Saturday, September 30, 2006

On Call

It is finally fall here. The air is crisp and the colors are starting to deepen into bright reds, oranges, and yellows. I cannot believe that tomorrow starts October. I'm doing my vacation penance by taking call for myself and OtherDoc for the next two weekends. This is actually an improvement from my previous situation, where I was taking call 24 hours a day, every day and every weekend. I finally convinced other doc to do call sharing for the weekends. It only took a year. (!) Last night was a late night. I had two laboring patients. One was a nurse on the L&D floor, so her entire shift was in the room being "support people." It was hilarious, and so nice to see how much they cared for their co-worker. Even more interesting, she had her older child in delivery with her. This kid is pretty bright, and has accompanied her to multiple prenatal visits with great interest in the baby. However, this child is only about 7 or 8 years old. I was a bit taken aback that they were going to be there for the entire process (I think birth can look pretty scary to a kid!) but, it was her labor and her choice, so I just went with it. The child handled the situation extremely well, and even cut the umbilical cord! Best quote of the afternoon, though was the exclamation shortly after birth "Look at his {insert crude slang name for testicles}!" I guess a kid still has to be a kid, especially in such an intense situation!

My second laboring patient was the one that I worried about. After so much time being an OB, you can start to get a sense of the patients that are probably going to necessitate a cesarean delivery very early on in their evaluation. It comes down to simple pelvimetry, usually done on the first prenatal exam. Now, much pelvimetry has sort of fallen by the wayside as far as actually measuring out diagonal conjugates, etc., but, with experience, it is easy to identify women with a narrow pelvis as more likely to end up with a surgical delivery. Regardless of my clinical opinion, which I do keep to myself, I believe every woman needs a shot at a vaginal delivery, as our bodies are generally designed to give birth. I have definitely been proven wrong before with respect to who will and who won't deliver vaginally.

At any rate, my second patient laboring yesterday was a patient whose pelvis was borderline narrow, meaning that all of the labor stars needed to line up just right to achieve a vaginal delivery. She was just past due, measuring 2 weeks larger than gestational age, and dilated 4 cm. We admitted her for augmentation of labor after no cervical change in one week, continued contractions, and elevated blood pressures. So far so good, right? Her water actually broke on it's own about 8 in the morning, filling the bed with about 3 gallons of fluid! After her membranes ruptured, the baby, while still reassuring, was not as reactive as I would have liked. We started an amnio infusion and low dose pitocin, as she was only contracting every 7-8 minutes, and waited. Her progress was excrutiatingly slow, yet she progressed with every check...Centimeter by centimeter. Around 7 in the evening, mom's temperature started to creep upwards, sending the baby's heart rate from the 140-150s up to the 160s. She was 9 cm dilated and about zero station, the baby was starting to develop caput. The strip, while moderately tachycardic, was still reactive, so I tried to let mom get to complete so that she could start pushing. It was not to be. Mom's temperature zoomed up above 101 degrees, and the baby's heart rate raced into the 180s. It was time to get the baby out. We went emergently to the OR and delivered the baby by stat cesarean section. It weighed a mere 9 pounds 10 ounces. I'm not sure that she would have been able to deliver vaginally at all! Today, both mom and baby are doing great. No more fever, and baby has no lingering effects of distress, thank goodness. Despite my best efforts, this patient ended up with a cesarean delivery, but she also ended up with a healthy baby. I think it was an equitable trade off.

Wish me luck for the rest of the weekend, I'm hoping for just a few hours of uninterrupted sleep and some quality time with Mr. Whoo and CindyLou Whoo. Have a great Saturday!

Wednesday, September 27, 2006

Weird Wednesday

Wednesday is my surgery day, a day to be in the OR and out of the clinic, and, therefore, it is a day to which I look forward every week. I had particularly high hopes for this Wednesday because my large and rather complicated surgery had to be postponed, shortening my day considerably. Alas, this day, while not particularly awful, did not go as planned. I was awakened at 3:45 this morning to my daughter in the midst of a nightmare. Her whimpers subsided within a minute, and no move from the bed was needed, but I spent the next 45 minutes worrying about her. Needless to say, I made up for that lost sleep by hitting the snooze a few too many times, and that resulted in not having enough time to shower. I also noticed, as I hastened to get ready, that my ring finger looked particularly swollen. The rest of my fingers were fine, so I slammed a bottle of water, iced the finger on the way to work, and prayed that I would be able to get my rings off in time for surgery. The swelling had not decreased by OR time, and I practically had to flay the skin off of my finger to remove my wedding band. The cause of the swelling appeared to be a tiny bug bite on the knuckle. It still has not decreased, though I wouldn't be surprised if I had additionally damaged the finger by forcing the ring over already swollen tissue. This was a most inauspicious beginning, and it was barely 8 AM.

The first surgery was a repeat section. It was complicated by masses of scar tissue, a new scrub tech who was not fabulous at first assisting, and difficulty delivering the baby's head. I am short, and I always have to have a standing stool for the OR. When delivering a baby by C-section, you have to give fundal pressure to deliver the head. When you are short, it is difficult to get a good angle and give enough pressure to bring the presenting part to the incision. I nearly had to use a vacuum to deliver, but I was finally (after what seemed like an eternity, but in reality was probably less than a minute) able to deliver the baby's head without assitance. The second case was a Hysteroscopy and D&C on a woman with post-menopausal bleeding. She also happened to weigh in the upper 300 pound range and was in possession of the longest vagina I have ever seen. I am not kidding. There were no speculums available that could adequately expose her cervix. I had to improvise with two different speculums to even visualize the cervix. The whole case was a struggle, and while I was able to see a couple of endometrial polyps, I was unable to completely resesct them. I didn't have instruments that were long enough to reach to her uterine fundus. I did the best that I could do, got an adequate specimen for pathology, and got the heck out of dodge. I really hope that she doesn't have cancer. We shall see.

Next, I headed to the office to dig out from beneath the mountains of charts that covered the expanse of my desk and filing cabinet. On Monday and Tuesday combined, I saw a total of 90 patients. I charted on about 15 of those 90 during clinic because I was so slammed, and I think it rather rude to be writing the chart while the patient is speaking. I may have to rethink this strategy. It took me no less than 4 hours to complete the charting, sign off the gazillion labs that needed checking, and complete several different types of bureauacratic paperwork (FMLA papers, prescription approvals, etc. etc.). I still have more discharge summaries to dictate. How do you physicians out there keep up with all of the paperwork? I feel as if I am drowning in forms and papers.

Then, tonight, strangest of the strange, my little one, my baby that has been sleeping in her own bed through the night since 3 months of age (no throwing stones, please?), did not want to go bed. She acted as if she were afraid. I thought back to this morning's bad dream, wondering if this could be the cause. She didn't want me to leave, so I lay on the floor next to her crib, holding her hand for about 20 minutes. Finally, I turned on a night light in the bathroom adjoining her room, and left the door open. She whined a little bit when I got up to go, but settled down quickly. I hope that this is just a fluke and not the beginning of a phobia of the dark or of bed. I did rock her in the chair tonight, and her body is so long! I can't believe how much she has grown. I can't believe I'm crazy enough to contemplate starting all over again. I can't believe that it is almost 10 pm and I still haven't showered! ICK! Off to de-grunge.

Monday, September 25, 2006

My Very First (and probably Last!)

Wow, my first meme! I've been tagged by Tundra Medicine Dreams to write about seven songs to which I am currently listening. My first response was "Just seven?" You have to remember that I've spent a great deal of time in the car on multiple road trips in the last month or so. I really love lyrically driven music, so the songs I have on heavy rotation tend to have lyrics to which I relate strongly. I think this post is going to be long, and I'm not sure that I even know 7 bloggers to tag! Eeek. I think maybe I just won't tag, and instead fill seven people's blogs worth of info into mine. It will save us all a lot of clicking.

Panic! At the Disco "I Write Sins Not Tragedies" A Fever You Can't Sweat Out
I'm pretty certain that this song is being played into the ground on the regular radio, but since I rarely listen to the local radio, I've been spared. There is something about the PATD boys that reminds me of the more theatrical 80s bands. I really like the upbeat tempo, and the lyrics to their songs are generally clever and unique. The phrasing of the chorus (sans the unnecessary profanity) is the hook for me. This song tends to repeat a little more than I would like, if anything. It leaves me wanting more meat to the lyrics. Of course, the obvious reason I've been listening to this song is because I have just attended two back-to-back weddings, and have the lyric "What a beautiful wedding! What a beautiful wedding, says a bridesmaid to a waiter" stuck in my head. The unfortunate verse that follows the lyric is that "And yes, but what a shame, what a shame, the poor groom's bride is a whore." This is totally not true of either of the brides, so I had to contain myself from singing the song in their presence, lest I offend them! You know, now that I think of it, between the use of "G-d"and the subject matter, this is a really offensive song...but I still like it. What does that say about me? Hmm.

Guster "Come Downstairs and Say Hello" Keep It Together
I don't know how many Guster fans there are out there, but Keep It Together is one of my all time favorite CDs and is in my CD player at any given time. I used to skip this song because it starts out really slowly, and I'm not generally into slow songs. On one of the many recent road trips, I zoned out whilst driving, and tuned back in to the song when it started to pick up tempo. The lyrics have something to do with the Wizard of Oz, ruby slippers, and "voices calling from a yellow road." I'm not deep enough to really understand that layer of lyrics, yet. I do tend to be a lyric hound, however, and the lyrics "To tell you the truth, I've said it before, tomorrow I start in a new direction. One last time these words from me, I'm never saying them again." really spoke to me and to my life of constant "do-overs." I always start with the best of intentions, and when I inevitably fail, I psych myself anew for "tomorrow." I'm in the midst of "Project: Improve Dr. Whoo," so I am motivating myself with this song...again.

Edwin McCain "Cleveland Park" Misguided Roses
As mentioned in the previous entry, we were drunk, singing "The Rhythm of Life" on the way home from a rehearsal dinner, which is on the same CD. (One of his best, in my not so humble opinion.) I had actually started listening to this song last month en route to my "girly weekend." I hadn't listened to the CD for years, and I played it on a whim. Have you ever forgotten how much you love a song? I heard this song, and remembered how much I loved it. Even more embarrassing, I got so caught up in loving the song that it made me cry and I was driving down the interstate, streaming happy tears, voice cracking as I sang along with the lyrics. What. A. Tool. The line that got me (and always has) is "There' a lifetime out there somewhere, somewhere in the dark."It brings me right back to the time in my life that I first bought the CD. I was in medical school. I had just met my future husband. I was living alone in a scary, big city. I had no idea what my life held for me, but it was out there...somewhere in the dark. Cue the tears. I'm a big mushy mess. Ok, enough of being lame, on to the next...

Counting Crows "Einstein on a Beach (For an Eggman)" Films About Ghosts: The Best of Counting Crows
This is another of my All Time Favorite CDs, and one I would have to have on a desert island. I could mention at least half of the songs on this CD, but "Einstein" has a special place in my heart because it was one of those songs (back in the pre-iTunes era) that you used to get so excited about when it would come on the radio. I don't know exactly when this song came out, but I do know that it was getting radio play when I was college (i.e. the Dark Ages). I think it must have been on a movie soundtrack, because I looked for the single off and on for years. This is another upbeat song (surprise) with cool lyrics. I fear I'm becoming predictable, but the line I love from this song: "What you fear in the night, in the day comes to call anyway. We all get burned as one more sun comes sliding down the sky." I heart the Counting Crows.

The Fray "Over My Head (Cable Car)" How to Save A Life
Yet another over-played radio song that I adore. For me, I tend to pick anthems for different stages in my life, and these anthems tend to be songs that are in the background all of the time, sort of like a soundtrack. For example, graduation from medical school era = "Drops of Jupiter" by Train. Graduation from residency = "Speed of Sound" by Coldplay. First year out of residency on my own = "Everyone knows I'm in over my head, over my head." Seems appropriate, doesn't it? I sing this song really loudly and with abandon in the car, drawing askance glances from my fellow motorists. What can I say? It's cathartic...and true.

Goo Goo Dolls "Broadway" Dizzy Up The Girl
A third album on my favorite CD list. This song actually reminds me of going to take USMLE Step 1, because I listened to it on repeat the whole drive to and from the testing center. The whole CD has a little bit more of a rock edge to it, which is out of the norm for me. This is another "sing loudly and off-key in the car" song for me. To tell the truth, I'm not sure why I love the song as much as I do, but right now the line that is speaking to me is "It always rains like hell on the Loser's Day Parade." I think this is funny. I am such a pessimist some days, and this song cheers me up and makes me stop taking myself so damn seriously.

Sister Hazel "Champagne High" Fortress
Yet another wedding-inspired song. I admit with just the teensiest bit of chagrin that I may have been, at one time, the biggest Sister Hazel groupie on the planet. (I still like the band, but I'm now in groupie recovery.) In college, they were just starting to make a name in the college music scene when my sophomore roomies and I heard them in a local bar and were in instant (read, scary fangirl) love. We actually talked with the band members quite a bit, they ate dinner with us at our sorority house a few times, and we would go pre-(and post-)party with them before their shows. We were shameless groupies, but we were always on the VIP lists for concerts whenever they came in town. I still remember the first time they played this song live, thinking that they were going to be "big-time" and we would hear them on the radio. About a month later, that thought became reality. The song is about being single at an ex's wedding, and while being happy for them, looking back and wondering what might have been. It may very well be the best karaoke/drunk song in the entire world. This is why it is still in my CD player...more drunk, post-wedding singing. (Are you picking up on the general theme, or could I be more transparent?)

Ok. Whew. Anyone still reading??? Have a good night!

Saturday, September 23, 2006

The Rhythm of Life

Just enjoying another wedding rehearsal, driving home, singing at the top of our lungs several different songs, and these lyrics just never fail to speak to me. I had to post them on the blog to get them out of my head! Happy Weekend!

The rhythm of life
Heaven withstanding and smiling we're all swept away
The rhythm of life
Is not so demanding as some caught in narrows would say

Fragile as ships as we pass through Gibraltar
The sirens have long given way
Dark as the murky graveyard of sailors
Whispering secrets told in the crashing waves

The beating of hearts
Set walls to trembling the power of silence persuades
The stumbling feet
Stagger predestined we all end up wild eyed and crazed

And from the madness most jaded of vision
Reflections of horror invade
Running and falling relinquish your venom
The antidote surely will cause your affliction to fade

How little we know of what we are blessed with
Our shimmering island it turns
How little we look at what we see clearly
Of tragedy's lessons not learned

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

The rhythm of life, how little we know of the
Rhythm of life
How little do we know of the rhythm of life.

~ Edwin McCain

Thursday, September 21, 2006

Going Home

One day, I am going to be independently wealthy, so that I can throw my daughter a swank wedding like the one we attended on Saturday evening. It was an absolute blast! I personally think it would have been great fun if it had been at a McDonald’s, just because of the company, but the perks (like the fantabulous dessert buffet) were not to be surpassed. Not to mention that Damon Wayans, Rocco DiSpirno, and freaking Nelly (and his black Lamborghini) were staying in the same hotel as we. We ate too much, drank just a little too much, and laughed until we cried. It was everything a wedding should be and more, and I wish the bride and groom a wonderful and relaxing honeymoon.

We have arrived at yet another stop on the September 2006 wedding tour, my parents’ Florida home. Once upon a time, it was my home as well. This house is the closest thing to a childhood home that I have. Growing up, my father was in the Navy. We moved approximately every 2 years, which wasn’t exactly easy on me. I had to make so many new starts, new schools, new friends, and I eventually learned to reinvent myself with each move. By nature, I’m told, as a child I was brazen and very outgoing. I had no qualms “performing” Christmas carols a capella in front of restaurants full of people. As I got older, while I was forced to be outgoing and receptive to new people and experiences, I became more and more of an introvert. I’m not really sure how this happened, but, over time my innate open nature became something only those that were very close to me could see. Outwardly, I was more reserved and quiet. I moved to this house when I was 13, and being here now, with my small child feels so strange to me.

Last night I sat with my daughter, reading to her and tucking her in to sleep, in my former bedroom (usurped by my younger brother once I moved away from home). My brother has since moved away from home (finally, but that’s another rant for another day) so it is littered with the remnants of his childhood/adolescence, deemed unsuitable for his new bachelor pad. While it is no longer decorated in the same way, it was still the same place that I dreamed my teenage dreams, got ready for proms, and snuck in and out of the back window. This house reminds of being tempestuous and rebellious and so much more of a “bad” good girl than my parents ever knew. I guess more than anything, this house reminds me of who I thought I was going to be, more than it reflects who I have become, much like my little girl reminds my parents of a little girl that they once raised. In my parents’ eyes, I will always be the little girl in pigtails, and I know that I will feel the same way about my daughter. In this house, I will always remember the promise of what there was to come, and the realization that what has transpired in my life is so much greater than I could have even imagined.

Geez, enough of the heavy introspection! On a lighter note, the other thing I had forgotten is the freaking HEAT! (The heat, my God, the HEAT!) I miss my seasonal September weather already. (Mrs. Mom, I had forgotten just how bad it is here!) I also had forgotten love bug season. We were driving along on a perfectly sunny day, with the patters of, not rain drops, but squished love bugs all across the windshield. Ick! I am just so happy to visit Florida instead of live here anymore. The local newspapers are plastered with the story of my football team’s recent embarrassment (Effing Jeff Bowden!!! Luckily, I didn’t have to sit and watch it, as I was consuming far too many apple martinis at the aforementioned swank wedding). They are also full of news of the people with whom I once attended high school. This town is a vortex, it sucks you in, and very few escape. I am so happy that I have moved on from this town. In a convoluted way, leaving this town was the only way that I could ever appreciate it. Today we went to breakfast at a small, favorite local restaurant, and then we played at the beach and finished the day at the pool. When I lived here, I never went to the beach, and never took advantage of the pool. So for the next few days, I may not be blogging or bitching. (It’s strange, I know!) Not to worry, I’ll be back in the saddle at work soon enough, the next vacation is months away (January) and I’ll have lots of doctorly angst and snark to share. Like it, or not. Have a great week!

Friday, September 15, 2006

The Griswolds take Atlanta

Yesterday we loaded up the family truckster and headed southward to the ATL for our good friends' wedding. If you've never experienced the joy of a nine hour car ride with a cranky toddler, then you've not lived! Bless the person that devised the portable DVD player; it was the only way we could have made it. We survived a water soaked car seat and chocolate milk-stained clothes (good idea, Dad), and countless rounds of "Twinkle, twinkle Little Star" and the "ABC song." We arrived, bedraggled, me in scrubs with "L&D" emblazoned across my ample posterior and not so ample left breast pocket, Mr. Whoo in track pants and shirt, and CindyLou Whoo (just a little more than 2) in a non-matching football jersey and capri pants (thanks to the great water vs. gravity experiment) one pigtail in, one pigtail halfway down the side of her cute little head. Just where did we arrive, you ask? Well, only at one of the more swank hotels in downtown Atlanta, with valets, chandeliers, and a room rate that is usually in the ballpark of $500 a night (we had a significantly reduced rate because of the wedding). All of the people in the lobby were dressed in suits and designer finery. Our friends were waiting in the lobby for us, equally as shabby, feeling equally out of place. It is strange, our group of friends are all young professionals. We have three doctors, three MBAs, a clinical psychologist, a general contractor, a banker, and a recent law graduate among us, yet, when we get together, we act like college freshman! For example, last night all of the boys stayed up in one of the swank ballrooms, playing cards, until 5 am. On their way back to the rooms, they swiped two large obelisks and one jam filled ceramic hen, placed them in bed with one of the more sensible people that went to bed before 5 am and took multiple pictures. I'm shocked we've not been kicked out onto the street! What's even worse is that I really love the way our group can be when we get together; it is never boring, for certain. Here, we truly are the "backwoods relations."

Being in the city only reminds me of how unsophisticated I am, and it also brings to the forefront the realization that I am totally ok with my level of sophistication. We truly are suited to our small mountain town, and being here in the city crystallizes that notion. I hate the traffic, I hate the $500 purses, the $600 shoes, and the attitudes of those that surround us. I love the simplicity of our quiet life, far removed from the rat race, the Prada bags, Jimmy Choos and soy lattes. It is wonderful to have found our place in the world so young. For now, we'll settle for being the tacky tourists, tooling around Atlanta in our shorts and t-shirts, gazing up at the sky scrapers, and being ridiculed by the hotel staff. To pretend to be anything that we are not would be far, far worse.

Monday, September 11, 2006

Five Years

Five years ago today, I was a harried and hurried OB/GYN intern, the only intern on the OB floor. Rounds ran long because of a long patient census, and we were late getting over to Labor and Delivery to "run the board" (aka, check on the laboring patients). I had four laboring patients, three patients to see in OB triage, and a 30 week pregnant woman just involved in an MVA on the way into the ER. I was just about to check on my first labor patient when the charge nurse came out of a patient's room. "A plane just crashed into the World Trade center!" The sarcastic comments followed, ranging from jokes about air traffic control to what substance the pilot was smoking. It mildly piqued my interest, but to tell the truth, I hadn't the time to sit and ponder the significance. I was halfway through my triage and labor checks when the second plane hit. Then, we knew, this was no accident, and I, like everyone else that day, was scared about what this meant. Ever in constant motion, I caught what updates I could from the patient's TV screens, as I went about the routine business of histories and physicals on a most unusual and frightening day. My chief resident and I went together to see the MVA patient, it was merely a fender-bender, no real trauma, and we hooked her up to the labor monitor to look for contractions. She gasped, suddenly, eyes wide in disbelief, locked on the television mounted on the wall in the corner of the room. My chief and I turned, to see the mighty towers collapsing into dust and rubble. I don't know how long we sat and stared, silent.

The rest of that day is a true blur. I delivered eight babies between 9 am and 5:30 pm that day, four inductions and four natural labors. I distinctly remember one young patient, just 17, crying after the delivery, not tears of joy or even pain from labor, but of sadness and terror. I couldn't help but think that the baby boom that day was simply a surge to replace the souls so tragically lost. I think the unit had a total of 11 deliveries that day. This year, they are already five years old, nearly ready for kindergarten. In the days that followed, I was morbidly fixed to the TV and the news. My husband couldn't tear me away. I couldn't stop watching. It lasted for about 3 months, and then the shock was not nearly so fresh, and I could watch non-news programming once again. Tonight, my husband is watching the commemorative movie on television. I have no desire to see any films about that day. I don't get why five years is the magical number for it to be permissible to start turning a profit on such a terrible day in our lives and the lives of the victims. I could barely sit through the previews of United 93 without bawling. I don't need a reminder of the tragedy, as it is indelibly burned into my memory. I was fortunate that I did not lose a loved one or a close friend, and for that I am grateful. But we as a nation suffered the loss of, not only the lives of the victims and the heroes of that day (in itself a staggering loss), but the loss of life as we had so complacently come to know it. We lost innocence and we lost feeling secure, and I'm not sure that we will ever feel the same way as we did five years and one day ago. Today, I, like so many of you, will ponder in silence and return to the day when we knew things would never be the same. Today I will remember to never forget.

Saturday, September 09, 2006


It is amazing what a good night's sleep can do for your psyche! Mr. Whoo took toddler duty this morning so that I could sleep in, and what a difference it has made. I set off for the hospital around 10:30 this morning, and on my way in to the building, I was stopped by two different people, both of whom made the brilliant observation that I "sure {am} at the hospital a lot!" Natch. "It's my home away from home," I snarked back, realizing the painful veracity of that statement. I got all three of my patients seen and set up for discharge home. I pumped the nurses for info about a high falutin' dress store and got a recommendation from one of the day shift nurses. She is outspoken and blunt and pretty hardcore, but she's a really wonderful nurse. Her clinical instincts are consistently spot on, and I trust her completely with labor assessments. Have I mentioned recently how much I love nurses? Because I do. Nurses are great! She must like me, because she even looked up the phone number to the shop, called them to ask their hours, and told me the directions to get there! Her dress shop instincts are every bit as good as her clinical instincts. I walked into the store, got directed to dresses in my (gigantic) size, and picked a dress off the rack within 10 minutes. I think it will be perfect. It is a long black gown with a beaded detail bodice, spaghetti straps and a shoulder wrap. It is an A-line shape, which hides all of the post-baby body lumps and ever-present chunky thighs. I think I may be a bit pasty in it (read, white as a sheet) but all-in-all it fits well, is appropriate, and I feel pretty wearing it. (This is an accomplishment, folks!) I still have to get it taken in and tailored (I am pear-shaped and short!) so it's not completely done yet. As for the second wedding's dress, I think I am going to wait until I get down to Florida to buy it, since all of the fashions here are not going to be appropriate for an evening wedding on the beach! Even though I'm hating my body right now, it's nice to know that I can still look pretty. Even with all of the food debauchery this week, I'm only up one pound. Go me. Break out the pizza rolls to celebrate! (Just kidding....?)

In other exciting news in my life, I have discovered yet another fabulous time suck. Fish Tycoon. Most addictive game I've played since SimCity. Yes, I am one of those people who would get up at 3 am to see if I had enough money to buy a park and build a subway. Essentially you buy fish and breed them and sell them and furnish your aquarium with cool decorations. The object is to breed seven magical fish, and let me just tell you that I am a fish breeding master. Between myself and Mr. Whoo, we have found four of the seven so far. (Big geek = me.) The bad thing about the game is that it runs even when you aren't playing it, so if you don't feed your fish for so long, they get hungry and die! It's a good thing that I never had an inclination to try drugs, because I think that I may have an addictive personality. I may be one of the only people on whom the "Say no to Drugs" campaign truly worked. So today, between finding a dress, playing with virtual fish, and lots of good college football on TV, I am, once again, a happy camper. I'm updating my blog roll with a couple of new sites. Check them out, and thanks for stopping in and reading my mindless drivel. Now if I could just get started on the laundry...

Friday, September 08, 2006

Chaos, inside and out

What a crazy week! I'm still swimming, but it seems that the water is rising rather quickly! Forgive the rambling nature of this post, but try to remember that it is coming from someone who tried to put deodorant on her toothbrush this morning! Where is my brain? Often a "short" work week in our office means a couple of long days to play catch up. I'm not sure what it is about some patients, but they seem to really lose it if they are unable to talk to someone in the office for more than two days. I got paged all day long on Labor Day for insignificant minutiae that totally could have waited one more day. Maybe I'm just being bitter again, but I would just never page a physician at home on a holiday at 10 pm to talk about my "constipation" (once every other day, for the curious) woes. It truly boggles my mind. Maybe it is DMS, but people have really annoyed me all week long!

The week started on a high note with the win that FSU eked out over Miami. Neither school looked stellar, and I dread the coming season with our "offensive" coordinator at the helm. Of course, I stayed up way too late to watch the whole thing, overslept, and was almost an hour late rounding and getting to the office. From there I was jam-packed with patients all day long on Tuesday. I never stopped moving between the hours of 8 am and 7 pm. I'm not sure how it works in other private OB/GYN offices, but I know that seeing 40 patients in a day is almost more than I can handle. My partner sees twice as many some days (and his patients end up waiting 3 hours in the waiting room), and I have no idea how he pulls this off. He must not chart at all. My little one played in the office with my nurse while I finished charting. Poor thing, I hope she doesn't grow up feeling neglected. Tuesday night was spent dictating pre-op charts. I think that I put some laundry in the washer Tuesday night.

Wednesday was a big day in the operating room. Two hysterectomies and two c-sections. Talk about swinging between the extremes of a woman's life! I lucked out and got another physician to assist me on the (rather difficult) hysterectomies. It makes all the difference in the world to have an experienced assistant. On the first section, once the baby was out and the student and I were repairing the uterus; we noticed a bizarre hematoma on the top of the uterine fundus, well away from the incison site. It expanded to about the width and breadth of an adult thumb and then spontaneously ruptured and bled like crazy! We eventually got it stitched up and hemostatic, but it was like nothing I had seen before. My second section was for pre-ecclampsia and frank breech presentation. The patient and her family are extremely nice. She also happens to work in the hospital, and her family member is on the hospital board, so no pressure there! We actually had to do the surgery a week earlier than planned because of her worsening symptoms. Her pressures really never got much above 150s/90s, but her standard pressures are 90s/50s so it was a significant elevation for her. Luckily the early baby (a girl) had fantastic lungs and never had a bit of trouble with the transition from womb to world. In retrospect, Wednesday was a pretty good day, but ever so exhausting.

Thursday clinic was more of the same left over from Tuesday. If I have one more pelvic pain patient come to me with codeine, aspirin, and Tylenol (ha!) allergies, I am going to scream. I have only been here a year, so I know that I am considered "fresh meat" for the pain seekers. You can pull up these patients' med records on the hospital computer system and see dozens of ER visits for vague "pain" related issues. Thousands of dollars are wasted on unnecessary work-ups on these people, not to mention all of the wasted time and personnel, going through the motions with these leeches when there are honest-to-goodness *sick* people to be seen and attended. What they don't know is that I *so* was not born yesterday, and I do not play the narcotics game. At all. The strongest pain med they get from me is Naprosyn (prescription strength Alleve). If they require more than Naprosyn, then I offer them exploratory surgery. One of the patients actually exclaimed to my nurse as she was checking out, "Naprosyn? That's it?" It is unbelievable the things these people will pull to get narcotics. What is even worse is that some docs hand them out like candy. Can you tell this is a hot-button issue for me? It makes my blood absolutely boil, and I had more than my share of them this week.

I found the mildew-y laundry, still in the washer, this morning when I was frantically looking for underwear. My house is a sty, and the cleaning babes just came on Tuesday! I had a "short day" in the office, my last patient left at 2 pm. I spent the hours between 2 and 4:30 catching up on office charts and sorting through labs. I am on the bad girl list for discharge summary dictations, so I have to get those done this weekend or I can't schedule any more surgery. This weekend I also have to find, not one, but TWO different formal dresses for upcoming back-to-back "black-tie optional" evening weddings that will cover my gargantuan ass. In Mountainville, USA, where "High Fashion" is found at the local Elder-Beerman. I can't wear the same dress to both because the weddings are in the same circle of friends, and everyone will be at both weddings. Don't even get me started on the size of my ass. Exercise has become a four-letter word and my husband and I have both been "off the wagon" all week long. I shudder to think about what my cholesterol and blood pressure are doing at this very minute. I had to cancel my appointment with my own doctor because I have too many patients of my own to see on the day that I had scheduled. In a way, I am glad, prolonging the inevitable. You could say that I'm stressed. Thus, I am going to spend tonight stretched out on the couch.....after I start the laundry for the 3rd time this week. So how was *your* week? Are you up to the challenge? ;)Hopefully a little sleep will chase these grumpy demons from my psyche and I'll be fun and interesting again soon! Good night, 3 readers of mine!

Monday, September 04, 2006


Oh. Hell. Yes. That is all!

Labor Day Labor

All last week I joked with my nearly due patients that I would see them on Labor Day. This joke is inevitable in OB/GYN, and yet, every patient that comes up with it believes that they originated the idea. I had a wonderfully relaxing weekend, despite being on hospital call. My office is closed today, but somehow I just knew that I wasn't going to get away with a true 3 day weekend. The better part of last week, I was focused on buying one of my patients, PreTermMom, just a few more days of pregnancy. She has a history of two prior term deliveries, however, she had pre-term labor with both of the prior pregnancies. This pregnancy, too, was plagued with pre-term contractions amongst other complications. She has been in and out of the hospital, on various tocolytic regimens, but all medications were stopped just recently. My personal goal was to keep her pregnant until she hit the 36 week mark. She fell just a day short of this goal. Her water broke around six this morning, and I got a good morning wake-up call around seven from labor and delivery. Not willing to be burned by a precipitous delivery again, I dressed, showered, and got to the hospital within 40 minutes. It turns out that I didn't really need to rush today, but had I taken my sweet time, I just know that baby would have been out in the bed before I could get to my car!

PTM was having intense contractions, and really hurting through the peaks. She really didn't want to move around very much, but she happened to roll to her right side during one contraction and the baby did not want to go there! She had a 5 minute deceleration to the 90s, and for a few heart-stopping seconds, I was afraid that I was gong to have to rush her back to the OR. Luckily, we found a position that the baby favored, and the heart rate returned to normal. She requested IV pain medicine, which seemed to take the edge off of the pain, but it also slowed her contraction frequency. She was 4 cm on admission, then 5 cm, then 5-6 cm (the repetitive checks were due to her constant sensation of pressure and the need to push). I think that the mere scent of pitocin hanging in the room was sufficient for her to turn the final corner; I don't believe that it even reached her IV.

Right at the time that she was ready to push, her husband began to get ill. He was gagging and trying not to vomit, yet he stood valiantly at her side, not running for the bathroom. Poor guy, labor can be pretty gross if you stop and really think about it! Just three pushes, and the baby was really crowning well, stretching the perineum. Since the baby was tolerating the labor well at this point, I helped things along with perineal massage (not super-popular these days). She had a history of a significant 3rd or 4th degree laceration with a previous pregnancy and was very leery of another tear. Thanks to a small baby and a controlled second stage, she had but one small vaginal tear that required one stitch. Though small, the early baby was pink and screaming as she entered the world, and her birth time was in double numbers...good luck! This small baby was due in October, tried valiantly to be born in August, but compromised on September. In the process she gets to have a pretty birthstone (Sapphire) , and her parents get to have an actual Labor Day labor story. What do I get? I get to write off this day as an "un-used" holiday, and, even better, to extend my upcoming vacation by a day without using precious vacation time! Woot! Now if we can only manage four quarters of football without embarrassment and, perchance, win? Then all will be well in my little corner of the world. Happy Labor Day!

Sunday, September 03, 2006

It's the most wonderful time of the year

College football season has arrived. I awoke on Saturday every bit as giddy as a child on Christmas morning. I drove to and from the hospital listening to the local radio station hyping the game in NearbyUniversityCity with a silly grin plastered across my face. I arrived back home to a Tivo'd College Gameday, lots of snacks, and a full afternoon of college football gluttony. I was raised by college football fanatics, and, in retrospect, I realize that I never had a chance to be anything but a fanatic myself. My high school won the state football championship my freshman and senior year and went to the playoffs during the intervening years. I went to a major college football power school during it's glory days. Football Saturdays kicked off early in the morning with pitchers of bourbon and Coke and beer. Each Saturday night was a victory celebration. The question was really never whether or not we were going to win, but by how much. I became a very, very spoiled fan. My entire adult life has been spent in or just outside a major college football mecca. I feel most at home in these places. (In other words, I don't feel like such a freak!) The interesting thing is, that wherever I resided, that particular team would win a conference or national title during my tenure there. The streak has continued, even to my current residence. The tides have since turned on my alma mater's football program, and apparently I have now become hell to withstand during their games. I yell at the TV as if they could hear me. I chant superstitious gibberish on each major play. I whine and moan about the coaching staff, and, even if it doesn't show, I love every minute of it. Luckily for me, Mr. Whoo shares my passion, and we are striving to pass it on to our daughter. I'm afraid she doesn't have a chance, either. So, this weekend, we are opening all the windows in the house, cooking up some chili, and I am praying for a less than 5 loss season for my team. They play for the first time on Monday night. I am scared. Go 'Noles!

Friday, September 01, 2006

Same due dates, different philosophies

It never ceases to amaze me, the range and experience of each individual woman's pregnancy and delivery. I know that it is a tired expression, but every delivery truly is unique. Since I am contemplating pregnancy number two, I feel hyper-aware of my patient population and everything that they experience. OlderMom and YoungerMom were due on the same day, but that is where the similarities ended. OlderMom was having baby #4, YoungerMom was having baby #2. OlderMom had a history of large babies and gestational diabetes. YoungerMom's pregnancy was complicated by first trimester bleeding and poor weight gain. YoungerMom wavered between VBAC and Repeat C-Section. OlderMom almost got forced into C-section by my unwitting partner. I delivered both this week, in very different ways.

I returned home to a frantic phone call from one of the L&D nurses. "Thank goodness, you're back!" she exclaimed. When I left, we knew that OlderMom's infant was measuring large for gestational age, a common complication with gestational diabetes. She had attempted to undergo amniocentesis for diagnosis of fetal lung maturity, but backed out at the last minute (fear of needles). The plan when I left was to induce her labor at 39 weeks, upon my return from vacation. While I was away, OlderMom saw OtherDoc for a prenatal visit. He ordered an ultrasound which showed fetal macrosomia (surprise) but he decided to schedule my patient for a PRIMARY C-SECTION the day I returned from vacation. My patient had 3 previously successful vaginal deliveries. Her largest baby was nearly 9 pounds. She had a very proven pelvis, and I was shocked that my partner would make such a decision in my absence. Luckily, the nurse that was doing her surgery intake realized my patient's reluctance to have a primary section and called me. I spoke with the patient, and she very much desired a vaginal delivery (of course?) so we settled on induction of labor. It turns out that induction really wasn't necessary, she was 4 cm dilated and contracting fairly well on her own. I observed her overnight, and once she was comfortable with her epidural early in the morning, we started a small amount of pitocin to increase the frequency of her contractions. She progressed from 4 cm to 10 cm in about 4 hours. They called me in from the office for delivery around lunchtime. OlderMom's poise amazed me as she sat upright in the bed, barely hurting and serene, with the baby's crown visible as I sprinted into the delivery room. I dressed and gloved for the delivery with my new 3rd year med student in tow. It was a textbook delivery. She should have been the Lamaze birthing video model! As soon as I was dressed and ready, OlderMom began to push. She pushed exactly one time and the head slowly delivered, crowning and controlled. The second push yielded a very large anterior shoulder (and an internal sigh of relief from me) followed by the posterior shoulder. The infant's body was delivered, as if in slow motion, and the cord clamped and cut by a tearful father. The nearly 9 pound baby was placed on OlderMom's bare belly, his cries heralding his arrival to the world. It was one of the smoothest deliveries I have done. She had but a small perineal laceration that required no stitches. A triumphant failed C-section, and I was so happy to have arrived back in town when I did.

YoungerMom sat in my examining room on the self-same day that OlderMom delivered, debating her course of delivery. Her first pregnancy was delivered as an emergent cesarean section for prolonged second stage and fetal distress. She was asleep for the birth of her first baby, and didn't get to hold the baby for 5 hours after the surgery. This was an experience she was not anxious to repeat. As I have mentioned before, I am one of the few docs around here that will staff an attempted VBAC. I have fairly strict guidelines to which I adhere, in order to have the best possible outcome. One of these guidelines is that I do everything I can *not* to induce women desiring VBAC. Not only do induction agents increase certain risks associated with VBAC such as uterine rupture, I truly feel that a natural onset of labor is one of the best case scenarios for a successful VBAC. This logic boggled YoungerMom's mind. She wanted a baby before her due date, because her older child was starting school. She wanted to VBAC, but on her own schedule. I was firm in not allowing an induction at her current dilation and desire for VBAC, so she settled on the predictable choice, repeat cesarean section. This struck me as an oddity, because women who are committed to VBAC will usually do anything to enhance their chances of a vaginal delivery. We proceeded to a repeat cesarean section. The surgery was easy. The infant cried even before the body was delivered. Mom was able to see the baby as soon as she was delivered from the womb. The baby scored a perfect 10 on the APGAR (a rarity in this hospital). Unfortunately, she developed a fever and was kept under strict supervision for the next few days. YoungerMom (another patient with the grating habit of calling me by my first name) said repeatedly as the surgery concluded, "That was so much easier than my last C-section! All I wanted was to see the baby when she was born."

Different delivery outcomes, different delivery methods, different women altogether, tied together by the common bond of motherhood. As different as these two deliveries were, I saw them as the same. Two mothers, wanting to glimpse their child's first breath of the world, to share in the wonder that is birth. I am so lucky and blessed that I get to help these women share these moments, however they are attained, with their newborn children, and I hope that I never become too bitter or overworked to remember why I chose this profession.