress. The surgery was uneventful, and the so-called macrosomic baby was just a smidge over 7 pounds. Ah, the accuracy of third trimester ultrasound. I beat myself up for the remainder of the surgery for inducing her for an LGA baby when she didn't have one. There was no way that I could know, based on the info that I had, but I berated anyway.

Baby # 7
I induced Lady #7 for mild pre-ecclampsia and gestational diabetes class A2 (medicine controlled) . Funny, she works in the hospital too. The baby was also measuring greater than 90% (should have known better than to trust those darned US techs) but this was a secondary consideration to her blood pressures and urine proteins that were slowly creeping upward. She was already 2 cm dilated, so I broke water right away and started pitocin. She weighs over 300 pounds, so it was difficult to monitor her externally. Internal monitors were placed, and I proceeded with my surgery day. As I was finishing the C-section of Lady #6, the nurse called with a 3 minute fetal decel to the 60s. It had returned to baseline, but she had (correctly) stopped the pitocin. I headed immediately to the patient's room to check on her once I completed surgery. The baby had recovered, the fetal heart tracing was good, and when I checked, she was a good 5 cm dilated. She was very uncomfortable, and IV pain meds were not cutting it. She decided on an epidural, and I told the nurse to hold off re-starting the pitocin until the epidural was in to give Mom a break and allow the baby to recover from the deceleration. All looked well, and she got nice and comfy after her epidural. Time to restart the pit, as her contractions were non-existent at this point. The baby did not like this idea at all. As the pitocin went on, the baby misbehaved. It had repetitive decelerations (dropping of the heart rate) and lost variability (a sign of impending acidosis - bad stuff, fetal distress). Something wasn't quite right about the contraction pattern, either. She was camel-humping, or doubling her contractions, a usual sign of posterior presentation. When a baby is occiput posterior (OP), it is looking up toward the sky instead of down to the floor (occiput anterior or OA). OA presentation is the most common delivery presentation, and it is also the easiest to descend through the pelvis. At any rate, the contraction pattern was, for a lack of a better word, shit, and the baby looked like crap, and Mom was only dilated 6 cm, too long to wait. It was off to the surgical suite once again. This time, when I opened the uterus, two eyes blinked up at me. The baby was indeed OP. This (also supposedly macrosomic, 8 plus pound) baby was barely over 7 and a half pounds, and I curse the US techs once again. The surgery was difficult because of the patient's size, but it went well, and I left the hospital around 10pm. As exhausted as I was from the events of the day, I had to stay up and watch the Tivo'ed finale of SYTYCD. Yay for Benji, the year of the everyman continues! (I would have been happy either way, but I felt a little sad for cute little Travis.) They all will do well, and I am sad because it is all over.

Baby #8
I am getting tired all over again just typing this, and I'm quite sure that I lost most readers around Baby #2, but it is fun to write about the events of the week, so if you're still reading, last one! Lady #8 was an induction of labor for post dates and elevated blood pressure. I dreaded inducing her, because from her first check in the office, I was pretty sure she would end up as a C-section for a narrow pelvis. Her pressures were creeping up around 150-160s/80s, and her poor feet were so swollen they looked like Fred Flintstone feet! I brought her in for cervical ripening overnight on Wednesday night, and by Thursday morning she was already 3 cm dilated. A good place to start! I broke water, placed internals, and headed to the office. Hoping, once again, to be given a reprieve from my ridiculously long patient schedule for the day. That prayer was once again answered, as the nurse called around 3 pm to say that she was already 9 cm dilated. Not bad for a first time mom! Hopefully I was wrong about her pelvis! I cancelled patients for the rest of the afternoon, somewhat begrudgingly, knowing what it would mean for clinic days to come, and once again sped off to the hospital. By the time I arrived, she was completely dilated and really feeling the urge to push. Usually, I am very happy about all of this, but when I checked her, the baby was still relatively high in the pelvis, and developing some caput (swelling at the top of the head). I talked my fears down, and allowed her to start pushing. The. Baby. Did. NOT. Like. Pushing. AT. ALL. It dipped it's heart rate into the 60s and threatened to stay there. It had late appearing decels (a sign of distress). It dropped it's baseline from 130s to the 110s, and it stayed nice and high in the pelvis. (I envisioned the kid with its arms and legs planted widely, pushing itself away from the vagina.) When the patient did not push, the baby did well, so we tried to have her "labor down" where the uterus pushes the baby through instead of active maternal order to conserve Mom's energy and to give the baby a break. No such luck. She couldn't fight the urge to push, and baby couldn't tolerate the pushing. It was too high to place forceps or a vacuum, and as the baby took another dip down into the 60s I called for a stat C-Section. A race to the OR. Catheter. Prep. Cut, rip, and tear. The good news? I went from skin incision to baby in under a minute, and after a rough first minute (Apgar of 5), the baby started squawking and perked up nicely. The bad news? A uterine incision extension into the cervix. The baby was so low in the pelvis, and the lower uterine segment was so thin at the time of incision, that it simply ripped like paper when the baby was delivered. I fixed the laceration and ligated a vessel that appeared to be the cervical branch of the uterine artery. A common complication of an extension like this is bladder injury, but I inspected the bladder thoroughly and it appeared intact. I had to re-enforce the incision with a few layers of suture, and finally got it to stop oozing and bleeding. The rest of the surgery proceeded well. I went to speak to the family after the surgery, detailing all of the bad things that could happen in the next 24 hours (bleeding, occult bladder injury, infection, etc.) This is kind of a voodoo for me, I feel as if I prepare people for the very worst, the outcome will be good. I'll let you know if this is a good practice or not once she heals, but so far, so good. They were all relieved and happy, and thanked me (warm fuzzies). The patient said the surgery was way easier and nicer than having to push the baby out, anyway. (Go figure!) SO, all is well that ends well! With that, so ends my exhausting week and even more exhausting post. This next week, I am on vacation! Yip, yip, yippeeeee!

Saturday, August 12, 2006

Toddler Trials

I want to preface the post with the statement that I love my little toddler with all of my heart. She is the sweetest, smartest, most adorable kid in the world 95% of the time...But when she is bad, she is horrid. The age of two is so legendarily rife with strife (hee) it has procured it's own notorious label, the "terrible twos." Today I got a taste of the terrible. My husband had a service club commitment early this morning. I realize this sounds kind of high school, but he seriously is in a service club for grown men. They do lots of community service, and he was out of the door by 6am (for a change) to be there. Any other time, my little one would snooze until 8 or 8:30, allowing me a rare chance to "sleep in." Not so today. "Mommy and Daddy (we are one, you see)!" the strident command coming through loud and clear on the static-filled baby monitor,"{kid's name} is HUNGY!" (That isn't a typo.) I roll over, pray that she finds a binky in her bed and is overcome with sleepiness. "Daddy and Mommy??" again, loud and clear, "Come heeah, peese?1...2...3..." Argh. The counting thing is my fault. I give her to the count of three to get things done (or to stop doing something, whatever it takes). I drag myself out of bed, drag her out of her bed, change her diaper, and take her back to my room. "NO SEEPING, Mommy!" (Dammit!) " {kid's name} wants cheese and bar." This is toddler speak for string cheese and a NutriGrain Bar, the standard breakfast fare. No more bed for me. We go downstairs, get her a cheese, a bar, some juice, and turn on "Cookie (code name for Sesame Street)." I check email, weigh in (down 3 pounds this week, woo hoo!), and celebrate weigh in by eating too many carbs for breakfast. I enter all my foods into the online food journal (averaging 1127 calories for the week, sweet!) and right about this time, "Cookie and Melmo" are over. Since I have patients to see and round on in the hospital this morning, it is shower time...For both of us.

My toddler is generally very psyched about bathing with mommy, so getting her upstairs and naked is relatively easy. Once in the shower, however, it starts to go downhill. I get about halfway through washing my hair, when she throws a mini-tantrum about inspecting the soap. Big deal, let her have the soap, right? I give her one caveat, "Don't touch your eyes with the soap, it will hurt. " "Ok!" Toddler immediately grabs the soap, it slips from her grasp, she picks it back up with one soapy hand...And with the other? RUBS HER EYE! Screams and tears and furious eye flushing with shower water ensue. I feel instant guilt for allowing my child to blind herself with the Zest..."It was....Soap Poisoning!!" I finish the shower with my 30 lb kid in one arm. Since her eye was assaulted, she no longer wants to be standing in the shower on her own. I get myself as reasonably clean as possible, turn off the shower, and get both of us out and into towels. You would think after her shower trauma, she would be pleased to exit the scene of the crime. Not so. She wants to stay *in* the shower. Another mini-tantrum follows, ending with her *peeing* on the floor and the bathmat. Then, she giggles. UGH! Mop up the pee. Mop her up. Throw it in the laundry room sink to deal with later (i.e. sometime next week). I proceed to her room to get her dressed and to avoid further potty incidents. Unfortunately for me, out of all of the bazillion cute clothes she has that fit her, she chooses a jumper which is in a pile of too-small-clothes-that-need-to-be-placed-in-a-neat-storage-container-but-Mommy-is-too-lazy-to-do-it-just-yet. It is an 18 mo size, and while it fits her body-wise, length-wise, her bottom is in the breeze. Better yet, she wants to wear only the jumper with no shirt or bloomers underneath. I put my foot down on the shirt and bloomers, get her hair into a ponytail, and get back into my room to get myself dressed.

The hits just kept coming while I was at work. She actually was really good for about 30 minutes, and this is a long time in toddler world. Unfortunately, I had two patients to discharge (this means lots-o-paperwork) and a circumcision to do. The nurses were great and helped out with her a lot. I was already mortified because her (cute) little butt was hanging out of her jumper, and while it was covered with cute bloomers, I felt like I couldn't dress my child respectably. Then, she (the little devil!) called another female physician (who really hates me and views me as her nemesis) "Mommy." This woman looks nothing like me, I swear. Finally it was a round of "The Boundary Game" better known as "Let's see how far mommy will let me go before she cracks..." She tried me, and found her boundaries firmly in place. She ended up squirming on my lap while I wrote notes and prescriptions with one hand. The final insult was, as we were leaving, a patient came up to the desk and exclaimed "What a good little nurse in training!" Last straw. I apologized for myself and her to the very nice nurses all the way out the door. I got her home, fed, and in bed for a much needed nap. Now I am eyeing up that new bottle of Riesling in the fridge, despite my self-imposed alcohol fast. It has truly been a day, and it is just barely afternoon! Of course, she was forgiven all when she whispered "Wuv you, Mommy, have a good day!" when I put her down for her nap. Love that little pumpkin. SUCKER!

P.S. "The One" WAS cancelled! Poor contestants! Poor "Flock of Segulls" Guy! Poor ME! Guess I should have voted.

Friday, August 11, 2006

The year of "Everyman"

Have I mentioned before that I *heart* reality TV? American Idol, So You Think You Can Dance?, Last Comic Standing, The One (did this get cancelled already?), and so on and so forth ad infinitum. I've noticed, starting with Taylor Hicks' victory on AI, that an interesting pattern is emerging. Every day, average appearing/acting people are becoming the stars of reality TV. It's not just for the beautiful people any more. Benji (goofy and lovable, a fantastic showman) appears to be a heavy favorite for SYTYCD. Josh Blue (he has Cerebral Palsy!) won LCS. One of the most talented contestants on "The One" is an overweight guy with "Flock of Seagulls" hair, while one of the most beautiful girls got voted off the first week. (I really hope this show isn't cancelled!) America is voting for these "average Joes," and I think that is terrific. If they can do it, then so can you and I (totally buying into the gimmick). Well, at least we could if we had great talent at singing and/or dancing! I believe that this is the pinnacle of what reality TV is supposed to be about, average people "making it to the top." Real World started out being about "real people", but it has now devolved into cramming a bunch of beautiful people in a house, sousing them with alcohol, and hoping that they will all hook up with one another. Of course I know that even "reality shows" are very formulaic, edit-happy, and not totally un-scripted. I get this, but boy, am I a sucker for the act! The producers of these shows must be brilliant at manipulating the masses or just very, very lucky. Either way, I'm completely entertained. (Puppet, thy name is Dr_Whoo.) I don't think I'm making any sense; it must be all of the sleep that I got this week! That and the full moon hanging above doesn't bode well for the weekend! I'm off now to Google whether or not "The One" has been cancelled. I'm curious. Happy Friday!

Thursday, August 10, 2006


An early Madonna song, a personality disorder, and the term that best describes my blood pressure and cholesterol. Borderline hypertension. Borderline hypercholesterolemia. The borderline between just being fat and being fat with long term health consequences. Physician heal thyself! I went for a routine follow up with my internal med doc early this week to discuss my allergies, which are terrible since I have moved to this new town. I wound up with a diagnosis of borderline hypertension and borderline hypercholesterolemia. Since that day I have been scared into submission. I'm eating salads (without cheese or french fries on them, thank you) for lunch. No carbs after 3 pm (high triglycerides!) No food at all after 7 pm. Exercise? 2 times this week for 30 minutes, shooting for 5. Omega-3 fatty acids. Eating veggies. Check, check and check. I'm in my early 30s! I'm far too young for high blood pressure and cholesterol. I'd like to be around to see my little one grow up. I now have more motivation than the reflection in the mirror. Unfortunately I'm holding water like a sponge thanks to my hormonal status, so the scale is not my friend this week. I know that I'm doing better, and that is enough for now.

This week has been very busy, but thankfully not terribly exciting. I (just barely) made it to the delivery of one of my patients on Sunday evening. She had been into triage earlier in the day, contracting, but only dilated to 3. She went home and came back dilated to 6 at 11 pm. The nurse called me at 11:15 pm. I got to the hospital at 11:32 pm, and the baby delivered at 11:34 pm! I'll say it again. You have got to love a spontaneous, natural labor! I also delivered 2 breech babies by C-section and a uterus by vaginal hysterectomy yesterday. My hyst patient has an allergy to the type of suture most commonly used in the procedure, Vicryl. No problem, says naive little me, we'll use Monocryl (different type but comparable suture). Unfortunately, no one clued our OR in, because they didn't have the kind of suture that I wanted on the kind of needle that I needed. A compromise was made, and though it did prolong her surgery, I got that uterus and one ovary out from below. I counted that and pulling out a 10 lb breech baby as my workout for yesterday.

I got a *stat* consult from one of the family docs on a patient whom (they were convinced) was bleeding to death. I called the nurses to gather the equipment to facilitate an exam and possible emergent surgery, I rushed through the rest of my office and sprinted to the hospital to find a very stable, not sick, perimenopausal patient. She was indeed bleeding, equivalent to a regular menstrual period. Her vitals were stable. Her blood levels? Normal. Me? Feeling foolish for getting all in an uproar over this "stat" consult. The punchline is that when I called the admitting doc (whom I like very much) and told him my impression and plan for treatment he seemed surprised (and pleased) that I would call him to tell him my thoughts. Isn't this what a *consult* is supposed to be? You ask my (expedited) opinion and I relay it to you immediately? Community medicine confuses me. Good night.

Sunday, August 06, 2006

"The smell of hospitals {in August}

and the feeling that it's all a lot of oysters, but no pearls..." The Counting Crows did capture a sentiment in this lyric that I find myself hearkening to whenever I first enter the hospital from the fresh air and find the scent the same, no matter where the hospital may be. It's the unfailingly familiar antiseptic smell, a combination of clorox, lysol, alcohol foam, and hibiclens, mixed with the heavier, musky odor of illness, bodily fluids, and, at times, necrosis. It's true that cancer has a scent, and I caught an inkling of that smell as I passed one patient's room on my way to round this morning. It's a scary and sad smell, cancer, and I found myself holding my breath and hurrying forward.

Most of the time, working in the hospital doesn't bother me; it's just where I work. Granted, I spend the majority of my time on the L&D floor. This floor is full of young, healthy, and happy patients. Luckily, one doesn't encounter much death and decay on this floor. Since I've been rounding on my TOA woman on the Med/Surg floor, though, I'm reminded once again how the majority of the hospital is full of the sick and the dying, not just the brand new and living. It forces one to stare their own mortality in the face. It makes me uncomfortable and melancholy. Denial, denial, denial. We all are great at this. For example, I had to walk past the smoking area on my way into the hospital today; patients garbed in gowns, some in wheelchairs and towing IV poles lined up and happily puffing away. Slaves to their addiction. Killing themselves with a smile. At least smoking will get your post-op patients up and about to ambulate. Gotta love the drive to smoke for that.

I'm sending my TOA lady home today. She is speaking optimistically of adoption and alternate parental avenues. I'm hoping that the depression doesn't hit her like a ton of bricks when she gets back home. She's coming to see me on Tuesday and Friday. Gotta let them go sometime. Many times as an OB/GYN, I find myself acting as counselor as well as physician. I've spent well over 30 minutes at each visit with this patient and her family, explaining, encouraging, and uplifting. I know that they appreciate this, and I love to do this for them, but it does drain me. I chose OB my 3rd year of medical school because I loved to read about it, loved to do some hands-on procedures, and most of all, because I loved talking to the patients. You have to love to do this job. At times it takes all that you are. I am lucky because I do love it, and I am unlucky because becoming the counselor in my profession has carried over into my "real-life" relationships. I am the confidant and problem-solver for my good friends, and, because of this "super competent" role that I have assumed, I am too reticent to vent my own problems to anyone. Not that I have huge problems, mind you. My life is relatively charmed. I'm finding that this blog is a wonderful, anonymous outlet, and I am thankful for that.

P.S. Don't you think it is weird that the word "blog" isn't on the spell check? Funny.

Saturday, August 05, 2006


TOA lady will likely go home today or tomorrow. I pulled her JP drain today, and if she continues to tolerate a regular diet she will be able to go home and start picking up the pieces of her shattered fertility. None of the fluid or blood cultures grew out any other bacteria except for the inital culture which showed trichomonas. I have never heard of a TOA caused by trich. Time to do some research, I may have a case report.

Copycat, copycat

Herein let it be known that I am, indeed, an honest-to-goodness copycat. I came into the blogger world via the (very popular) blog that my friend from college maintains (beautifully, I might add...flatter, flatter.) She is fabulously creative and fun, and in many ways I aspire to her verbosity. I have been a little afraid that she would happen upon this blog and cry copycat, since I started this blog after reading hers, so I am coming clean up front. The fact that I started a blog on the same site is where the similarities end, however. She is far better than I at this than I could ever hope to be. I also have been cyber-stalking her ever since she sent me the link to her blog because we have somewhat lost touch (hopefully, just due to mutual procrastination, and not due to deliberate intent) in the last few years and it is cool to catch up on everything that is going on in her world. At any rate, I will add her to my blogroll and if she happens to stumble across the site now, hi from your (very) old roommate :)

Friday, August 04, 2006

I want to know...

....why grilled chicken salads from the local restaurants here come smothered with cheese and french fries???!!!! (I'm totally serious!)

....why can't I resist said french fries and cheese, even though I am of gargantuan proportion?

....why charts mate and multiply on my desk overnight, covering its expanse and making it damn near impossible to clear before the weekend?

....why my office manager (OtherDoc's wife) has been out of town for the last 4 out of 5 weeks, and therefore hardly any billing of mine has been done (even though I'm sure OtherDoc's billing is all in)???

....why very few of my patients just want to just go into labor on their own without being induced?

....why I already want a weekend off, and I just came back from vacation?

....why I am so addicted to "So You Think You Can Dance" that I actually *voted*?

....why are all of my August babies macrosomic?

....why can't I be hyperthyroid, just until I lose about 30 lbs?

....why my toddler just dumped a whole cup of sunflower seeds into her seat, and then cried for more?

....why physicians, physician's wives, and nurses always have complications with pregnancy and surgery?

....why on earth I am even considering getting pregnant again, considering how miserable I was in my last pregnancy?

....why isn't Hubby home with dinner yet?

....who cares?

Happy weekend to you poor souls who happen across this blog! Hope you have lots of AC and cold beverages close at hand.

Wednesday, August 02, 2006

Early Day

It's my surgery day, and I am out of the hospital earlier than usual. I had an unusually abbreviated surgery schedule due to the fact that a few of my repeat C-Section patients had the audacity to deliver while I was out of town. It's nice to get home a little early; I feel as though I am playing hooky. In some respects, I am, as I have laundry, grocery shopping, dishes, and five discharge summaries to dictate. Instead I have spent the last hour perusing blogs, eating lunch, and (what I do best) procrastinating. Surgery days always start early for me (7:30), but this morning it was tough to get up and out. My husband is out of town, so it was up to me to get my 2 year old up and out of the house by 6:30 in order to get to day care (I call it school to allay my guilt.) She was *not* pleased. I'm going to make it up to her by picking her up early.

My TOA patient is moving from the ICU today, and I spoke with both she and her husband about the trichomonas infection. They (visibly) handled this news remarkably well. Color me surprised. I'm still awaiting the final pathology and bacterial cultures. Keeping my fingers crossed that she continues to improve. In other more boring news, I have successfully dropped the 5 "vacation pounds!" I celebrated by making a Boboli pizza for lunch (it was a whole wheat crust, though!) I am trying not to have any starchy carbs after 3 pm. Just meat and veggies for dinner. So far that is working relatively well. I'm also doing no food after 7 pm, just water or tea. Tonight I'm going to do the elliptical if it kills me. I have to wear a bathing suit on vacation with skinny girls who look like fashion models. It's kind of neat that some people are finding their way to my blog. It's unfortunate that most days I will likely bore them right out of their skulls. Sorry all, I'm still just trying to find my blogging "voice." For now, stream of consciousness will have to do.

Tuesday, August 01, 2006

Back and Fat

Why is it that vacations are always 1) too short 2) filled with fattening food and 3) ultimately more exhausting than your life before vacation? My short hiatus was all of these and more! I'll try not to whine about how much weight I gained since it was totally my decision to drink a half a case of Raspberry Lambic with my friends and eat french fries at nearly every meal. I have so little self-restraint when it comes to what feels good at the time. Vacation was fabulous. Now I have another (beach!) vacation upcoming at the end of this month, so it's time for salads, starvation, and drudgery at the old gym. Yee-haw.

Yesterday I saw one of the sickest patients that I have ever seen. OtherDoc admitted one of my infertility patients to the hospital over the weekend with fever and abdominal pain. OtherDoc put her on IV antibiotics and (I think) sat on her, praying I would come back before she died. She had a huge tubo-ovarian abscess. Eleven centimeters by seven centimeters, and she was out of her head with temperatures up to 104 degrees. I took her to surgery with a general surgeon, and thank goodness that I did. Her belly was encased in adhesions (scar tissue). We worked for over an hour to just get far enough into her belly to look for her tube. All of her anatomy was distorted. I never even saw her uterus or ovary, just felt them through masses of scar and bowel. We removed as much of her fallopian tube and all of the pus and abscess as we safely could, put in a drain, and closed her incision. Today she is fever, decreasing white count. She will live. She had previous surgeries in the past, gallbladder, right kidney removal as an infant, and previous removal of her right tube and ovary due to ovarian torsion 2 years prior. She has never been pregnant, and now never will be able to conceive on her own. The only culture that has been positive so far has been for the STD trichomonas. She has only had one monogamous parter, and was recently negative for any STD in my office. Translation? Her (likely non-monogamous) husband may be the reason that she can never have a baby. It's terrible, and I am dreading this conversation with both of them. I'm waiting until she is well enough to come out of the ICU, likely some time tomorrow. Most of the time, being an OB doc, I get to deliver happy news to patients, but the flip side is that I sometimes have to deliver the most devastating news. Blech.