Sunday, November 26, 2006

Water is Breaking All Over Town

I've decided that I don't like being OtherDoc for the week. I seriously don't know how that man functions with so many patients! This whole weekend has been overtaken by OtherDoc's patients, and I feel like I am a resident again with deliveries and emergencies around the clock! I got called away from Thanksgiving dinner to do an emergency surgery on a second trimester miscarriage that hemorrhaged half of her blood volume in the ED. What a terrible experience for this poor woman. She was OtherDoc's patient, scared to death, and she didn't know me from some idiot off the evidenced by her query, "So, have you ever *done* this before?" I guess I understand her concern, but criminy! She had already been started with a transfusion in the ER. The surgery went really well, and the source of her bleeding was a retained placenta. I kept her overnight to observe her blood levels, and fortunately they stabilized. What a horrible Thanksgiving for her, though.

The multiple hits kept on coming through Thursday evening, between the ER and OB triage, I think I was paged every 1-2 hours. Not very conducive to rest, I might add! Earlier in the week, I had gotten the early morning (5 am) bathroom report two mornings in a row from one of OtherDoc's patients, QuestionWoman. I was treated to a fantastical description of the appearance of QW's mucus when she wiped (clear with a few brown spots if you must know). I was thrilled beyond belief to tell this woman (not a first time mother, either) how normal she was, both mornings. Fast forward to 1 am on Friday morning when I got the ruptured water report, followed by the question of what to do? (Hmmm, I wonder?) I pushed back my jaded cynicism and tried to be a pleasant and understanding sleep-deprived physician. I put my very best phone voice on and urged her to get up to OB triage, and then silently prayed that she had peed. No such luck, the call came in from triage at 2:30 am, she was definitely ruptured.

CindyLou's daycare was closed on Friday, and in an unprecedented show of optimism, I had figured that I would be able to bring her to round at the hospital, then spend the majority of the day at home, having mother-daughter time. Well, that all went out the window with a labor patient, so I asked Mr. Whoo to take CindyLou to his office during my rounds, where I would pick her up in between rounding and delivering QW. I discharged the one patient that had the miscarriage, and got QW tucked in with her epidural right around 10 am. I was about to fly to Mr. Whoo's office to pick up the munchkin and get her home for lunch when I received the wonderful news that another of OtherDoc's patients was in triage with ruptured membranes. "That's funny!" I told the triage nurse, "Great joke." Only she wasn't joking. Ok, make that two labor patients. I called Mr. Whoo back and broke the news that it was he that got to keep CindyLou for the work day, and I felt terrible. He was his ever-gracious self, though. I love that man.

Long story, short, between the two labor patients and multiple triage visitors and admissions(some of whom were actually *my* patients), I was at the hospital until about 6:30 Friday evening. I got to see CindyLou for about an hour before she was ready for bed. I stayed up until around 10:30 or so, more just to decompress from the day than anything, and I then became as dead to the world. I was awakened by tiny fingers on my arm at 1:45 in the morning. In my sleep fogged brain, I didn't question the rarity of a middle of the night venture into our bedroom, I simply began to lift CindyLou into the bed...and then I touched something damp on her PJs. That smelled like vomit. (Mental note to self, do quick puke check on darling child *prior* to lifting her into your own bed and fouling your own sheets.) The poor thing had vomit all over the front of her PJ's. The smell was just a little too much for my super-sensitive nostrils, and it triggered my extra-sensitive gag reflex. Before I made my own mess, I handed her off to Mr. Whoo, composed myself, and set about cleaning the bed.

Vomit was *everywhere;* on her pillow, on the side of the bed, and piled on the floor. I couldn't believe that we didn't hear her puking on the monitor. I felt like a really bad mommy. Between the two of us, with Mr. Whoo dealing with most of the vomit clean up due to my constant gagging, we got CindyLou cleaned up, clothes changed, hair washed, her bed remade, and tucked her back into bed. Then we changed our own bed and puke tainted clothes, and were back in bed by 2:30. Cue the pager at 3:16 am. ( I am not kidding.) One of my patients (1 of the the remaining 2 due this month) was in triage, a mere 8 cm dilated. I was out of the bed, dressed, and back at the hospital by 3:45 am. The patient delivered her baby in about 15 minutes, and sustained a partial 4th degree tear in the process, despite my best efforts. Ah, there's just nothing like fixing a 4th degree on a woman without an epidural at 4 am. Fun times.

I finished the delivery, and dragged myself to the nurses' station to write orders, where I was greeted with more wonderful news that OtherDoc had yet another term patient in triage, who had (you guessed it!) ruptured membranes. I considered dissolving into a raving, sputtering heap at that very instant, but somehow kept it together enough to find out her stats and determine that I could, at least, go back home and sleep in my own bed for a few hours. I drove, zombie-like, back home, narrowly missed hitting a deer, and fell into my bed at about 5:15 am. At this point, sleep was fitful and disjointed, and punctuated with pages at 7 and 9 am. OtherDoc's patient was requesting an epidural, so I dragged myself out of bed and back to the hospital by 10:30 am. I rounded on a gazillion patients, admitted yet another one of OtherDoc's patients with ruptured membranes (are you seeing the pattern, here?) for a repeat C-Section, did the C-section, caught a baby, and made my way back home in time to watch my Seminoles blow opportunity after opportunity to beat the hated Gates. I don't think I did much more than stare blankly at the TV for the remainder of Saturday. I was too tired to even nap. Mr. Whoo is amazing, and he had the whole kitchen cleaned up, and even did laundry all day yesterday. He is Superman.

I had a few more pages for wanna-be labor contenders last night, but no further admissions, thank you, lord. I still have 7 or 8 patients to round on today, and 5 o'clock (when OtherDoc starts taking his own patients again) cannot get here fast enough. Unfortunately, I'll not have much of a reprieve this week. I have a few inductions, a few surgeries, and full clinic days looming ahead. Thank goodness for a weekend off in the not too distant future. I can't keep this frantic pace; I am getting too old for this!


Anonymous said...

Yikes. Sounds like the week that my doc had when he delivered my daughter. Imagine rural community hospital where it can go for days without a baby and then BAM they get hit with 4 moms post dates and 1 preemie with an emergency induction and severe pih all at once. They were all my doc's patients, lol. Well his and the midwife. They were running from delivery to delivery. Fortunately by the time I delivered, it had quieted down a bit for the night. Three patients delivered between 3 and 945pm. I delivered at 1140pm. Then I saw my dr running down the hall for the last patient at 430am. Poor guy and the midwife slept at the hospital in the call rooms. same thing happened a week later. Except he had patients in labor and now had to do an emergency d&c on me in between the laboring patients. It was chaotic. At least all the gyn/ob surgeries were off of the ob/maternity floor and everyone was on the same floor. They said it hits in cycles. Other doc must have planned his vacation for when all of his patients were due for you.

There are only three docs in my town. My ob comes in even on his off days if there is a problem. The only time he doesn't is when he is out of town. That doesn't happen a lot. I would have to say I would have been like the ER patient. Me, I check out my doc's credentials before seeing them. NY has a fabulous website for patients to do this with.

It's nothing personal against drs but I had a disasterous delivery with my first child where basically the dr abandoned me. I can't even tell you to this day who was in charge of my care. 10 days after being admitted and 7 days after being delivered, she finally came and saw me as she thought she could talk me out of leaving AMA. I said nope too late. Ivs are out, baby is here safe and sound. I'm off mag and not on any meds, I am leaving. I did followup with a different dr.

My own ob, I didn't trust him till after my daughter was safely delivered. He didn't abandon me and watched me like a hawk. He even had his nurses calling me at home when I was on bedrest to check on me and get bp readings. I never had any L&D nurses check me. He did everything. Mine was an emergency induction and the hospital has a policy that the dr or midwife has to be at the hospital/hospital campus from the start of the induction till 2 hours after delivery. I had to get past the period of delivery before I could trust him. It's sad because he is a really good dr and is kind, considerate, and is just a good doc. He can usually tell patients what they are thinking before they say it.But I had to get past that point. Now that I am and have been through a high risk pregnancy, emergency delivery, and 2 surgeries with him, I wouldn't consider anyone else. Speaking of which I should ask him what his vacation plans are in 2008 cause I plan on ttc in the fall of 2007. I need to plan around his schedule. LOL. He does have the other doc in town cover him when he is out and vice versa, but they are way more considerate and at least give a heads up!

I guess they do call for ob. I know they do for the ER. But each delivers their own patients. The hospital gets all records from the offices at night starting at 28 weeks. Then they send the records back over in the am. They have a log book where all pregnant patients in town are recorded and pertinent information. I was shocked when I found that out. My ob always had told me to page him if I had a problem.

Do they have call rooms where you can catch some sleep between deliveries? My hospital is a small community hospital and they have a male and a female call rooms on the ob floor. Also don't they send records to the hospital so that you could know what the other dr's patient schedule looks like?

I found out all that information about my hospital when I spent an entire day on the ob floor waiting for my daughter's blood test results. It took 5 hours to get the test results back. They forgot to do the newborn testing before she was discharged and called me and asked me to bring her back to maternity to do it. Seeing she had an order for bili testing, they did that too. I waited because she looked too yellow for me. Turns out I was right. After the first test was too clotted, the second test was 23 and she was admitted immediately to maternity and put on the lights then transferred a few hours later to the peds floor.

Jawndoejah said...

I am so sorry!

And to think, my ob was not on call when I went into labor with my 5th born. She had on her chart to be called (is she crazy?). She made it in time for the placenta to be born (my daughter was born at 4:51 she was called probably at 4:30 am on her night off). I now have so much sympathy for her due to reading your story. My ob is in a big group but there are so many on her schedule, when I called for a pap I was told she would have availability in March (this was in Sept). Scary. You people are amazing!

Anonymous said...

You are amazing. I give anyone who chooses OB/GYN SO much credit, as I could never ever be up to the task( s) : I'm much too selfish:-)

Anonymous said...

OMG. That's all I have for you. Sheez. Poor CindyLou Whoo, how's she doing? Nothing like barf to wake you up!

Anonymous said...

The few times my son has gotten sick in bed I have felt so bad for him. He is always such a good sport; it can't be easy for him waking up to a smelly wet mess, being taken half asleep to the bathtub, and finding out that Pooh Bear can't return to bed because he needs a bath that will require a little more time...

Anonymous said...

What was the weather like? Local L&D Nurses say when a big storm or weather change comes in, LOTS of water breaks come trickling in! I attended with a cousin on one of these occassions, we were the 2nd set there - by noon the next day the place was packed to the gills with laboring gals. An old wive's tale and coincidence? Probably, but it makes me wonder anyway...

Anonymous said...

How is cindy feeling?

medstudentitis said...

Wow, that's one long day. I wonder if Otherdoc feels like he got the better end of the bargain when he partnered up with you.

I'm also glad to know there's someone else in medicine who has a really sensitive gag reflex. I have a really hard time watching or hearing someone else vomit without almost vomiting myself. At least I know you made it through residency without being kicked out for your vomit reflex, there's hope for me yet!

Fat Doctor said...

We could use an update on your July should have had the sono yesterday, right?

dr. whoo? said...

amy1970~ Luckily, my life isn't always this way. It seems to come in cycles. Otherwise, I don't know how I would function.

OMG on your puking stories! LOL! I'm sure that it will happen to me eventually. I can deal with a lot of gross stuff, but I abhor vomit. It just eeeks me out.

missgamecock~ Yes, we have call rooms, but I really would rather not sleep in the hospital if I can avoid it. I just can't relax, and sit and stare at the monitors for hours...even if everything is fine. (Plus, I did enough of that in residency; well, minus the actual sleeping part.)

As for OtherDoc, the man is so busy that I'm quite certain that he doesn't even know how many patients he has due in any given month. He is just that busy. I still know the names of my patients and have a pretty good idea of their gestational age. I'm sure as I get buisier, it will be more difficult to remember them all.

jawndoejah~ That is great about your OB. I still deliver about 85% of my patients. I definitely have a very close relationship with some of my OB patients, and there are a few that I would request that they call me should they deliver on one of my off weekends. Sometimes, though, you just have to have a few days off.

labelladoctora~ Aw, you are too sweet! Honestly, I believe that I can be selfish, too, but I love my job. It is definitely a passion. You'll find something that you love despite the drawbacks. Thank you for your kind words!

frectis~ I know. When it rains, it pours. CindyLou has never been sick in the night until this past incident. I felt like we had reached a parenting milestone or something!

3carnations~ Awww, bless his heart. They are such resilient little creatures, aren't they? I agree that the loss of favorite stuffed animals for laundering is definitely a challenge!

anon~ You know, I was wondering if there was going to be a storm or something (change in barometric pressure seems to set water breaking) but I think what it was is that it's been really chilly at night, and then warming up rapidly during the day. Really drastic temperature swings? I dunno, maybe they are just conspiring to kill me.

anon2~ CindyLou is feeling much better, thank you!

medstudentitis~ You know what the kicker is? OtherDoc was complaining to the nurses on Monday that he'll never "make up" for all of the deliveries he missed. Unbelieveable.

As for the gag reflex, mine has only gotten worse since the pregnancy started. I find that deep breathing seems to keep the reflex under control. You'll be fine. :)

FD ~ As you wish. :)

Anonymous said...

Came across your blog. Current OB/GYN just joined a private practice and was looking to see if all docs have it as hard as I do. I see that is the case. It seems you at least like the people you work with, which makes the difference. Looking at later posts glad life is better for you. I am already quitting lol.