Thursday, April 24, 2008

72 hours (In bullet points, because I'm just that tired)

Listed below are 3 days (in a row) that I have had the pleasure of undergoing recently. You can't make this stuff up. The only thing that makes it better is wine. So for those of you wanting to "know what it is like to be an OB ," here you go.

Day 1

2:00 am - Page #1 - Induction for preeclampsia, asking for pain meds for contractions. Nurse didn't bother to check the orders I had called in the evening prior, for pain meds, for contractions. Oops.

3:00 am - Page #2 - Triage - 32 weeker, pain with urination, no contractions, cervix closed. UA, Rx antibiotics, see in office.

5:00 am - Page #3 - Induction requesting epidural, IV bolus running. Please come in?

5:01 - 5:15 am - Lie in bed and curse the universe.

5:15 am - Shower, dress, warm Bean's am bottle, label bottles for daycare, prep CindyLou's breakfast, take upstairs to Mr. Whoo, drive in to hospital

5:40 am - Arrive, find a place to pump while epidural gets placed.

6:00 am - Check now comfortable patient, 6 cm, BBOW, no contractions picking up on the monitor, AROM, IUPC

6:15 am - Start rounds

7:15 am - Triage patient, term, in labor, 4 cm. Write admission orders.

9:00 am - Induction patient now 9 cm/0 station, variable decels, FSE. Call office, cancel AM patients.

9:30 am - Breakfast, pump, rest in empty labor room.

10:30 - 11:30am - Dictate delinquent charts, field office pages for various "emergent questions."

11:30 am - Labor patient gets epidural, induction patient complete, but too numb to push...laboring down.

12:00 pm - Check labor patient, 5 cm, SROM after epidural (she had thought she had peed) comfy.

12:30 pm - Pump, induction patient pushing.

1:30 pm - Labor patient feeling pressure, complete, starts pushing.

1:45 pm - Deliver labor patient's baby, placenta, get called away before laceration repair to catch induction patient's baby.

1:49 pm - Deliver induction patient's baby, sew 3rd degree laceration (14.5 in head).

2:10 pm - Return to labor patient's room, repair 2nd degree laceration. Write orders on both patients.

2:30 pm - Sign off NSTs, head to office, stop for fast food lunch on the way.

2:45 pm - 6pm - Office patients.

6:30 pm - Arrive home. Make dinner.

6:32 pm - Page # ???? - Triage patient, 38 weeks, oligohydramnios. Admit for induction.

7:30 pm - Baths, stories, and bedtime.

8:30 pm - 12 am - Dishes, bottles, tv, and sleep.

Day 2

7:00 am - Page #1 - Triage patient, 39 weeks, labor, 4 cm. Admission orders.

7:30 am - Rounds, oligo induction 3 cm/60% effaced, start pit, encourage ambulation.

8:45 am - Arrive at office, pump while signing off labs.

9:00 am - 5:30 pm - Office patients (32, not too shabby!), charts, 20 min for lunch and pumping.

5:35 pm - Page #2- Labor patient 9 cm with BBOW, call Mr. Whoo to pick up kidlets, drive to hospital.

5:50 pm - Check oligo patient (who's been walking the halls all day long on pit). No cervical change. Decide to rest overnight and restart in the AM.

5:54 pm - AROM Labor patient, complete, fetal decels, resolution with O2 and reposition. FSE placed.

6 pm - 8 pm - Intermittently push with patient. Get hemorrhoids. Pump with "fred" the hospital pump. Fun times.

8:15 pm - Maternal exhaustion, deep variable decels, successful vacuum delivery, repair 2nd degree episiotomy.

8:30 pm - Write orders. Check on induction for post dates for the AM. Finally leave fragging hospital. Curse universe once again. Get page from UTI triage patient...still with painful urination. Encourage to continue antibiotic.

9:00 pm - Arrive home.

9:15pm - 11 pm - Dinner, Ti.Vo, and bed.

Day 3

6:30 am - Get up, pump, see kids for 2.5 seconds, drive to hospital. Eat breakfast bar. Yawn. A lot.

7:00 am - Rounds. AROM oligo patient, place FSE/IUPC.

7:30 am - 1st surgery of the day. L/S, endometriosis, ovarian cystectomy, lysis of adhesions. Dictate. Talk to family.

9:30 am - Check on postdates patient, getting epidural. Pump. Round some more.

10:45 am - 2nd surgery of the day. L/S, endometriosis, adhesions, H/S, endometrial ablation. Smooth. Dictate. Can't find family.

12:00 pm - Check back with postdates patient. 4 cm, AROM, IUPC. Contractions not nearly as impressive on the IUPC.

12:15 pm - Oligo patient's epidural not working. Re - do epidural. Pump. Consider eating, but get called for...

12:30 pm - 3rd Surgery of day - LEEP, easy. Dictate. Reassure overanxious family.

1 pm - Grab bag of vanilla creme cookies from Doctor's Lounge for "lunch." Get paged to speak with 2nd surgery's family. All is well.

1:10 pm - Check Oligo patient. Cervical change! Yesss! 5-6 cm, comfy.

1:30 pm - Finally finish rounding on 10 patients. Write orders and scripts and discharges.

2:30pm - 4th Surgery of the day - D & C, endometrial hyperplasia. Lots and lots of curettings. Pray for no cancer. Dictate. Talk to family.

2:55 pm - Check post-dates patient. 6 cm, sleeping. Check oligo patient, sleeping, no cervical exam.

3:00 pm - Circumcision on 39 weeker's baby.

3:30 pm - Leave hospital, get fast food snack (mmm, french fries), go to pick up kids a little early from daycare. Feel like a good mom.

4:30 pm - In the midst of gathering kids from daycare, get urgent page. Oligo patient complete and ready to push (!!!) !@#@*#&(*!&

4:31 pm - Drive like a crazy person to the hospital, with kids hanging out in the backseat. Leave frantic messages on Mr. Whoo's cell to pick up the kids at the hospital.

4:45 pm - Arrive at hospital. Hand off kids to kindly nurses. Feel like a terrible mom. Go catch a baby.

5:15 pm - Repairing laceration and working on post partum hemorrhage. Guess birth weight exactly. Get word that Mr. Whoo has arrived to pick up the kids. Also, post-dates patient is 8 cm.

5:30 pm - Finish paperwork, check post-dates patient - 9 cm. Call Mr. Whoo, check on kids. Kids are sad and miss the mama. Feel like a criminal. Cry a little.

5:30 pm - 8:00 pm - Hang at the nurses station. Pump. Feel sorry for myself. Whine a little bit. Check post-dates patient. Patient begins pushing once night shift nurse is ready.

8:00 pm - 10:00 pm - Pushing. More hemorrhoids. Anguish. Bitching at the nurses station. Occasional fetal decels, and, finally, fetal tachycardia.

10:10 pm - Have "come to Jesus" talk with post-dates patient. Decide to place vacuum. Successful vacuum with one push. Berate myself for not doing this 2 hours ago. Repair 2nd degree episiotomy. Get the birth weight right within one ounce.

10:30 pm - Finish paperwork. Hear about term fetal demise getting admitted (not my patient, but still devastating.) Leave the god forsaken hospital. Curse the universe, once again.

11:00 pm - Arrive home. Shower, dinner, and bed.

Glamorous, is it not? More wine, please?


Jenna said...

I just wanted to tell you I have really been enjoying reading your blog! I have met some amazing OB docs in my career (and as a patient, before I was a nurse) and they tend to be such a dedicated lot of really gifted people. You sound like you give so much to your work and even tho it is hard on you, you have got to know what a difference it makes in the lives of your people! Anyway, enough babble. I am just a new l&d nurse making my way in the world, add me to your long list of readers! Have a great weekend...

Anonymous said...

And I thought dealing with whiny students in extended office hours for the last week and a half was tough! Even without understanding most of your abbreviations, it sounds like hell, for you and several of your patients!

Anonymous said...

14.5 inch head? Ouch! And a tribute to you that it wasn't a
4th go, girl.

mitchsmom said...

You go see your pts when they get epidurals?!? Why? Our OB's don't. We don't even talk about it - just call when kid on perineum.

A Lupie Momma said...

I don't know how you guys do it! I always wondered how my ob managed to never miss an appt with me with all the babies he delivers. He is solo practice. Well he is the only MD and has 2 CNMs with delivery privileges. But there are still enough high risk that he does to keep him busy. The only time that they tried to move an appt was my very first with him. I was like um ok, but I was told to see him only from now on because I was high risk. I was never asked to move an appt again. Demises suck. I didn't realize how hard it was for all staff involved till I had mine......

Its Time to Live said...

relax, come to my blog and daydream.

Anonymous said...

Greetings Dr. Whoo,

I just stumbled upon your blog and I love the post.

As a home birth midwife’s spouse, with 5 children, I think our family may have a similar dynamic. I am always amazed at The Midwife’s energy level and resolve on so many fronts. I could not do what you and I don’t know many men who could…

The male lions are much better suited at lying around, saving their energy in case the pride needs defending, consulting on philosophy, while the lionesses bring down the buffalo.

My hat is off to you. It ain’t easy, but you should be proud.


p.s. We do have a disparity in my house, however. The Midwife enjoys foot rubs almost nightly (well, at least when she’s not pulling an all-nighter). I have to use my birthday foot rub coupons to get one!! I respect and adore her anyway.

izzy said...

Gosh, how do you do it? I really enjoyed ob/gyn as a student but it's working hours like that, that I don't think I could cope with! Hope there's a break coming up for you!

Anonymous said...

Total respect for you and OB's like you...

I hope you can find a better office, really. I cannot imagine if you had quality time in your life how much your patients would think you were the queen!

You are not a bad mommy, by the way. You do the best you can do...

MamaDoc said...

Holy cow. Now that's what I thought a weekend on call as an Ob would be like.


Anonymous said...

Dude, you have serious volume issues. Of course you're handling it fine, but you are still living like a resident! there anyone who will say, "no, I'm sorry, Dr. Whoo already has 80 patients due in May?"

Dragonfly said...

The "come to Jesus" talk?

Anonymous said...

Comparing a midwife to an OB/GYN is like saying a shade-tree mechanic is similar to a certified ASE.

Midwife with a Knife said...

And I thought my schedule was bad!!

By the way, I'm wondering what happens if you have to cancel office patients? And how often does that happen? (Just curious about practice management stuff)

Not Afraid To Use It said...

Sorry you are feeling so sad that your kids missed you and were sad. It's so hard to be a mom sometimes. Sounds like you are hanging in there and doing a great job. Try not to be so hard on yourself. Your kids know you love them--they will be fine.

Mama to Monkeys said...

I honestly don't know how you do

Anonymous said...

I thought of you and this post when my doc just missed the birth of my second kiddo May 2nd because she was pumping (she has an adorable 3 month old girl). Took me 13 hours to get from 1.5 to 7 cm, and then 10 min from 7 cm to baby. My poor doc answered her page immediately and unhooked from the pump and ran downstairs and got there right as my daughter was born. She was very apologetic, but I told her I thought she was a hero for sticking with pumping with such a hectic and demanding job.

And I think you are too! We pregnant/laboring moms are very lucky to have kind and compassionate docs who share our experiences as mothers despite the toll it takes on your lives!

Anonymous said...

Hi there-

Came upon your site by accident, but staying here on purpose.

My hubby is an OB/GYN so I can relate to this totally psychotic day...crazy isn't it?

Anonymous said...

Oh, honey. I want to hug you, reading I sit here doing my completely non-important recruiting work. Man, I am lame.

G2P2 MD said...

I start Ob/Gyn residency in - gulp - 8 days. And I have two kiddos 3 and under, and am nursing my youngest toddling still. Hope I can keep it all together...any tips?