Saturday, December 29, 2007

I Resolve... drink more wine. have more fun. stop worrying so much about whether people like me or not. find a way to take less call. pass the oral boards. take advantage of breastfeeding and lose some serious weight before weaning. say "no" more often to unwanted obligation. say "yes" more often to invitations to play. tell my office manager where to stick it (ok, not really, but still.) make great memories with my kids. preserve said memories in some sort of album. appreciate my husband more. take care of my appearance (nails, hair, clothes, lotion, general pampering.) be a better friend. find some local friends (so lonesome, this life). plan more family trips. be an understanding physician. take good care of patients without being a pushover. blog at least 4 times a month (it is therapeutic). learn something new. finally get my closet organized. cook more "real" meals. be a good example and role model for my impressionable (and smart) little girl. be the woman that deserves the wonderful life that I am so blessed to lead.

Now, if you don't mind, I'm going to start a little early on resolution number one! Happy New Year, everyone!

Tuesday, December 25, 2007

Merry Christmas to All

....and to all a good night! I'm too sleepy to make a coherent post, but I hope that everyone had a wonderful Christmas Day. It is hard when a holiday falls midweek, I don't *wanna* work tomorrow! Wishing you all (including myself) a silent (read, page-free) night.

Saturday, December 15, 2007

Feliz Naviblah

So where was I? Oh yes, Thanksgiving travel with an infant. The day started out well enough. We had splurged on the extra luxury of actually departing from the teensy tiny airport in Whooville, as opposed to driving 2 hours to BigCity to fly out as per usual. The flight left around 9, so we got to the airport and checked in around 8. No baggage to check (thanks to Mr. Whoo), but I did have my (oh so stylish) breastpump, a diaper bag, and a 14 pound infant in the baby bi.jorn. The first two puddle-jumping flights were great. I had a bottle of freshly pumped milk so that I didn't have to get half naked in one of those itty bitty planes. Bean had his second breakfast and filled his diaper in that order, and all was right with the world. We arrived in the BigCity airport with just enough time to change Bean's pants and for me to grab a quick bite to eat. Our next flight was scheduled to go out on time (a first for me on this particular carrier with the letters N and W prominent in the name). Then it all started to unravel.

The flight was full, not unexpected for the day before Thanksgiving, so I had to check the breastpump planeside and the diaper bag was too fluffy to fit under the seat so I took as much as I thought I would need (diaper, blanket, burp cloth) and jammed the bag into the overhead compartment. I was seated near the front of the plane, window seat, next to a rather portly gentleman. Being of an ample posterior, myself, we were very, ahem, cozy (read jammed together with very little room to move). Bean was sleepy and cranky, so most of my attention was focused on getting him settled. It took a while to notice that we were taxiing a little longer than usual. Then the announcement from the pilot, inclement weather in our destination was forcing them to delay departure for approximately 30 minutes, so we were going to sit on the runway until we could take off. Ummmm, WTF? They didn't know that the weather was bad before they jammed us on the plane? The cessation of movement awakened the Bean, so my last weapon in the arsenal, the almighty boob, was offered in the most awkward and uncomfortable way....ever. We got through the wait on the tarmac, and he fell blissfully asleep once we were in the air. The remainder of the flight passed uneventfully, until we reached the destination. Then, for some undisclosed reason, we then proceeded to circle the city, unable to land for an additional hour and a half. I *had* to pee, and Bean needed a new diaper. When it became evident that we weren't landing any time soon, I braved the airplane bathroom, infant in tow. Of course I was very near the front, and the bathroom was all the way in the back, so I did my best not to whack each and every aisle seated passenger with either my arse or my baby's feet. Peeing in that laughably small restroom with the baby in the baby bi.jorn was effort enough, but changing a diaper in there? Damn near impossible. I put the burp cloth down for a minute on the only available counter space (the sink) only to have it get sopping wet. Bean screamed throughout the whole ordeal, for extra fun, and I was near tears myself by the time we had finished. I did my best to avoid the disapproving eyes as I headed back toward my seat with my overtly vocal, unhappy child, wedged myself back in between the window and Mr. Portly, offered Bean the other boob, and willed the plane onto the runway, like, yesterday.

We did finally make it to the ground, a grand 10 minutes after my connecting flight had departed. (No, of course, I wouldn't have the *good* fortune of the flight being delayed!) I want to know, if the weather was so terrible, why flights were still leaving on time?? It was about 1:45 pm (felt like midnight) and the next flight out wasn't available until after 7 pm. With the darkening skies and this carrier's oh so stellar reputation, that wasn't a gamble that I was willing to take. I had been scheduled to arrive at my destination city at approximately 2:30 pm, my sister in-law, niece, and nephew were to pick us up, and then we were to drive 3 hours north to the Grandparent's house. I phoned my sister-in-law and we both agreed that she could drive to my present airport and pick me up before my next flight even left (ha, ha!) So we estimated that she was a little less than 2 hours away, so I took myself to the Chili's and ordered fajitas and a margarita. All was right with the world once again....until Bean blew out his diaper and needed a full wardrobe change, bunting and all.

Flash forward 3.5 hours when my sister-in-law finally arrived, having underwent a small circle of hell, herself, involving ice storms, driving rain, and holiday traffic to get to the airport. As we settled in the car, I thought, surely, things would get better from there. Fate laughed loud and long at that assumption. The weather went from driving rain to freezing rain to blizzard-like snow, the traffic got increasingly snarled, and the three children got increasingly testy. What should have been a 4-5 hour drive turned into an 7 hour drive. We had reached a tenuous peace, with all three children finally asleep. We turned the radio to an all Christmas music station, and proceeded to laugh about how horrific the entire journey had been. Just after we had reached the last 30 minute leg of the trip (through snowy, country back roads), my nephew began to cry to get out of the car seat. Then my niece awoke and cried because she was still sleepy, my poor SIL was doing all she could to see the road through the blizzard, and there was no placating the children. As we turned onto the final road to the Grandparents house, Bean awoke to complete the trifecta, the screaming escalated, the road was icy, we were behind a car going precisely 2 miles an hour, and playing in the background? A cheerful "Feliz Navidad." Delirious from prolonged travel with children, my SIL turned the volume up over the throng of screaming voices, and we sang along at the top of our lungs....either to save our sanity, or because we had completely lost it, I am still unsure. We slid past the driveway just after midnight, arriving safely but insane, a mere 16 hours after the journey had began (it takes 11 hours to drive the distance between our houses). I vow to never, ever, fly anywhere ever again. That is all.

Saturday, December 01, 2007

Going It Alone

December the first. Wow. I know that you are all dying (dying! I say) of suspense with respect to how solo call with an infant worked out for me. Chaotic? Anxiety producing? Strangely manageable? The answer is: All of the above! Fortunately for me, OtherDoc had "brought the house," so to speak, the week prior to his departure, so the weekend was eerily quiet with respect to laboring patients. I had lots of phone calls to field and triage patients to work up and manage, but actual admissions and labors were scarce. Unfortunately this lulled me into a false sense of security, because at 2 am on Monday morning I got the call that one of OtherDoc's patients had shown up to L&D in labor. Oh, and by the way, she is 8 cm dilated. Ack! There was no time for me to call my backup plan for childcare, since she lives a good 20 minutes from us, and by the time she got here the baby would likely be making an appearance. So I bundled up a very confused Bean, put him in the car, and away we went. Luckily for me it was a relatively slow night, and the nurses were thrilled to see him and watch over him.

I arrived just as the patient was starting to push, and my stomach knotted as I saw the verrrry sllloooww emergence of the baby's head. It was a hallmark shoulder dystocia presentation, and I locked eyes with the nurse, who knew automatically my suspicion. She moved quickly to get the bed down and the patient into McRobert.s. She also called an additional nurse for help. Sure enough, the anterior shoulder was wedged tightly against the pubic bone. Supra pubic pressure didn't budge the stuck baby. I reached posteriorly to try to deliver the posterior dice. By now, time seemed to have completely stopped. I could hear the blood rushing in my ears as the adrenaline surged, threatening to overcome my systematic approach to the delivery. Next step, I began rotation of the infant 180 degrees. Mercifully the anterior shoulder rotated free and the baby was delivered...a little purple but screaming. All 9 pounds and 13 ounces of him! Later the nurses told me that it was only 2 minutes total from head to body, but it felt like an eternity. I have had a few worse dystocias, where I have had to break clavicles, etc. but it never ceases to be scary. Bean, however, oblivious to the drama happening just steps from his cozy perch, slept sweetly the entire time we were in the hospital. What a kid.

We went back home for a couple more hours of fitful sleep before Monday began properly. Monday, by far, was the worst day. Hectic rounding, two laboring patients, busy office, an admission for a post operative abscess on one of OtherDoc's patients, and an eventual vag delivery and C-section for failure to descend (The baby never moved past 0 station despite 1 hour of "laboring down" and 2+ hours of pushing, poor girl!) My nurse had to pick up Bean from the daycare, and I didn't get home until about 8pm. Tuesday was moderately better, since I never even made it to the office due to a surprise labor, a preterm patient of OtherDoc's with seriously whacked out liver enzymes (but no other signs of HELLP), and drain placement on the post op abscess.

Suffice it to say I was properly exhausted come Wednesday morning, but I was optimistic for a smooth travel day with the Bean. Ha. Since this entry has run on quite long enough. I'll save that story for the next post! For now, we need to start "Christmas-ing" the house, and CindyLou will not be deterred any longer. More later...

Saturday, November 17, 2007

Standing my Ground

So, alas, all good things must come to an end, and I am on call once again. I am taking call for OtherDoc, as well, not only for the weekend but until I leave town for Thanksgiving on Wednesday; he is on vacation this week. I know that I have bitched multiple times over about how very much I dislike taking call for his patients, but get ready to hear some more.

I think, scratch that, *know* that the man is seriously overburdened with patients (60-80/day!!) and I am quite sure that I wouldn't know my own ass from a hole in the ground if I were that busy, but he lets his patients run his life...and now they are trying to run mine. He is more than, shall we say, liberal with narcotic pain medications. Aw, face it, he hands it out like candy! It never fails, as soon as I take over his calls the pages for narcs begin. I can't stand seeking. It truly makes my blood boil, but I calmly state that I will not prescribe narcotic medications to patients that I haven't seen or examined personally. (Even then I rarely give narcotic meds, truth be told.) You should hear the stories, and if you work in the medical field, you probably do. Today it was, well OtherDoc gave me a prescription for (name your favorite narc here) and said I could have a refill, but he didn't mark the refill, so you just need to call it in (sic!). Ummm, sorry honey, but no. I'd be happy to call you in some Nap.rosyn for your pain until you can get to the office to be seen, though. Silence...then click. Sigh.

Even better still, OtherDoc had scheduled an elective term primip for induction of labor earlier in the week. The reason for induction? Well, because he was going out of town, of course. Labor and delivery has been insanely busy, so this elective induction got bumped, not once, but twice due to people being in actual (gasp!) labor. The news, each time, was met with shrieks and screaming at our office staff and labor and delivery, but there was nothing that could be done to accommodate her for her very elective (and early, at 38 weeks) induction.

The patient then decided that she wanted me to induce her on Monday, since I was covering OtherDoc. Never mind that I have never once met this woman nor examined her. Never mind that I truly don't *do* truly elective inductions because of the risks associated with them. *She* had already started her disability leave from work, thus she needed to have the baby now. (Priorities much?) Other Doc actually tried to guilt me into doing it, too! Her due date isn't even until the end of the month!

Could you just imagine, should the induction go awry, the cross examination? Dr. Whoo, why was this induction scheduled? Oh, the patient was tired of being pregnant? Hmm, that's not an ACOG approved indication for induction. Had you ever met this patient prior to *pumping her full of drugs to hasten a premature delivery*? On and on and on! Oh, by the way, drop your license at the door on your way out. I'd be painted in the media as "just another doctor" trying to screw up how women give birth. ('Cause, you know, all evil OBs really want to do is c-sections...all the better to ruin your "birth experience" my pretties! Cackling! Evil! Laughter!) But, I digress...Guess what my answer was? That's correct! It was a resounding "No!" I will be seeing her for an office visit this week, however, if she decides to show up. We shall see.

I am disconcerted at how browbeaten I feel by patients on such occasions. It shouldn't be so antagonistic to practice good medicine. One of my favorite attendings used to say, "This isn't Burge.r; you can't have it *your* way!" Only more and more often, it seems, you can! I fear for the future of my profession. Dr. Google-topia is closer than we think. Eep.

In other news, Mr. Whoo and CindyLou are wending their way to the grandparent's house, far, far away. Bean and I will be flying to meet them on Wednesday, since I have very little remaining time off, what with maternity leave and all. Yes, I *am* taking call for myself and OtherDoc alone, with a baby, for four that crazy? I think, yes. Happy Weekend!

Sunday, November 11, 2007

Suspended Animation

That's what the weekends seem like when I am off call. I feel like I rush, rush, rush through the weekdays...labeling bottles, rounding on patients, surgery, office, child pick-up, sundry essential (and I am talking only essential) household chores from dawn until dusk. Then Friday hits, and I experience a euphoria (on the weekends that I am off call) that compares to no drug once the pager gets turned off. And then? I sit....and laze...and eat...and laze some more. Don't I have just as much (if not more) to do on the weekends as I do on the weekdays? You bet I do. For some reason, however, I have no spark or motivation to do *anything* but sit and eat and laze.

Undoubtedly college football plays a role in my sloth on Saturdays. Between Mr. Whoo and myself we have no less than 4 football teams for which we root on a regular basis, so someone we follow is nearly always playing in any given time slot. The football viewing extravaganza starts at 10 am for Gameday and lasts well into the evening should we be interested in a late night game. Of course the child care duties do take precedence over the football viewage. CindyLou gets to go outside with Mr. Whoo and run around, the Bean gets fed and entertained and changed regularly by yours truly, and we get through the day making half-hearted efforts at the laundry, dishes, and cleaning up after ourselves. The bare minimum effort, no more, no less. The result is by Sunday I am feeling so freakishly slovenly and lazy that I begin to hate myself just a teensy bit, but not enough to actually get a lot more accomplished. Add that to the fact that the ladies that clean our house every other week were out last week on vacation so our house hasn't been cleaned in 3 weeks and you can imagine the appalling disarray at the Whoo household.

The bad thing in all of this is that the clutter seeps its way into my psyche, making my head feel cluttered and disheveled as well. So I am faced with the overwhelming desire to power clean the house, and simultaneously crippled with the perfectionist's curse of wanting to do it all at once and to do it flawlessly, at that. It isn't hard to figure out that this is impossible in the best of circumstances, much less in a household with a 3.5 year old and a 4 month old mucking the routine about, so here I sit in suspended animation...knowing what I need to do, but unable to do it the way that I want to do it. Yes, I've heard of Fly.Lad.y and the clean sink rule and the 15 minute rule, which seem great in theory, but my pathological brain can't just stop at 15 minutes. If I can't get it all done, then I don't want to do it at all. Lather, rinse, repeat.

Oh, and the *eating!* OMG, I am a bottomless pit. I know I am breastfeeding, but this is ridiculous. I bet I could have lost so much weight if I took advantage of my milk-making revved-up metabolism. Instead I am plateaued, and still eating bad foods by the boatload. Someone stop me! I am powerless over food. There, I said it...what is the next step?

I am ever so grateful for the 4 days a month that I do get the option to do nothing at all, but I know I need to stop doing nothing and start tackling the to-do list on my days off. It is just such an unappealing prospect. With the holiday season looming ever closer on the horizon (seriously people, Christmas music? the day after Halloween? It is madness, I tell you) I guess I need to just suck it up and get it together. Right after I write this blog, I mean....oh, and after I read everyone Else's blog too....yeah, that's the ticket. ;)

Saturday, November 03, 2007

A Baby a Day

...keeps the doctor exhausted! It has been a big week for babies here in Whoo-ville. This is the week after the full moon, and man has it felt like it! Many believe that the day of the full moon is the big day for baby-having, but it has been my reality that the moon driven baby boom tends to fall either the week before or the week after the full moon. I have also noticed that there seem to be more demises and miscarriages during the new moon, whatever that may mean, and miscarriages also tend to come in threes.

My first delivery of the week was a multi-gravid patient with a history of rapid labors. She called me around 10:45 pm with "vaguely uncomfortable" contractions, due to her history, I urged her to head in to the hospital, and I tried to get a little rest in anticipation of a late night trek to the hospital. Triage paged at 12:30 am stating the patient was 3-4 cm with contractions every 6 minutes, she was admitted and wanted to move around so she started walking the halls. At 1:30 am she was 7 cm, and I rose from my cozy bed and cuddly baby, dressed, and was out the door within 5 minutes. On the way into the hospital, labor and delivery paged (around 1:45 am) and reported the patient was 9 cm. I walked into the hospital at 1:50 am, the patient's membranes ruptured as I walked into her room. She gave a low grunt as I quickly gowned and gloved, the nurses barely got the bed broken down, and the beautiful baby girl was delivered in one slow, fluid, controlled push at 2:00 am. No lacerations, no pain meds, just a quick and easy labor. I was back home and in bed by 3 am, but, as is often the case after a delivery, the adrenaline was flowing and I had a very difficult time sleeping. The day in the office passed in a blur, and then it was off to a costume party with the kids in tow.

The following morning, the pager bleated at 5:00 am, yet another early morning labor...just in time for Halloween! This patient, too, was 7 cm upon arrival to the hospital, and dedicated to delivering without pain medication...but she certainly wasn't happy about it! She had an epidural for her prior labor, and she kept remarking that "it never hurt like this last time." (!) She did very well, stayed focused, and delivered a bouncing Halloween boy at 7:30 am. She only had one small first degree laceration that did not require repair. Unfortunately, the plastic drape fell during the delivery spilling all sorts of wonderful goop upon the floor of the labor room. Ick. I then sprinted for surgery and once surgery was over, I dragged myself home...not for a much-needed nap, but for a shower and a trip to the kids' fall festival at the daycare. Then it was time to prep for Halloween tricks and treats. Lots of pictures of the costumed children, and a trek around our very hilly, steep driveway-ed neighborhood. CindyLou got more candy than she could ever hope for, Bean rode agreeably in the stroller, and Mr.Whoo and I exercised more in that one hour than we had for at least 8 weeks prior!

The following day, I had a scheduled induction for a post dates pregnancy. When I checked the patient, there was an odd band of scar tissue around the cervix...likely from a previous cervical surgery. The cervix was very effaced and thin, but it was only a tight 1 cm dilated. I waited for the patient to get her epidural, then gently stretched the scar tissue from 1 to 4 cm. I then headed for the office. At 11:30, L&D paged stating the patient was 7 cm and feeling pressure. I wrapped up my waiting office patients, raced to the hospital, and caught a baby at 12:05 pm. I barely had time to eat lunch before the afternoon patients started at 1pm.

The week ended with a jam-packed Friday morning office schedule, topped up with an afternoon scheduled repeat C-section. Fortunately this went beautifully, and I had time to go back to the office to finish up a bulk of charting and paperwork before starting an unexpected weekend off call. I even got to "sleep in" until 7:30 this morning, when I was awakened by the Bean's overflowing wet! We have plans to take CindyLou and Bean to the "Bee Movie" today and tonight to watch FSU get destroyed by BC (all the while hoping that some miracle will happen to let us actually win the game). Wine may, scratch that, will also be involved. Also, woo hoo, I won in Lara's contest! I never win anything! My luck has got to be looking up! :)

Monday, October 22, 2007

Eight More Random Things About Me

This is long overdue, sorry Mark ! I think I did this one a while back, too. I'm out of the office this morning (1st true sick day that I've taken in about 8 years) with a high temp and pukiness from the mastitis (woo!) so this will be a good way to distract me from how crappy I feel.

1. When I first started medical school, I thought I wanted to be a dermatologist. Good hours, good pay, good lifestyle, etc. I had it all figured out...until I worked my first derm clinic. Granted, I did my medical training in a huge city with a lot of indigent care and really sick people, but the things I saw in that clinic grossed me out beyond measure. I came home itchy every single day, and before the rotation was finished, I picked up a nice case of ringworm to boot. Thus ended my grand career in dermatology. I think it worked out pretty well, but oh how I pine for 9-5 office hours.

2. I am powerless over potato chips. There, I said it. I can resist sweets, cake, cookies, and even ice cream, but I cannot resist any kind of chip. If I walk past a bag or a bowl, I must indulge. My favorites are sour cream and cheddar, with Doritos running a close second. Love. Sigh. And I wonder why the weight isn't coming off?

3. I love to sing, but I am not very good at it. Mr. Whoo and I sing to the kids all the time and make up goofy songs to current radio hits to make them laugh. When CindyLou was a baby, we sang "Let's Get it Started" and "Crazy In Love" (the uh-oh-uh-oh-uh-oh part, especially) with altered lyrics to her. We also sing a bath version of "Oh My Darling, Clementine" with body parts (such as "wash your bottom, wash your bottom, wash your bo-ttom, CindyLou.) With Bean, so far the favorite is "Ridin' Dirty" (but we sing "gotta catch him wet and dirty...") Dorks, I know!

4. I am the proud owner of a karaoke machine, and Mr. Whoo and have been known to take it with us when we travel and subject our friends to our caterwauling. Our friends usually join right in! My favorite karaoke machine memory is once, after I had gone to sleep, I woke up to hear the guys singing the theme song to "Growing Pains" on the karaoke machine. Priceless.

5. On a somewhat related note, I am the master of remembering lyrics. Seriously, I am the *true* reigning "Singing Bee" champion. Unfortunately, my expertise is somewhat limited to the songs of the 80s and 90s. I can get some popular 70s songs, but when it comes to disco, I am totally clueless. It amazes me that I can remember all of these lyrics, but can't easily cram new medical knowledge into my overstuffed brain. I do occasionally memorize facts to a tune. That seems to stay with me.

6. I am a binge shopper. I would say that 90% of the time, I'm not a big shopper. I dislike going to the mall. I do not get a rush out of buying new clothes. In fact, I could really do without clothes shopping altogether. (This is probably partially due to the gargantuan proportions of my posterior.) However, when I do shop (especially for things for the house), it is like I cannot stop. I blow a ton of money, suffer a shopping hangover, and don't shop again for months. Does anyone else do this?

7. Sometimes I feel like I have just a small tinge of psychic ability. Nothing that I can control consciously, but sometimes I just know things are going to happen. I also have dreams that come true on occasion. I wish I could tap into it more, but for now I guess it is like a step above intuition.

8. I can't even do a sick day right. I'm into my sick day one hour already, with a temp of 102 and a round of GI distress early this morning, and I find myself planning all the chores that I can get done today. It is pathological. My body wants to lie on the couch and watch "The Price is Right," but my mind is thinking about laundry. I just feel guilty about being sick. How sad is that?

I don't tag anyone since this me me is 3 months overdue, but I hope that this peek into my warped psyche was entertaining. Now for TPIR...or maybe some laundry.....

Sunday, October 21, 2007

Caution! Full Force Whining Ahead

This weekend has been less than ideal. I'm on call (which always puts a damper on the weekend), I'm nursing a second bout of mastitis due, I think, to Bean weaning some night feedings, even when I'm not getting called every couple of hours, I'm not sleeping well. My best sleep seems to be right around 6 am, which is unfortunate because that is when CindyLou has decided to wake up for the last 3 mornings and demand to be fed. The house is a wreck, I don't feel like cleaning, something in the fridge smells bad, I don't want to search it out, the bottles need labeling for the week, and I don't want to do it. I feel fat, but all I want to do is eat bad food like pizza, pasta, and Chinese. I need to organize baby photo albums, not just for Bean, but for CindyLou, too. I need to go shopping, but I don't want to leave the house. Florida State lost (again) to a team they should have beaten. I got a new consult this morning on a patient with an adnexal mass that looks like cancer. Oh, and Mr. Whoo is sleeping in today. (Now, this is partially my fault, since I told him to go ahead and keep sleeping when I took the kids downstairs at 6:30 this morning, but he is taking full advantage, let me tell you!) Bitch, bitch, nauseam.

I feel really short tempered and snappish, but I think it all stems from being bone tired. Yesterday I had to transfer a patient with PROM to the tertiary care center, and I got treated like some kind of second class resident by the accepting physician. Usually I can let these things roll off my back, but they really ticked me off. I got the business about whether or not I had personally examined the patient (I had), whether or not the appropriate antibiotics had been started (they had), and whether or not the patient was in active labor (she wasn't). I realize that I am a community physician, but I'm not stupid. I trained in a residency that was 90% management of high risk patients. I know that tertiary care centers get a lot of "dumps" on the weekends, but I have never shipped a patient that didn't warrant transfer. I don't know why I let that physician get to me that way, but I'm still silently fuming about it.

I also heard about a terrible call that the L&D nurses and pediatrician had to attend. Apparently a woman was being attended in a home birth by a lay doula, (no midwife, no back up physician, just a doula with no medical training) the baby was footling breech and had a cord prolapse...instead of immediately going to the hospital, she continued to labor the mother at home. The baby was dead when it was delivered. A beautiful, perfect term baby that didn't have to die. When the medical team arrived the doula was chanting and lighting incense around the house and the mother was hemorrhaging in the tub. It just makes me physically ill to think of it. Don't get me wrong, I respect the art of midwifery, and I think that having a doula can greatly enhance a mother's birth experience. In this case, the doula overstepped her bounds of expertise with deadly consequences. I wonder if she will be subject to the kind of lawsuits that obstetricians face daily. Sometimes, even in normal births, things go terribly wrong, and ignorance of when to forgo the desired birth "experience" and get to the hospital to save a baby or a mother is catastrophic. So sad for that family.

I'm dreading heading back into the hospital. The only patients in house are OtherDoc's patients, and it is always difficult to manage his patients because our styles are so very different. I tend to be overly cautious, and I write a lot in my progress notes. He tends to be a bit more relaxed, and often will not write notes at all. It can be really frustrating. Oh well, at least I have next weekend for which to look forward. Two whole blissful days off, just 5 short days away. I think I can hold out until then. Hope your collective weekends are going far better than mine! :)

Saturday, October 13, 2007

Whoop, dere it is

Do you ever get inappropriate song lyrics stuck in your head on constant repeat? (Whoop! Shakalaka-shaklaka-shakalaka, whoop!) Just me? Damn. The inspiration for my chosen song of the weekend is not so funny, unfortunately. It seems that Bean may be in the early stages of whooping cough or pertussis. A child in the daycare was just diagnosed this week, and yesterday he started with the characteristic cough. Since he is such a little man, and has not completed his vaccinations yet, he is now on antibiotics to (hopefully) keep him from developing the paroxysmal coughing spells that are pathognomonic for the illness. Poor guy. He actually otherwise seems very happy. He is eating and sleeping well, so that is all that I can ask in this situation. Hopefully we have caught the illness in the mild stage in time for him not to develop the severe symptoms. Fingers are crossed.

Did I mention that I am playing single parent this weekend? Well, I am, and boy, is it rough. Mr. Whoo is off in the woods with his (boy)friends, acting like 13 year olds (video games, junk food, staying up late, oh and also with beer, lots of beer). They do this trip once a year, and I think it is great for their friendship, but man, it is difficult at home. When CindyLou was a baby, she decided to get her very first stomach bug when Mr. Whoo was off on his "guy" weekend. Bean just had to do her one better, I guess. You may remember at the onset of this blog that the wives started their own little get-away weekend. We didn't do it this year (logistics were tricky with pregnancies and whatnot), but are in the early stages of planning next year's trip. (A whole lot less video games, same amount of alcohol, and more spa time.) CindyLou and the Bean have actually been angelic, though, so I have been really lucky. She is off on a playdate right now, and he is sleeping somewhat peacefully in his swing. Hence, blog time! Woot!

I am taking a little longer to adjust back into a full work schedule than I anticipated. I am booked for new patients out into April, with women approaching me personally in the hospital and elsewhere (!) requesting to be seen sooner. I also am trying to decrease my patient load for less deliveries per month in hopes of eking out some sort of better lifestyle. I am going into the 3rd year of a 4 year contract, and I have a lot to consider. Now, with two children, I am finding that lifestyle is becoming increasingly important. I came in to this opportunity with the attitude that I could do anything for 4 years (just like residency). When I come out of this contract $200,000 of my student loans will have been repaid. (You read that figure correctly.) This is huuugge. I will not be "debt free" but the amount left over to pay after that is entirely manageable. I love the location and the patients. I do not love the call all. I am still only getting 4 days off per month (every other weekend). I am on call 24/7 all week long and 2 weekends a month. This is too much. I was led to believe that call would be 1 in 3 when I arrived here. This never materialized, and I am somewhat bitter. My employer is looking to expand, and I am hopeful that adding one or two more OB physicians is in their sights in the coming years. If I could have a true 1 in 3 (or 4) call with 1 in 3 (or 4 )weekends, I think I could be a very happy camper. If this does not happen, I'm afraid I may have to start the process to look elsewhere. Bleah. I hate moving. I am trying to be patient.

I am glad to be back with my patients. It is awesome to get back into the OR, and catch some babies. One of my favorite patients is due this month, and I can't wait to deliver her second baby (I delivered her first about a year and a half ago). That is the part that I love about OB, the continuity of care and the relationship with the patient. It is such a privilege to be a part of such an intimate occasion as childbirth. I wish sometimes that I didn't love my job as much as I do. I wish it would be an easier decision to scrap years of training and debt and say "I'm staying with my babies." I just can't. I love my children immeasurably, but I know that the work that I am doing is more than a job, it is a calling; just as much as motherhood is a calling, and so I do my best to serve both of my passions in an equitable way. It isn't easy, and I will state now that I am choosing not to engage the work vs. stay home debate mongers here. A few of the comments I have received and chosen not to publish are hurtful, not only to me, but to women in general, and I will not allow this misogynistic rhetoric on my blog. If you are looking for a fight, please look elsewhere. We women are doing the best we can, and we don't need members of our own sex seeking to tear us down for the choices we make in life. With that, it is time to nurse the little man. Happy weekend, one and all...thank you for reading my stream of consciousness. :)

Friday, October 05, 2007

Been Away

....haven't seen you in a while. Thanks for continuing to check in on me. I really have missed blogging and checking in with all of you. It is like a missing part of who I am, but who has the time? If I thought life was crazy before, it was nothing compared to working full time with a toddler and a newborn. As much as I hate to do it, I am being forced to become more organized, lest I pay the very hefty price when I neglect organization. I now try to shower, prep bottles for daycare, and, if I'm really good, lay out clothes for myself and the kids in the evening. If these three things are done consistently, mornings tend to be hectic, but smooth. If not? Unmitigated chaos.

Our daycare likes to complicate matters more by these ridiculous restrictions on the bottles that we bring in for Bean. For example, all bottles must be labeled with the baby's name (naturally), ounces in the bottle (mmm, okay, but can't you see the marker yourself?), and, here's the kicker, the date can only be the day prior or the date that the bottle is being used (seriously?? Don't they know that breast milk keeps longer than 24 hours in the fridge??) In addition, all bottles must have nipples on them, as they cannot rinse and re-use a once used nipple (ridiculous). This is a pain in the ass because half of the bottles we have are breast milk storage bottles, so nipples must be washed twice as frequently during the week. I have offered to provide a "doctor's note" that it is perfectly acceptable to re-use nipples and to use breast milk that is older than 24 hours, but no one seems to take that offer seriously.

So, every night we have to re-date bottles (because let's be serious, I'm not washing perfectly good breast milk down the drain, the stuff is liquid gold), wash and re-place nipples, and keep track of how many bottles are needed for the next day. It seems a small feat, but add that to feeding, entertaining, and bathing a toddler, feeding, bathing, and entertaining the newborn, and feeding (and in my case, bathing) ourselves, and things get a little more hairy. Then there are mornings like yesterday morning when we all woke up late, and Bean decided to give himself (and his mother) a different kind of shower. Now when changing a boy's diaper, unexpected sprinkles are not uncommon, but this one occurred in between the removal of the requisite "shield wipe" and the fastening of the diaper. The result was pee on his head and chest, my hair, my clothes, and all over the bed (he even peed over the chux that he was being changed on!) This earned him a quick wash down from head to toe with my closest available "washcloth" (a clean sock) and baby shampoo, and it earned me a whole new shower. Which,in turn, made me unable to go in for rounds and just barely on time for the office. Ah yes, life is different indeed.

On the work front, I am working with my staff to whittle my schedule back to a reasonable pace. For now I am restricting OB patients to 15 total deliveries per month, with the availability to go to 20 per month if my schedule allows. I have blocked time to pump throughout the day. I also have stopped having routine scheduled patients after 4 pm, leaving the hour between 4pm and 5pm for work-in patients and emergency room follow-ups. If there are no work-ins, then I have that time to do the office charts for the day, sign off on labs, and dictate. So far it is working well. Time will tell if I can keep that pace and still be profitable for the hospital. The call schedule is still less than desirable, only 4 days off per month is not going to hack it in the long term. I am holding out hope that the hospital will hire one (or two) more physician(s) sooner than later. If no help comes for the call schedule, no matter how much we like everything else, here, we will likely go looking for a better quality of life. My patients are happy that I am back, and that makes coming back a whole lot easier. I did miss the patients and the relationship I have with them. I love what I do, I just need to find a way to make my job fit more into my life rather than working my whole life around my job.

Eh, this entry is boring, but it is what is on my mind. I am glad to have this time to write, and will make an effort to make more frequent forays into blogland. As for topics, if you have any requests I'll be happy to try to work them in between the whiny me, me, me posts! :) Happy (OMG it is freaking) October!

Friday, August 17, 2007

Letter to Bean and Ramblings

Oh little Bean, you are already 4 weeks old. There are many days when I debate adding an "o" to the end of your pseudonym. Why? Because of the surprising, staccato bursts of sound which issue from both ends of your maturing digestive tract. Your other affectionate nickname is Vladimir, as in Vladimir "Pootin'". Yes, your parents are corny, may as well accept that now! Seriously, though you have got to be the gassiest baby I have ever the great fortune to know. And the sheer volume of solid waste that you manufacture on a daily basis? Impressive, my friend, especially for a breast fed baby. There is never any doubt of when you need to be changed, because we can hear you fill your diaper from across the room! I can't believe that I used to fret about your sisters weekly movements, only now to fret that there is nary a diaper change that you aren't at least a little dirty. You are the sweetest little man, though, so laid back. Every time you fuss, there is a solution. You can even fall asleep all on your own! This amazes me. You are also so serious, it takes a lot to get you to crack a smile; however, you are very chatty, cooing and squeaking all day long. I am treasuring this ever dwindling time with you, cuddling you when you sleep on my chest. Too soon you'll be "all grown-up," just like your big sister.

It's been a trying week in Whoo-ville. Last Friday I was practically in tears I felt so horrible, but I had no idea why...until I spiked a temp. Then the vague aching in my left breast took on a more significant role than an after-effect of overaggressive pumping. I had the fantastic luck of getting a rip-roaring case of mastitis. Fortunately for me, I could call in my own antibiotics. Unfortunately, I got really sick really fast. At one point my temp was up to 104.7, and Mr. Whoo was on the brink of forcibly carting me to the ER (I'd really have to be dying to go to the ER!) I knew I was on the correct meds, but when I was on my 24th hour of spiking temps, I must admit I had visions of MRSA dancing in my head. I defervesced sometime between Saturday and Sunday, and I'm still taking antibiotics. The illness took a lot out of me, and I was feeling pretty wiped out until yesterday, when the next great thing happened, we lost power.

Big deal, right? The loss of power in our particular section of the neighborhood occurs approximately every 15 days, and is out for 8-10 hours at a time. The frustrating part is that it is only our street. The other houses in our neighborhood, including the street over never lose power, so this puts us low on the priority list to have power restored. The first winter snowstorm that we had when we moved in resulted in power loss for 3-4 *days*, forcing us to move ourselves and (our then 18 month old) CindyLou into a hotel. When your power is out this long, you are forced to throw hundreds of dollars of food away, and spend your nights either sweltering or freezing cold, oh, and no cooking because the stove is electric as well. Throw in a 3 year old and a newborn and 10 hours of power loss in the middle of the night is just not ideal. We sweat our way through the night, CindyLou came into our bed because her nightlight was out, and Bean wouldn't nurse in the total dark, so we had a flashlight sitting upright on the bedside table, which woke up CindyLou, Bean was too hot to sleep on me, but wouldn't sleep in his bed, either. Mr. Whoo and CindyLou eventually moved to her room and Bean and I stripped the covers from the bed and rested, albeit fitfully, throughout the night. The following morning, poor Mr. Whoo had to go to work. I kept CindyLou home with me, which may have been insane, now that I look sleep and keeping and active toddler entertained all day? Not the wisest of moves.

My hat is off to all of you stay at home mothers out there, especially those with multiple children. It was exhausting trying to keep up with all of the demands of both children. At one point, CindyLou decided that she wanted corn for lunch. Once I was able to detach Bean from the breast long enough to fix her lunch, I complied (I thought) with her request, and opened a can of corn. Oh no, it was meltdown time! You see, she wanted corn in a *line* (ie. corn on the cob) not a bowl! By the time I had her calmed down and eating the much maligned bowl of corn, the Bean had audibly filled his diaper, then CindyLou needed to go to the potty, then Bean needed to on and so forth. Mr. Whoo came home to CindyLou planted firmly in front of her portable DVD player with a movie, the house in utter disarray, and me catatonic on the couch with Bean sleeping on my lap. Mother of the year, I am not. That day did cement in my mind that I do not have what it takes (patience, aplomb, creativity, a will of iron, etc.) to stay home with kids. I think they would be miserable and I would be certifiable. This is a small thing to hold onto as my re-entry into the work fray draws ever closer. *sigh* I have more to post on that at a later date.

I believe that I have rambled long enough for now, my poor sleep deprived brain doesn't know when to stop the literary diarrhea. Maybe it is related to lack of adult interactions during the day? I'll spare you more painful minutiae for today. Thanks for all of your comments, I am reading and posting them when I can, and I appreciate everyone's advice!

Thursday, August 09, 2007

3 Weeks Old and Searching for a Routine

Oh, who am I kidding? We definitely have a routine, it just isn't the most productive routine. My life is incredibly boring right now, a far cry from my usual life, so if you snooze easily you may want to skip this post. My days since all the company left have shaken out something like this:

7am - 8am CindyLou barges into the room, wakes me if I'm sleeping, ignores me if I'm not, and searches immediately for Mr. Whoo. Mr. Whoo and CindyLou get ready for work and school as per as normal routine as they can manage. (Yes, she is still in school, especially this week while I am adjusting to being alone with the Bean), we are trying to keep her life as normal as possible and not to break routine.) It goes without saying that sometime during this period we are nursing, changing diapers, etc.

8am-10am - Variably spent napping, nursing, and lazing about in bed with the Bean. We have mastered side-lying nursing, which I highly recommend for maximum sleep. When I'm not sleeping, I am composing the day's to-do list in my mind. You see, I *have* to be productive if I'm staying home.

10am-1pm - The Bean's usual morning "awake" period. I have managed to shower (once) during this time and at the very least am able to attend to some basic self-care like the brushing of teeth, changing of clothes, using the bathroom, and even, sometimes, eating! I can usually entertain the Bean with the bouncy seat or swing while I attend to basic personal needs, and sometimes I am even able to get some chores done. It is this time of day that I am usually contemplating on writing/typing out a to do list. It is day 4 of this not happening yet. Nursing happens toward the end of this time period to put the Bean into a "milk coma."

1pm- 3pm - The Bean is sleeping. I'm finding it very hard to put him down when he sleeps because he is oh so very snuggly and sweet. I usually will compromise and hold him for a bit before putting him down and working on the day's to-dos and, more likely, surfing the internet.

3pm-5pm - I eat my second lunch because I am hungry *all* of the time. This is probably why my weight loss has plateaued this week. Then there is dinner planning, chores, nursing, and napping (both Bean and myself). Did I mention that I am a rotten housewife?

5pm-8pm - Mr. Whoo and CindyLou come home. We have dinner, a little play time, CindyLou has her bath, if I haven't showered, I get a shower, and CindyLou goes to bed. Mr. Whoo gets some Bean time, and Bean sometimes will have a little fussy period at this time.

8pm- 11pm - It is nurse-a-thon time. The Bean is at the breast every hour, cluster feeding like crazy, drifting into light sleep, awaking and nursing again. Once he is sated, we both tend to pass out on the couch until Mr. Whoo rousts us up to go to bed.

11pm - 2am - My blissful, longest sleep period of the day.

2am - Nursing, diaper changing, dozing, watching Disco.very Health, TLC, Brav.o, and WE. I even saw my own OB on one of the "Special Delivery" shows on Discovery Health. Awesome.

4am- Nursing, diaper changing, dozing, watching only Disco.very Health or one of the news channels because all of the rest of the cable channels turn to infomercials after 3 am.

*Aside* Let me just say that DH and TLC need some more commercial sponsors, or at the very least, they need to run different commercials for the same shows. Some of their commercials are burned into my subconscious - The Last Days of Diana (where they have made some kind of dirge out of "Modern Love." Mightily depressing.) and Diagnosis X (where there is an equally depressing snippet of song playing over and over in my head.) I am also convinced that the lead singer from Cake is the vocalist for the Coc.oa "cereal straws" jingle. That's just *sad* y'all.

Lather, rinse, repeat.

Why yes, I *am* slowly losing my mind, why do you ask? I am having a hard time putting the baby down to sleep 1) because he doesn't sleep very well on his back 2) he sleeps great on his tummy, but I can't sleep worrying about SIDS 3) the kiddo is a very noisy breather, squeaking, squawking, and snoring (I have made the totally non-professional diagnosis of laryngomalacia) making me think that he is awake when he is not, and 4) selfishness, he's only going to be this little and cuddly once. This results in me sitting semi-reclined in bed, propped up on pillows, with Bean sleeping on my chest.

Yes, I *know* this isn't the best arrangement. Actually, I slept with CindyLou this way for the first 6 weeks of her life due to her horrible reflux, but we slept out on the couch, not in the bed. I am attempting to get the Bean to sleep on his back during his daytime naps in preparation of trying to get him down at night. It's sad that I get better sleep with him on me than in his own bed.

I'm trying desperately not to think that my maternity leave is just about half over (sob!) because right now I'm just not ready to go back to that chaos. I am seriously considering cutting my schedule as much as I can and cutting back deliveries for a while until we adjust to the two child family. There is nothing I can do about the call, unfortunately. Also looming on the horizon is the Oral Boards. Argh. I don't even want to think about this. Thank you all for your congratulations and compliments on the Bean. You guys are the best, and I promise that I will get back to more witty, interesting posts as I become more witty and interesting. I am starting to think this is directly proportional to the amount of continuous sleep that I get. Back to the laundry for now....

Sunday, August 05, 2007

The Delivery (Long and unnecessarily descriptive...consider yourself warned!)

Eeek. Sorry guys, for leaving you hanging for so long. I fully intended to post this post later the same day, but life got in the way. I guess the picture kind of gives away the ending, huh?
Ok, so where were we? Oh yes, it turned out to be a very good thing that I had packed my bag prior to my office visit. I, however, was fully convinced that since I had the foresight to pack the bag, it would not be needed, as is often the case in my life. My mom and I stopped for lunch at the Oliv.e Gard.en, a rare treat for me as the restaurant is in UniversityCity, about 40 minutes north of MyTown. Then it was on to the office where I had the great news of gaining 5 pounds (and I only had soup and salad at the restaurant!) in the past 4 days, a BP of 150/90, and trace protein in the urine. On recheck the BP went back down to 130/72, and there was no question that I had mild preeclampsia and needed to deliver, there was merely the question of when to do it. I had an ultrasound which showed good fluid, an estimated fetal weight of 8 pounds 10 ounces, and a very, ahem, mature looking placenta. My cervix had actually become more favorable changing from closed/thick/high to 2cm/50%/ -2 station. My OB was on call on Friday 7/20 and I liked the date of 7/20/07, so we "set the date." Then it was time for my NST, where we found that the Bean had other ideas. He was having spontaneous, repetitive variable decelerations in his heart rate, and I thought my heart would stop every time his slowed down, because I wasn't even having contractions yet. Sometimes it sucks to know too much. In between the variables, his heart rate was reactive with fantastic variability, and he was moving all over the place. It was apparent that the Bean had designs on a different birthday other than the one that I had planned. The decels were the last straw, arrangements were made for my induction to begin immediately...and I was scared.

Mr. Whoo went to pick up CindyLou at daycare and leave her with SuperNurse, and also to go home to pack a bag for himself. My mother stayed with me while I got checked into Labor and Delivery. It took some time to get into the room and to be assessed by my nurse because the unit, I could tell, was extraordinarily busy. It was about 6 pm before the pitocin was started. My admission labs, apparently, were starting to bump, as well, and somehow I was able to talk my OB out of magnesium as long as my pressures were stable and I was asymptomatic. They placed me on high dose pitocin, and to be perfectly honest, I didn't feel a thing. I was contracting every 2 minutes, and I didn't feel them at all. It was bizarre. His heart rate remained fairly stable. He did have occasional variables that I could hear, but the monitor was in the cabinet next to my bed, so I could not easily see it (frustrating, but probably by design!) Once the nurse and all of the residents came running into the room together, which is never a good sign, and he was having late decelerations for a period of time. I was a measly 3 cm dilated. The possibility of C-section was seriously discussed, but luckily kiddo decided to straighten up and behave himself with reposition and oxygen.

Around midnight the contractions were starting to not only register but hurt like a mother. My mantra for this delivery was that I had wanted the epidural placed before my membranes ruptured, because with CindyLou they ruptured when I was only fingertip dilated and man, did contractions hurt worse after that happened. I requested the epidural shortly after midnight, but, since my bloodwork was "borderline" I needed an updated platelet count prior to anesthesia blessing me with their presence. Once that was drawn, I knew I wouldn't be able to hold it long enough to have the foley placed, so I wagged myself and my IV to the bathroom. Once I used the bathroom, I couldn't help but think about how my water broke in the bathroom with CindyLou, all over the slippers I was currently wearing. I'm not sure how that visualization affected my body, but as I got ready to leave the bathroom a contraction hit. I held onto the IV pole to breathe and sway through that contraction when, with a pop and a gush, my membranes ruptured all over my slippers...again. "Um, guys?" I called from the bathroom, "My water just broke." The nurses laughed at my puddles as I schlepped back to the bed. Dammit if the contractions didn't start hurting worse, just as I had feared. I think I waited another 30-45 minutes for anesthesia, and even though the resident didn't have the warmest or fuzziest bedside manner, I was ecstatic to see her. I warned her that in my previous delivery, the anesthesiologists had a very difficult time placing my epidural and had mentioned something about small spaces between my vertebrae. She totally blew me off and proceeded to speak to me as though I were mentally deficient. Ok, whatever. She was soon singing a different tune once she felt my intravertebral spaces. She struggled for another 20-30 minutes, grudgingly admitted that I *did* have small spaces, and, mercifully, successfully started the epidural. As unpleasant as her personality may have been, her epidural worked like a dream, and for that, I was grateful.

It was beyond strange to touch the bottom half of your body and for it to not feel like your own. The pain from the contractions was totally gone, but I still had a bit of "pins and needles" feeling at the periphery, almost like my body was lying on a flat board and I could only feel part of it. My OB came in around 1:30 am, placed an IUPC and delivered the utterly depressing news that I was 4cm/100% effaced/0 station. I had been hopeful that I'd progressed farther in proportion to the pain I was feeling. It turns out I'm just a big puss. I tried to settle in for a few hours of sleep, and made the mistake of pressing my bolus button. Immediately I knew something was wrong because the bolus went on for-ever. The medicine just kept going and going. I rang for the nurse to let her know, but by the time she made it to the room, the bolus was in...too late to do anything. Within 5 minutes my pressure was 90/50, I was shaking uncontrollably, and kiddo's heart rate took a dive. What followed was kind of a blur, because I felt seriously out of it, but I know I got ephedrine, 3 liters of fluid, oxygen, and flipped side to side to side. At last the pressure stabilized, and I was then too scared to try to sleep. I positioned myself so that I could see the monitor and waited.

Around 4 am I started to feel the tiniest bit of pressure, but nothing overwhelming, so I continued chatting with Mr. Whoo. Close to 5 am I was really not feeling any more pressure than I had an hour ago, but I knew shift change was coming up and I was curious to know how much progress I had made. The resident came in to check and informed us that the baby was about to fall out (!!!!) Whoa! I was expecting 7 or 8 at the pace I had maintained previously. Since I wasn't feeling an overwhelming urge to push, they took a bit of time to get the table (and later I found out they had a 33 weeker moving back to the OR to deliver, as well) and get organized. My OB was there, but I had consented that the intern could deliver if he was close by and did any sewing/operative delivery that needed to be done. (Seriously, it was mid-July, people!) I think that I pushed for 3 contractions, about 10 minutes, and baby Bean Whoo came into the world at 5:33 am on July 19th. He weighed 7#4 oz. and was 19 inches long (the exact same measurements as his sister, so much for late trimester ultrasound measurements!) and had a double nuchal cord to account for most of his misbehavior. Oh, and he is gorgeous and perfect (of course!) After delivery my blood pressure improved significantly, and I have already lost all of my pregnancy weight. Unfortunately I have 40 extra pounds to go, but I am hoping that breastfeeding will give me a head start on that.

Bean is now 2 weeks and 3 days old. He is a sweet boy, very relaxed and laid back. He pretty much eats, sleeps, and soils diapers. He also is having more alert periods where he contemplates the world seriously and quietly. He rarely fusses, which is so different from CindyLou, who was (in comparison) extremely high maintenance. I'm not getting more than 2-3 hours of sleep at a stretch thanks to breastfeeding, but it seems easier this time around. We shall see as time goes on. Today we just said goodbye to the last of the company/help for a few weeks, so I'll see how well I will fare on my own. CindyLou loves her baby brother and seems to be adjusting very well. I find that my patience with her is shorter than it should be, and I'm trying not to be so impatient with her. I want to thank you all for checking in on us and for all of your great support and comments! I will do my best to update when possible, but forgive me if I don't respond to comments individually for a while. It is almost time to open the dairy bar for lunch, so have a great Sunday and I'll check in soon!

Tuesday, July 31, 2007

Catching Up

Sorry to disappear from the blogosphere for such a long time. I've just been a wee bit busy here. When I posted last, my partner was off on vacation, I was on call, and my blood pressure was teetering on the borderline. I made it through the first week of OtherDoc's vacation relatively unscathed. I had lots of clinic patients, but the deliveries remained somewhat manageable. I, on the other hand, was feeling pretty drug out and worn down. (Wonder why?) At my 38 week appointment, my OB was on vacation as well, so I saw another physician in the practice. My pressure was 148/89, my cervix was closed (surprise) and my NST looked great. I got the lecture about taking it easy (yeah, right) and I had to repeat the dreaded labs and 24 hour urine protein. I saved that joy for the weekend. I collected on Saturday and turned it in on Sunday when I went in to round on patients.

I'm not sure if this is a coincidence or not, but on Sunday I admitted and delivered a severe HELLP patient of mine. She had no preeclampsia, only HELLP, and she got really sick really fast. She came in complaining of upper abdominal pain. Her labs were just mildly bumped at that time, but she was term with a favorable cervix, so we began Mag Sulfate and started the induction immediately. Luckily she delivered within a couple of hours. Then the fun with labs started, her liver enzymes soared as her platelets plummeted. The platelet count nadir was around 40,000, just shy of needing a platelet transfusion. Luckily, with the help of Dexamethasone, she turned the corner and recovered very quickly. She was able to go home on her 3rd day post-partum. Later that day I checked my own labs. No signs of HELLP, but my 24 hour urine protein was solidly in the mild preeclampsia range. Knowing that my time was limited, and in anticipation of having the smackdown at my Wednesday afternoon appointment, I attempted to stack my schedule for Monday, Tuesday, and Wednesday morning.

Monday was an absolute blur, lots of clinic patients, charts, and 3 inductions, not to mention my sick HELLP patient. I was waiting on a delivery (around 5:30) when I got a phone call from my physician at labor and delivery. Uh-oh. It turns out that he had been looking for my labs, and when he saw the 24 hour urine protein, he was compelled to find me and tell me to stop working...pronto, and to pick a day for induction. Eeek. I immediately flashed on how sick my patient had gotten in such a short time, and I knew that it was time to start taking care of me. He sounded like he meant business, so I immediately called the back up covering physician, who was wonderful and told me not to worry about him covering my patients, even though I had stacked inductions and sections for the next few days. I then made out an extensive check out list and did the final delivery ( a rather difficult vacuum, at that). Then I went to see my patients that I had scheduled for induction and explained that I had been pulled from work by my own physician and would not be attending their deliveries. Then I cried, in front of the patients, and felt like an idiot. Both women were very understanding. I finally got home around 11pm, cried some more, and felt like the weight of the world had finally been removed from my shoulders. Tuesday I did absolutely nothing but sit and catch up on my patients via computer. Wednesday I (finally) packed my hospital bag and prepared to go to my appointment. Little did I know how important that would be....

To be continued...

Sunday, July 08, 2007

The Home Stretch

It seems as though, in these last few weeks of pregnancy, I should be surging toward the finish line with my last burst of energy...stretching forward and extending further than ever I have before. In actuality, I find myself barely limping (literally, stupid sciatic nerve pain) along, dragging my feet, and procrastinating the whole way. I haven't packed my hospital bag. The nursery really isn't ready. I'm really not mentally prepared for this new arrival, and yet I find myself hoping that he's getting here sooner than later!

Sorry for the long silence, but as per usual, I've been busier than ever at work and at home. I am covering call for my partner, as he is taking his annual 2 week long vacation (if this doesn't put me into labor, I'm not sure what will). We've had visitors for the last 3 weekends in a row, and while wonderful, it has been exhausting. I wanted to thank each and every one of you for all of your helpful comments, well wishes, and hints about flipping my stubborn breech baby! I promise, I've not been holding these comments hostage, rather, I've just not had a chance to get them all published until today. First of all, I did check the website to find it to be the same one I've directed patients toward in the past, I did do the knee-chest reposition manueuvers, the inclines were just too much blood rushing to my face, and I didn't have immediate access to a swimming pool deep enough in which to do handstands (without embarrassing myself at the public pool by having my stubbly legs waving about in the air, that is), but I did suspend my belly between two rafts in my daughter's oversized wading pool. I did not do moxibustion. I wasn't really sure where to get the candles and wasn't certain enough about the technique to order them from the internet. I barely have time to make my own OB appointments, so seeing a chiropractor was not a real possiblity, although I do have patients that have had success in this arena. As far as visualization/hypnosis stuff, I think it ended up more like begging, pleading, and cajoling the Bean...pleeeeaaaassssseeee turn around, c'mon, I'll buy you a pony, etc. The fact of the matter is, I don't think any of the traditional techniques had one iota of influence on my stubborn child. The evening before my second ultrasound, I could palpate his hard head right below my ribcage, and I had resigned myself to making the decision for version or elective section (because I am too a'skeered of the risks associated with vaginal breech births). Then, my 20 pound girlcat took matters into her own paws. She leaped upon my belly, positioning herself directly over the caput of my stubborn son, and proceeded to activate her very loud purrbox. She hatched my belly and purred for about an hour, and boy, did the baby respond! He wriggled and kicked like crazy, it was, at times, almost painful, but after that hour, I could no longer feel his head in my upper belly. The ultrasound the following day confirmed that I had, indeed, had a successful cephalic version via kitty, and vertex he has remained ever since. So much for traditional methods of flipping breech babies! If I were to try to rationalize why this worked when nothing else did, I guess I could say that it is close to vibroacoustic stimulation like we use to "wake up" sleeping babies on non-stress tests. Who knows? All I know is that he is now vertex, and getting way too chubbly (hopefully) to turn back around now.

As for his estimated weight, a good 7 pounds as of a little over a week ago, of course I'm taking it with a grain of salt. The limitations of ultrasound in predicting weight accurately in the third trimester are not lost on me, but what woman doesn't cringe a bit thinking about the possibility that, indeed, the measurement is closer to correct than not, or, worse still, is off by a pound in the positive direction? I'm trying not to think about it too much and trying to trust that I don't feel like I'm carrying an almost 8 pound kid at this point. We shall see. My BP has been holding steady 140s/80s, no protein, normal labs. I even lost a pound this week. (Whee!) This next week, we are going to try to take professional belly/family photos, so I must find some inoffensive similarly colored shirts for Mr. Whoo, CindyLou, and me. We have a to-do list a mile long. I thank you all once again for checking in on me and all of the encouragement. Now I must get into the hospital to round (I've started to deliver some patients whose due dates are *after* mine, and there is very little in my life as an OB/GYN that is more discouraging than that!), continue to wash baby clothes, and maybe, just maybe, pack my own hospital bag. Just like a real pregnant person.

Monday, June 18, 2007

The Good News and The Bad News

Today I had my OB appointment and my (long awaited) second ultrasound. The reviews were mixed.

The good news:
We have a beautiful, healthy, perfectly angelic looking baby growing and thriving inside. (All bias aside, we got a glimpse of his face with the 3D scanner and he is gorgeous.)

The bad news:
He's breech and near the 90th percentile of size for dates.

The good news:
My 24 hour urine protein was below the range for mild pre-eclampsia.

The bad news:
(TMI alert) I produce so much urine in a 24 hour period that I filled the collection jug to capacity and was unable to capture my last two voids. (I knew I went a lot but this is ridiculous! That jug is frigging huge!)

The good news:
My OB thinks I may be a candidate for an external version.

The bad news:
But that is subject to change if this kiddo continues to grow to gargantuan proportions.

The good news:
I don't seem to have pre-eclampsia, yet.

The bad news:
I definitely have gestational hypertension (146/90 today) and may have to repeat the 24 hour urine study in the not so distant future.

The good news:
I may soon be able to tell my patients what it is like to have both a vaginal delivery and a C-section.

The bad news:I may soon be able to tell my patients what it is like to have both a vaginal delivery and a C-section (sob)!

All labels aside, I am trying not to flip out too much about the Bean's stubborn streak just yet. I am just shy of 35 weeks, I have great amniotic fluid (18 cm plus) and a little more time. I'm more than a bit discouraged that he is measuring so large, because that can be 1) an impetus to proper positioning and 2) even less pleasant to deliver vaginally, should he decide to turn around. The fact that I am outgrowing scrub sizes in a matter of days despite not gaining tons of weight on the scale (18 pounds total for the pregnancy thus far) should have been some sort of clue to his rapid expansion, I suppose. While a C-section isn't an ideal outcome for me, it won't be the end of the world if if is necessary. There is no guarantee that I would have a vaginal delivery, even if he were cephalic, and if he's ginormous, I'm not too sure that I would be all that keen on a dystocia or a 4th degree over a surgery. In fact, I *know* I would much prefer a C-section over a 4th degree (just repaired one at 2 am this morning, as a matter of fact) some orifices just shouldn't combine. Ah well, patience was never a strong suit of mine, but I will just have to wait to see how this all turns out. For now, I'm (mostly) healthy, he's healthy, and that is all that truly matters. (But if you have any sure fire remedies for flipping breech babies, please do clue me in!)

Sunday, June 10, 2007

8 Random Things

Let me begin the post with apologies for the delay in responding to the tag by Medstudentitis; she is a great blogger and I'd hate for her to think that I was ignoring the tag! I'm sure that I am probably repeating myself with some of these "random things," as I have an embarrassing tendency to allow all of my inner random-ness hang out all over the place on this blog.

1. I am an introvert. If you want to get really particular, my Keirsey temperament profile is INFJ. This seems strange, I know, being in a profession that requires so much social interaction. I am quite easily fatigued by socialization and feel like I have to be "on" in social situations at all times. I much prefer small group settings to big parties. I require a certain amount of time to recharge and regroup either alone or just with my family. I love to just read, veg out in PJs, and just *be*. Now, don't get me wrong, I can be sociable with the best of them, it just really drains me emotionally. Sometimes I think having my job and an extrovert for a husband keeps me from being a total internet hermit full time!

2. I met Mr. Whoo in an online college football chat room. We were email buddies for about 9 months before we met in person and our relationship took a more romantic turn. We met online back in 1997, a time when internet dating was more fodder for Jerry Springer than mainstream, so we kept it kind of quiet until it became more acceptable. The best thing about emailing and chatting during the initial stages of our relationship is the solid foundation of friendship that we built, even before all of the physical attraction got started. Our friendhip is the rock of our marriage, and after all this time, he is still my best friend in the whole world. Aw.

3. I stubbornly dated the wrong guy throughout high school and college (7-ish years), thus stunting my dating experience dramatically. Don't get me wrong, he was a good enough guy, he just wasn't the right guy for me, and never would be, try as I may. I hate to say that those years were wasted, because the lessons that I learned from that relationship were invaluable, but I never had to work so hard to keep a relationship going. The relationship ended when, after seven odd years of dating, he told me he didn't know if he *ever* wanted to marry me. Crushing. I was devastated, but then I finally "got it" and moved on. Ironically enough, the week after that conversation took place, I had my first internet conversation with Mr. Whoo. There is a line in a Sister Hazel song that always reminds me of my first relationship - "You were the one who taught me what I don't need, and I thank you, I thank you for that."

4. In another lifetime, I was a competitive cheerleader. Seriously. I started cheering in the South at the ripe old age of ten. We practiced 4 hours a day for competitions during the summer months. I cheered through Junior High and High School, co-captaining the Varsity and Competitive Squads. I choreographed routines and lifts and cheers in my spare time. I coached a mini-squad and took them to competition. I went to a college cheer camp at the University of Kentucky and seriously considered trying out for my college squad...until I discovered I could either be a cheerleader or a Biology major. (Cheerleaders couldn't have Friday classes due to travel obligations, and all science courses were M, W, F.) I guess it's obvious how that decision worked out. No regrets here, either.

5. People fascinate me. I love to get a peek into someone's inner psyche. It is a large reason that I became a physician. I like to know what makes someone tick, literally and figuratively. From an early age, I was always the "counselor" of all of my friends. I think this is why I am so addicted to reality shows, reading blogs and message boards, and just plain people watching. Undoubtedly I am not alone, as I believe that this is the case for most Bloggers and blogging fans. Some people rock, and some people suck, but all people are interesting in one way or another.

6. One day, I'd like to write a book. I'm not really certain what I would write about, and I'm really not certain that anyone but my family and friends would want to read it. I just love books, and I love to write, and if I ever win the lottery and/or become independently wealthy, I'd like to write a book. I'll probably end up like Chevy Chase in Funny Farm, but that would be fun too.

7. I'm not really a "kid person." In fact, for a long time in my younger days, I swore that I would never have children. Then I met Mr. Whoo, and I decided that there was someone in this world with whom it was worth procreating. Don't get me wrong, I love CindyLou and we have fun together, and obviously I'm having another one, but I still don't know what to *do* with kids, especially in a group setting. I have the patience of a 3 year old...I know this because I have one, and sometimes, she's more patient than I!

8. I really love the *idea* of being outdoors, but the reality? Not so much. I love the scenery, but not the nitty gritty realities. Some outdoor activities are fun, like white water rafting, even canoeing. It is fun to hike, but I don't really want to camp unless there is air conditioning and a toilet involved. Bugs squick me out. I hate to be hot. I sunburn in 8.2 minutes flat. I guess that you could say that I love the great outdoors from a distance.

If anyone is still reading, I hereby tag anyone that didn't do this a month ago, when it first started making the rounds. Happy Sunday!

Saturday, June 02, 2007

Still alive, still pregnant, still whiny

Is it really June already? I'm not ready for it to be summer! The last few weeks have been (SSDD, I know) a whirlwind of work, catching babies, visiting family, and minor freak outs about the status of the medical blogging community in general and about my blog in particular. It is difficult for me to even see hits from the same *state* on my stat counter without getting antsy about being "found out." I debated stopping altogether, but I miss blogging and talking to you all out in blogland. I guess that I was never organized enough about blogging to figure out what I wanted this blog to be, a mommy blog? A doctor blog? Educational? Entertainment? To tell the truth, more than anything I approached it like my own personal journal, an outlet for all of the jumbled thoughts in my brain that I need to spill and sort out in black and white. A journal that talks back ! (The coolest part of all.) So, I think that is what it will continue to be, with major alteration of details surrounding the particulars of my job. I think I can live with that. We shall see.

So let's catch up. On a personal note, I am 32 weeks and 2 days. The Bean has hiccups regularly, and I am convinced that he is still in transverse lie. I've been measuring almost 2 weeks ahead for the last few appointments, and I am dying to know how much this kid is going to weigh. (Did I mention that I don't have free access to an ultrasound machine, so I am at the mercy of the insurance/physician order just like every other pregnant woman? Shameful. I'm dying over here.) The "due any day now" comments are coming fast and furious, along with the shock and mock horror when I tell them that I still have at least 8 weeks to go. People can be so jerky to pregnant women, it's unreal. It continues to be a real test to patiently listen and empathize with my whiny pregnant patients, being a whiny pregnant person, myself. More than once, when asked when their maternity leave should start, I've stifled the urge to quip "You can't stop working until *I* stop working." Ha. I would never say this out loud, but it's fun to fantasize about. I had a very busy delivery month in May, and I am looking forward to having only half as many patients due in June. Pregnancy symptoms include lots of contractions (but a negative fetal fibronectin, so all is well), sciatic pain, mild pubic symphysis diastasis discomfort, cankles, borderline elevated BP (130-140s/80s), and killer heartburn. I am happy to report that I am no longer puking, even on a weekly basis.

Remember the less than stellar med student that I posted about a while back as an example of what not to do? Not too long ago, that very same student cornered me in the Doctor's Lounge and proceeded to tell me how "shocked" they were at the grade that I had given them. (For the record, it was in the ballpark of an 85 percent. I felt that I was more than generous for the work the student did!) I got treated to a talk of woe, that they had really, really wanted to do OB/GYN and my grade didn't place them at the top, where they believed they should be. I also heard about how the grade I gave them was the worst grade they had ever received. (Which shocked the hell out of me, leading me to believe that this student must have been allowed to slide by with being "cute" and "sassy" because their clinical knowledge and work ethic was sub par, as far as I could see.) I was as gracious as I could possibly be, and stated that it was possible that I was a stricter grader than the student's prior preceptors, and I encouraged them to pursue recommendations and work hard in their 4th year electives in OB/GYN. Then I politely excused myself before their audacity completely caused me to lose all composure and give them a real piece of my mind. Now I wonder if it would have been better to just lay it all out for them, because, really, I am not doing them any favors, allowing them to think that they were the best student around, and I am just a mean, hard-grading jerk of a preceptor. (No, it isn't me, it's *you.*) I just suck at unexpected confrontation. I need time to formulate coherent arguments, otherwise, I tend to just make off the cuff, not so nice, and certainly not constructive comments. Ah well, just thought it would amuse y'all to hear the update.

I am off this weekend, and Mr. Whoo and I are about to tackle the master closet. A project a long time coming, accelerated by the fact that an entire rack of clothes fell off the wall this past week, requiring immediate attention. Sigh. Home improvement sucks.

Saturday, May 12, 2007

Promises, promises

Sorry, I should know better than to make grand promises of fantabulous posts only to disappear into blog oblivion once again! Time is flying past me more and more quickly these days, and many times I am too lazy to do more than lift an arm and swat at it as it zips past. I think that I am a pretty slovenly, lazy person by nature, yet the circumstances of my life rarely allow me to indulge those ingrained tendencies. Thus, I take the opportunity to do absolutely nothing whenever I can, preventing me from being more productive in my rare "off-times."

Last week my parents were in town for CindyLou's 3rd birthday extravaganza, which was great and probably a little over the top for a 3 year old (but not to the level of ponies and bounce houses over the top). We had the party at a local "fun center" that has all kinds of indoor and outdoor games/rides/ mini-golf/arcade etc. because, let's face it, nobody's idea of a good time is cleaning and hosting a whole bunch of 3 year olds and their parents at your own house. (Ok, for some people, maybe it is, but it is certainly not *mine*!) We also discovered the greatest birthday cake idea ever, the cupcake birthday cake. Basically it is a couple dozen assorted cupcakes frosted to appear as one cake. The great part is in the cutting, equal portion sizes for all, and you can have the flavor that you prefer. I must be quite sheltered because I thought this was awesome. She had a great time, and I can't believe that our baby girl is already 3 years old. I even wrote out the thank you notes and passed them out the following Monday. Go me! Ha. Needless to say, the party and surrounding festivities were enough to put me out of commission for several days, hence, no posts and nothing else got done around here, either.

This morning was one of those rare mornings that CindyLou graciously allowed us to "sleep in" (i.e. she woke up at 8 am and settled for watching Dora the Explorer in our bedroom as we valiantly tried to sleep through Dora's shrill bossiness.) Usually CindyLou is up no later than 6:45 am, and will not settle for less than breakfast shortly thereafter, so when I say that sleeping past 8 am is a treat, I am not kidding! The final straw was a painful song that Dora shrilled through (it was really pitchy, and just ai'ight for me, dawgs) to finally roust us out of bed. Then it was off to the hospital to round for me, out to breakfast and the park on a play date with my nurse for CindyLou, and out to the backyard to assemble the playhouse from hell (CindyLou's birthday present) for Mr. Whoo. I rounded on my patients and OtherDoc's patients, did the 5 circs that he so nicely left for me to do (I hate doing circs) and I am finally back around to visiting good old blog land.

So, as for interesting cases, a few weeks ago a colleague approached me to assist with a likely ovarian cancer case. This physician is rather "old school" and is brave enough to do cancer cases on their own. I, on the other hand, will refer in a heartbeat if I think cancer is in the cards. I'm a big chicken. At any rate, the patient was a young, mid-forties woman, who hadn't been to the gyn since the birth of her last child 19-some years ago. She presented to the emergency room with right lower quadrant pain, thinking she may have appendicitis. Instead she had a firm, fixed 12 cm pelvic mass, and a CA-125 of over 2500. We took her into the operating room, fully expecting an advanced ovarian cancer. Instead we found severe endometriosis. She had a twelve centimeter chocolate cyst that had torsed, causing her acute pain. She also had endometriosis implants throughout her pelvis, bowels, and omentum. We essentially did a debulking of endometriosis along with a hysterectomy. All of the frozen and final pathology came back completely benign. Amazing. Even more amazing to me is that, for as long as it must have taken for the endometriosis to become so severe, the patient stated that she never had a problem with pelvic pain until the day she presented to the emergency room. Women can be incredibly tough. She sailed through post-operatively, and went home within 3 days. It was nice to see that sometimes things that seem to be the worst may not be as bad as they appear. Sometimes it is easy to lose sight of that.

With that thought, I'm off to supervise the great building project and to enjoy some of this spectacular spring weather. Happy weekend, all!

Saturday, April 28, 2007

2 Weeks Post Call and Whiny

(I know I've posted a similar whine in the past, but humor me, this is on my mind.) Yes, it is just as it sounds, I have been on call, 24/7, for the last 19 days. Granted, I haven't been in the hospital/office the whole time, but it takes such a mental toll! Call as a private practice doc isn't anything like call when I was a resident. In residency, being "on call" means being in the hospital for 24 hours (and, prior to the 80 hour restrictions, up to 36 hours) at a time, working with a team of other residents/attendings, and caring for multiple patients, including surgical, laboring, antepartum, and post-partum. It was grueling, but the time was finite. Even on the worst of days, there was a definite time when I could turn the pager off, and take time only for myself. On days that I was not on call, I was generally out of the hospital around 5-6 pm, with no fear of having to return to the hospital until the following morning, as another resident team was shouldering the workload.

Now when I am on call, it is all me, and only me, on call for all of the patients that I have ever seen, and, over the weekends, on call for all of OtherDoc's patients, as well. Most of the time the calls I get can be handled from home with a phone call, and I can go about the rest of my day. Of course for deliveries and surgical emergencies, I need to be in the hospital ASAP. The hardest thing for me is that I can never quite mentally disengage, as at any time, I have to be ready to race to the hospital. I can't ever go further away than 30 minutes from the hospital, and if I am doing something with my family, we often take separate cars, "just in case" I get called. The pager can go off at any time, and you just never know what is going to be on the other end of the line.

When I was looking for positions post-residency, this was not what I had in mind. I was somewhat mislead into believing that call was split Q 3, and weekend call was to be every third weekend. What actually happened was that I was on solo call for a whole year until I could beg, cajole, and finally convince OtherDoc to at least split weekend calls. The other hospital OB has no interest in sharing call whatsoever, and only wants call coverage for vacations. Now there are some perks for being on call so frequently. I do get to deliver most of my own patients, and when I get calls for problems, I know my patients' histories and personalities fairly well, and can advise them accordingly. I also have fewer patients to cover than a group OB would, so that means less trips to the hospital/phone calls/ etc. while on call. I think that in the next 2-3 years the hospital is looking to hire another OB/GYN, and I am desperately hoping that this person wants more of a life and will go for sharing weekend call, and possibly sharing weekday call, as well. As CindyLou and the Bean grow up, I want to be available for sport games, recitals, and school activities without fear of having to leave to the hospital. I knew what I was getting into as an OB/GYN, and honestly, I don't mind being on call for my patients, because I know that they need me and trust me. I just need to strike a better balance of being available, mentally and physically, to my family and friends as much as I am for my patients.

I am now 27 and 2/7 weeks pregnant, and I am starting to physically slow down. Some days I feel just like a little old lady, whining about my "sciatica." Ha! I am rather short in stature, so the belly is quite "out there" and it is already inviting "due any day now" comments, which is maddening. My office has actually started to pare my schedule, and now, instead of 40-50 patients on my full days, I am averaging closer to 30-35 patients on a full day. This is infinitely more manageable, especially when it comes to charting, but now that I am moving slower and a little more tired it still takes all I have to get through those full days in clinic. My "half-days" are still averaging upwards of 20-28 patients, which is also difficult, but so far I am making it work.

It's funny (read kinda sad), because my patients are always commenting that it must be "so much easier" for me to be empathetic to my pregnant patients, as I am pregnant, myself. I am finding the exact opposite. It is hard for me to commiserate with the patients angling for time off work, complaining about common discomforts, and lounging about muttering about how *tired* they feel. Some days it takes all that I have not to tell them to "suck it up and deal!" It isn't a fair attitude to have, because I *do* know how miserable pregnancy can be, and misery is relative. Just because I feel like I am *more* miserable than they, doesn't mean that my patient isn't experiencing more misery than she ever has before. I do find it interesting that the majority of my patients that are having an "easy" pregnancy do not work, and those that are having the most complications are the working mothers.

For now I am going to close this post, because the whining is starting to annoy *me* so I know it must be most unpleasant for all 6 of *you* still checking back to see if I am still alive. I have some really good cases to discuss as soon as appropriate time has lapsed, so I will try to get around to updating in less than 2 weeks time. Happy weekend to all!