Friday, April 13, 2007


Your comments on my previous post are all awesome, and I promise to respond to each of you in the comment section. I have decided to accept the gifts gracefully and to send out thank you notes to the patients at their homes. None of the gifts have been over the top, and I really do feel blessed that my patients want to celebrate this little bean with me. What's really funny is the patients asking me how *I'm* feeling. That takes a little getting used to, and I find myself getting all flustered and embarrassed. It made me realize what an interesting physician/patient dynamic there is with respect to disclosure. We want to know everything about our patients, medical problems to marital status to sexual history (and for good reason). Yet we disclose little, if any, personal info about ourselves in return; so much so that when patients ask how I am feeling or how the pregnancy is progressing, I feel uncomfortable speaking about myself on "their time." Does that make any sense? Anyway, I'm getting used to it, and it is kinda nice.

So far my Friday the 13th has progressed in standard crappy fashion, I started the morning off puking my guts up. I had been off of the Z0fran for a solid week and was feeling too cocky. Next I got to explain to the young girl in her early twenties (who was admitted to the hospital for unexplained ascites) that she has a pelvic mass, and, in all likelihood, has a large ovarian cancer. She has never been pregnant. She has never even had sex. Therefore, she had never seen an OB/GYN. Please go get pelvic exams, ladies, even if you aren't having sex. I can't help but wonder if the mass would have been caught so much earlier if she had only had an exam.

Then I saw a million and a half patients squeezed into a "half day" of appointments, not to mention a large wound infection (on a section that my partner did, thankyouverymuch) that I had to open, drain, and pack in the office. While the rest of the office staff breezed out of the office by 2pm, I caught up my charts and sifted through mountains of paperwork, FMLA papers, consult letters, and lab results. This weekend I am on call, and so I am fielding asinine phone calls from OtherDoc's patients wishing for me to phone them in narcotics (I won't) and diagnose anemia over the phone. Sigh.

In positive news, I am 25 weeks and 1 day. My last appointment my blood pressure was awesome at 124/80 (yay!) my weight was up for a total of 10 pounds for the pregnancy thus far (boo!) and everything is measuring right on target. The Bean is a mover and a shaker, and he particularly likes to party between 9-11 pm. In other big news, Miss CindyLou Whoo is all but done with diapers. She has been dry for almost 2 weeks solid now! Woo HOO! We still put her in a diaper at night (more as a failsafe than a necessity) but she only wears panties during the day. It is sad to be so excited, but we were hoping to get her good and out of diapers before the Bean makes his debut. So far, so good! I hope you all had a better Friday the 13th than I, and I also hope that you are having nicer weather wherever you are, it is too fragging cold and icky for APRIL 'round these parts! Have a fantastic weekend!


Doc's Girl said...

Good news all around...! :o) Amazing that when you put the diapers away, you get a few months of peace before it starts right back up again. :-P

MarlaQuack said...

I've really enjoyed reading your thoughts. As a patient I usually always ask the Dr. how they are doing before I let them touch me. I've gone so far as to tell one to sit for a minute on my time and catch her breath. I thought Geez if you’re not doing alright how can you think clearly to help me. Granted this type of Dr. /Patient relationship is not for everyone, but I feel that by caring about how the Dr. is doing I receive far superior care from them.

Macha said...

Thanks for posting, Dr. Whoo! (I hope this is not a duplicate comment--if so please delete). I am curious about how many nurses/medical assistants you use to see the quantity of patients you see. What do they do for the pt, what do you do? Thanks for any info...trying to streamline my practice! Keep up the good work and here's hoping you get some warm sunshine soon.

AtYourCervix said...

Yeah on the little one with potty training! I just went through that with my 3 1/2 year old, and I am SO glad (and hopeful....) that she's done for good this time.

25 weeks already? My, how time flies!

Ottoette said...

Congrats on CindyLou's accomplishment! It's only been a few months since Kimo got there and I know what a huge relief it is - esp with the little one on the way.
Sorry for the news you had to break - what is it with these virgins thinking pap smears and pelvics are related to sexual activity? I have met a few of them in my day and gone crazy trying to convince them otherwise. My Mom took me for my first pelvic 2 years before I lost my virginity and it was pretty clear to me that it was a medical thing - not a sexual thing. So sad.

Anonymous said...

This is a story about a family from my church dealing with a poor prenatal diagnosis, birth, and death of their baby. I prayed for them, and saw them almost weekly. Their family watched our older children during my second sonogram. They understand what I am going through in my fear before the diagnosis, however, I cannot bring myself to seek them out for comfort as of yet. We don't have a diagnosis, are still considering amnio. Don't know what to do. We have a sonogram this Friday morning, and will decide.

Anonymous said...

Jawndoejah here. I am signing as anon because my husband's blog isn't working (I think he didn't update and it just died). I did have a 2nd level 2 u/s and the peri wouldn't do amnio for two reasons. 1. Baby looked good with no visible markers at the almost 20 week sonogram(still measuring 8 days behind the first dating sonogram at 10 weeks). 2. I won't terminate. I did say I thought hard about amnio and would do it to determine if I want a c-section or need to look at the heart to prepare for surgery for baby after birth. He then added, "if I saw a heart problem I would be in your face for the amnio so we could avoid a c-section or heart surgery that would not be warranted on a baby with trisomy 18." Fact is, if baby has a fatal condition (which seems unlikely with the good sonograms...I hope) I want time with baby. If the baby cannot tolerate labor but can be brought out alive, I want that so I can see my baby. If baby has a mosaic form of t-18, and looks like it might have any chance of being one of the few to make it past a few months, I want to do surgery. I know it's a chance, a slim chance, but some families are blessed with more time with interventions that would normally not happen. It all depends on how things look, and I understand comfort care is usually best...but if there is any chance, I'm going to take it. The peri just made me realize how much I need to study up and learn so I can decide what to do. I also have a low lying placenta, and it's anterior. My OB was a bit agitated that he didn't schedule another sonogram. She mentioned the placenta, and I think I will get at least another peek later. I want the heart to really be examined as I know SLOS and other things can come out as positive screen for Trisomy 18, and I want to at least be as responsible as I can. If any markers are found at a later sonogram, I will see if I can get amnio then. Otherwise, we're going to treat this as a normal far as we know baby is okay.
Dawn (Jawndoejah)

dr. whoo? said...

doc's girl~ Hi! It will be a short reprieve, but definitely worthwhile. In some respects, diapers were easier. Now we get to visit every public restroom in sight, and CindyLou's favorite time to go potty is right when the restaurant brings hot food to the table. Murder on the pregnant lady, let me tell you! ;) Thanks for reading!

marlaquack~ Thank you for your kind words. I am glad that you have enjoyed the blog...if only I could update more often! I agree that treating people well should increase your odds of getting treated well in return, oddly enough, this isn't always the case. I do try to make it a point to sit down and talk to my patient at every visit (as opposed to standing over them) even if the visit is just a quick consult. It gives a different feel to the encounter. Hope that you continue to enjoy the blog!

rural ob/gyn~ Hi there! I share an office staff with OtherDoc (who sees 50-70 patients per day sometimes on his full days, crazy) and we are both hospital employees, so the hospital actually hires our staff. OtherDoc's wife is our office manager (which is another rant for another day!).

Our front office staff includes a front receptionist, a discharge receptionist, a billing clerk/surgery scheduler, and a general assistant that can do any of the above jobs to some degree,call patients for appointment reminders, answer phones, and file.

I have a medical assistant that takes vitals and checks patients in (updates meds/allergies/etc.) and an LPN that assists me with exams, does injections, some diabetic teaching, wound checks, staple removals, and (most importantly) answers phone calls. She can also see prenatals if I get called out for a delivery (fundal height, heart tones, etc.) I just got the medical assistant. Prior to her hire, my LPN did all of the checking in, vitals, etc. in addition to her other duties. She is awesome, so she did fairly well, but I know it was difficult.

OtherDoc has a medical assistant and LPN, as well, with similar job descriptions. At times, if my nurse is ill, the MA will fill in and help with exams. I hope this helps, and good luck streamlining your practice!

atyourcervix~ Thank you! I just hope that CindyLou doesn't decide to regress once the Bean gets here. I hope you are feeling well and recovering!

ottoette~ Thank you for the congrats! We are so proud of her. As for the little girl with the pelvic mass, it just breaks my heart. Denial can be such a powerful force in the human psyche. I continue to be amazed at how little some women understand about their bodies (for example, one patient thought that a catheter in her bladder would prevent her from delivering a baby, you know, since pee and babies come from the "same hole." Eeeek.) I hope that your pregnancy is progressing well, you are getting close! :)

Dawn~ Thank you for your update. My heart just aches for you. The uncertainty has got to be so difficult. I am so glad that the ultrasound looks good, and I think that "hoping for the best but preparing for the worst" is a smart way to approach things. I will keep you and your family in my thoughts and prayers, and hope for a continued healthy pregnancy. Please keep me posted!

XE said...

Congrats on the potty training, and the progress with the bean! Hopefully the morning sickness will abate soon - doesn't it normally subside after 14 to 16 weeks?
I'm sorry to hear about the woman with the pelvic mass. I know that the guidelines are set up so that you're supposed to start paps and pelvics at 18 regardless of sexual activity, but I don't know how many teens adhere to them. Certainly not many I know. Thanks for reminding me to have a chat with the leader of the health promotion team at school about perhaps running some kind of information campaign.