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.


Anonymous said...

Nearly laughing at my desk at "longest vagina I have ever seen".

When we returned from our trip this summer, my two year old son developed separation anxiety at bedtime. He was also a former champion bedtime guy, so this surprised us as well. It lasted about a week, and then he was back to his usual sweetly saying "Goodnight Mommy" as I leave the room.

Anonymous said...

I was a receptionist at an ob/gyn clinic and a busy day for any of our docs was 25-28 patients tops. The logistics of seeing that many people in two days just boggles my mind, you and your nurse must be completely wiped out. But, our busiest docs would chart at every available moment, if they had a minute between patients they were charting, lunch time charting at their desk while eating. I would have no idea how to do that with 45 patients in one day, if I were the one in charge of your schedule I would cry, how in the world do you stay on time? Toni in Oregon

Anonymous said...

On Monday and Tuesday combined, I saw a total of 90 patients.

Holy smokes! How is that possible?! Can you get anything done in 5 minutes with them? I feel for you right there... less people, less charting ;)

Anonymous said...

Been there, done those things! Try using 2 stacked standing stools until you get the baby out (I'm 5' 1"). Make your OR get the Snowman speculum from Cooper Surgical. It's 15cm long. Buy a copy of The Terrible, Horrible, No Good, Very Bad Day and read it to your baby. Enjoy.

Anonymous said...

Sorry, got the book title wrong. It's Alexander and the Terrible, Horrible, No Good, Very Bad Day by Judith Viorst.

Guinness_Girl said...

Ha - the showering thing reminds me of my marathons and adventures in baby-powder-in-the-hair during college. Oh, good times. Yet gross ones.

And the "longest vagina I've ever seen" reminds me of the time I called you after reading an article about (ew) someone's "vaginal lips" (EW!) being extraordinarily large. Do you remember that? I called you all in a tizzy, saying I had enough to worry about my butt and thighs being too big, and now I had to worry about DOWN THERE, too? Ha. I distinctly remember your pause (presumably to compose yourself) and then question, "Well, GG, are they...cumbersome?"


Sorry you had a rough day! I'm home sick today. Yesterday was spent in a sleep-filled haze, and today...I'm feeling guilty because I totally could have worked. Guilt be gone!

Sara said...

Ah man! I always said that if I went into a surgical specialty, then once I qualified, NO MORE STEPSTOOL FOR ME - everyone else can damn well bend over!

Fat Doctor said...

I, too, had a long vagina problem this past week. Thin patient, but I couldn't find it, used about four different types of speculum, brought in another provider for a try, and we finally gave up. We sent her to gyn, where someone like you will curse us.

Your daughter is probably going through developmentally normal nighttime separation anxiety. Keep up the normal routine laden with extra hugs and kisses and reassurance, and she should be fine.

As for the paperwork, don't ask me. I was up until 2 a.m. working on the *&%$# EMR. I think it actually takes longer than paper charts, because we are so tempted to be overly thorough with documentation.

dr. whoo? said...

3 carnations~ Thank you for sharing your experience with your little one! While we were on vacation she was also sleeping with me for a couple of nights and not in her own bed (no crib available), so I think she liked snuggling with mommy, too. She is better these last few days, we've been giving lots of extra snuggles and rocking in the rocking chair. So far, so good!

Hi Toni and welcome! Wow, 25-28 patients for a full day seems like absolute heaven! 14 in the morning and 14 in the afternoon? Awesome. To be fair, I usually don't have 45 patients scheduled per day, either ( more like 35-40) but the extra few were added in because I had been on vacation and they needed to be seen. My nurse and I were about to die. The hospital is in the process of getting us a medical assistant to help out. The volume is just getting out of control. I as much charting as I can between patients and always eat lunch at my desk and chart. Once I know I am earning my keep, maybe I can cut my schedule back a bit.

As for staying on time? Not so much. I'm usually just about 30 minutes behind the scheduled appointment. (They usually get into a room right around their appointment time, then I seem them just a bit later.) I know it is not ideal, but on the other side, patients are waiting upwards of 3 hours to be seen. It is ridiculous.

frectis~ It is damn near impossible! Most of my patients are prenatals or annual exams, so those are pretty fast, but I am also seeing 7-8 new patients a day and that takes more time. Once I can confirm that I am making as much as I am costing, then, I hope, we can cut the schedule back a bit.

anon~ Thank you for both the speculum and book suggestions! We are always looking for more bedtime stories. I will give the speculum name to my OR equipment supervisor. Great idea on stacking the stepstools, but how do you get down (without breaking an ankle) to hand off the baby? :)

Hi GG~ I *do* remember that fateful question! LOL! Too funny. I hope that you had wonderful days off! I also want you to know that I really miss your blog! Come back soon, 'k? :)

msilf~ Welcome! Your comment made me laugh out loud! I share that attitude, to some degree; unfortunately, even with the table all the way down, I still need a standing stool. Yes, I am *that* short. Bleah.

FD~ Hi! Thanks so much for the toddler advice. It is reassuring that this all could be developmentally normal and not because I am some kind of horrible parent. I never curse the family docs for those kind of referrals (unless the patient doesn't have a cervix at all!) I tend to look at it as a challenge. (This actually happened once, the lady had a hyst, her family doc couldn't find the cervix and sent her to me for a pap! That was priceless!) From reading your blog, it seems you do a lot of GYN procedures (colpo, EMBx, etc.) that other family docs would totally turf to an OB/GYN, so I'm sure your lady was legit!

As for EMR, it scares and intrigues me all at the same time. I can see how you could tend to over-document (better for billing, though!)

Anonymous said...

7-8 new patients in a day! Whenever we had a new female physician join the practice after six to nine months they were limited to three or four new patients a day so as not to overwhelm them. And running 30 minutes off schedule is not that bad considering how many patients you see in a day, think about scheduling some of those new gyn patients out further to give yourself a break, believe it or not they will wait if they aren't having problems or concerns. Toni in Oregon

dr. whoo? said...

Hi Toni! Ooooh, four new patients a day, 2 am, 2 pm. Sounds fabulous. I am working on the scheduling. Right now, on the half days I am seeing about 5 or 6 new patients, full days I have 7-8. I am trying to scale back, but I am in a small town and a female doc in a town full of men OB/GYNs. I'm booked for appointments through November and into December. Bleargh.

Thank you for all of your advice! It is nice to hear how other practices do this, since I've never been in the private setting before, I wasn't sure what to expect! Please keep the tips coming :)

Anonymous said...

So, last comment for this post and then I am done. As you are building your practice the best advice I can give to you from a receptionist stand point is start practicing now how to say "no". It's hard right now I realize because you don't want to turn anyone away, but you will do no one any favors if you are burnt out. I've just started reading your blog and I'm worried about you. Your schedule is punishing, not only for yourself, but for your staff and your family. So, start now in your head thinking about that dialogue that you want to say but also start thinking about the dialogue your front office uses to schedule your patients especially new patients. Oh yeah, and my experience was in a 12 doc ob/gyn clinic we saw between 200-250 patients in a day. I spent two years working the front desk and then two more years directly in charge of scheduling five of our providers. Two of those providers were part-time female docs who worked two and a half days a week each. We crammed full time pratices into part time schedules. They had to practice saying "no" all of the time, and it was very hard for them. Anyway, you don't need to publish this if you don't want to just one last bit of advice that will give you something to think about. Anyway I hope this helps. Toni from Oregon