Saturday, May 23, 2009

Run, run, run

I'm coming off of another 18 day stretch of call, and has it been a wild ride. Most of the time, even with the unpredictable schedule I've come to expect, it isn't very often that I have a true, chaotic dash to the hospital to tend to an emergency. I know about most labors when they are early in the process, and can mentally prepare to leave for the hospital at the appropriate time. By the same token, most surgeries are planned well in advance. Of course, babies have a way of surprising even the most prepared, and they seem to have conspired against me in the past few weeks.

Emergency Dash #1 - Sunday afternoon, approximately 4 pm. I was out with CindyLou, Bean, and Mr. Whoo at the park, enjoying the weather. I answered an outside page from a husband, worrying that his term pregnant wife (OtherDoc's patient) had been in pain for 8 hours, and was now spotting. Of course, they were told to head straight to the hospital, and I pondered, loudly, why anyone would ever need wait 8 whole hours to make that call??? Just go, already!

As we rounded up the kids and were preparing to head out for ice cream, I received a "911" page from Labor and Delivery. Sure enough, the woman from the phone call had just arrived to triage...completely dilated. No time to change out of my sweaty workout clothes or to drop the family at home, we sped directly to the hospital. I dashed into the room, introducing myself, and promising that I was not some random person off the street in workout gear. Luckily, they believed me (or were so desperate that they just didn't care *who* caught the baby at this point), I made it just in time to catch the crowning baby boy, a mere 45 minutes after I had first received the page from the woman's husband. After all was finished, I joined my patient family in the parking lot, and we all went for some much deserved ice cream.

Emergency Dash #2 - Wednesday morning, 3 am. Awakened from a dead sleep, my groggy, sleepy brain was immediately doused with the equivalent of ice cold water as I saw the "911" page from labor and delivery. I dropped my glasses and the phone before being able to return the page. When I did get in touch with labor and delivery, I found that one of my patients had arrived in triage. She claimed that her water had been leaking since about noon the day before, but she came in because she was having pain. She was completely dilated, oh, and the baby was frank breech....and back down.

If ever there was an "Oh Shit!" moment, this was it. I think I got to the hospital in about 10 minutes flat (it usually takes 15), and the whole time I was on the phone with labor and delivery, checking fetal status, talking to the OR, and arranging for the patient to be in the operating room as soon as I arrived. The poor family medicine resident that had been up on L and D "just in case" she delivered before I got there (truly a nightmare, as a back down breech delivery in an inexperienced operator's hands would almost certainly lead to a head entrapment) offered to scrub with me. We did a true, stat cesarean section, complete with the nurses pushing the breech up from below. Luckily, the baby perked up nicely, despite a very bruised posterior. We got into the uterine arteries on both sides, due to the low position of the breech and extremely thin lower uterine segment, but were able to control the bleeding. Mother and baby boy ended up doing just fine, but I think I may have aged 5 years that night.

Emergency Dash #3 and #4 - I'm including these stories because they were eerily similar to one another. Both women were inductions, both in the same labor and delivery room, both on the same day, one week apart. Patient number #3 was an induction for post-dates. She had a very rough delivery with her last baby, and was leery of hospitals and interventions, but she had gone to 42 weeks, our agreed upon "exit point." She provided me and the hospital with her very simple birth plan, and everything progressed very nicely. She was 4 cm dilated at 11 am, and she decided on an epidural for pain control, as the narcotics she received at her first delivery made her have unpleasant hallucinations. I was at the office, seeing patients, when I got the call from labor and delivery. Her nurse had just come back from lunch, and as she went to check the patient. When she parted the labia, she saw the baby's head! Patient #3 was feeling *nothing!* She was fast asleep! I navigated lunch rush traffic as best I could, and, thanks to her excellent epidural, made it in time to deliver the baby boy at precisely 1:03 pm. She pushed exactly twice. Once for the head, once for the body. No tears, no pain, no long hours of contractions. She and her husband were thrilled, as was I.

Imagine the eerie sense of dejavu, when I had another induction, exactly one week later, in the same room. This time the induction was for IUGR, and the patient was a first time mom. Her induction progressed very smoothly, as well. At 11:30 am, I called to check in on her progress. Her labor nurse had just checked her, found her to be 4 cm, and medicated her with IV pain medication. Imagine my surprise, when a mere hour later, I got a call from the same nurse...she had just returned from lunch and was preparing the patient for an epidural. She checked the patient, as she was feeling pressure, and surprise! She was 9 cm and feeling very "push-y." It was yet another zig zagging race through town, at the lunch hour, where I seemed to catch every single light and get behind the *slowest* drivers on the planet. It is time like these that I wish I could have some kind of special "Ob/Gyn" flashing light to put up on my car to get people to move the heck out of the way!! I made it to the room, where she was trying with all her might not to push. I checked, found her to be completely dilated, and she proceeded to push. She delivered a healthy, if small, baby girl at precisely 1:03 pm. Weird, right?? Kind of cool, though.

Emergency Dash #5 - Yet another Sunday, about 6 pm. I had just arrived home after taking CindyLou over to the neighbor's for a playdate. We were just sitting down to the dinner that Mr. Whoo had prepared, when, you guessed it, I got the "911" page from L and D. This time, one of OtherDoc's patients, a G13P11 (that means 13 pregnancies, 11 babies) who had been wanting homebirth, arrived at the hospital. She stated her water had been broken for a week, she was 34 weeks pregnant, and "the baby just wasn't coming out." She was 9 cm when she arrived on labor and delivery. Fortunately, Sunday traffic isn't nearly as bad as lunch traffic, and I was there in time to help the resident deliver the little 34 weeker. The delivery was the easy part. The hard part came in the way of a retained placenta and post-partum hemorrhage (a risk in those grand multips). Thanks to cyto.tec and a banjo curette, we saved her a trip to the OR. Both mom and baby needed antibiotics post-delivery, probably due to her being ruptured for so long, but both went home a mere 4 days after delivery.

So, that's what I've been up to for the last few weeks. Freaking out, growing gray hair, and aging myself by leaps and bounds. Luckily though, all these moms and babies did well, so it was worth it. To say nothing of the other things swirling about, old job, new job, selling the house, looking for rentals, etc. I feel like I've been running a marathon, minus health benefits and sense of accomplishment. So, what have you been doing these days?


Anonymous said...

I just love your posts. Thank you so much for sharing them. I am in the library studying for my path final looking forward to when I will have the insanely cool experiences you do. - M2 Mommy

ER's Mom said...

18 (please say I'm NOT reading it right) call days in a ROW!!!!!


OMFH is smoking some good stuff and you have gone above and beyond the call of duty. I'm tired just thinking about it.

LauraT said...

Wow...I am in amazement at what you do. The excitement...the stress...the constant intrusion on your family time when you're on call...Praise God for the good outcomes! How do you de-stress?

mitchsmom said...

#5 oy!!! what are some people thinking... I'm glad it turned out fine, but at the same time now she'll think it was no big deal to go around ruptured for a week, at 34 wks. Probably tell all her friends, too, that it's no big deal.

drkay112 said...

Props to you for all the spectacular deliveries. How does OtherDoc counsel his patients? Some of those situations could have been avoided with proper counseling. Home birth of a G13 P11? Setup for a disaster a la that picture in Williams of the lady with the accreta.

dr. whoo? said...

M2 Mommy~ I am glad you enjoy reading the blog! Ah, Pathology. I really liked pathology...the peace, the quiet, no life or death I'm dreaming of Path! HA! Good luck with your test!

ER's Mom~ Unfortunately, you *are* reading it right. I asked for this weekend off because I thought I was going to have an out of town guest (plans then fell through). I think, since it was a holiday weekend, OMFH decided to make me pay for it through the nose. Ah, well.

Lct4j~ Thank you for reading and for your kind comments! I de-stress by venting on the blog and essentially zoning out with the tv or internet. I'd like to say exercise, but I'm far too exhausted for that.

mitchsmom~ I know, it is scary. She was so convinced that all would "work itself out." This was her first pre-term delivery, and also only her second delivery in the hospital. I'm glad all was well, but it is frustrating that she will be able to say "I was ruptured for a week and delivered a 34 weeker and everything was juuussst fiiiinnnee." Ugh.

drkay112~ Thanks for your kind words! To OtherDoc's credit, this patient saw him for her inital prenatal visit and around 20 weeks for her anatomy scan. That was all. Her other "care" was provided by an "alternative" health care provider. I'm sure he didn't know about her plans for homebirth, and, since he is so busy, probably didn't notice that she was lost to follow up. Since she had seen him a couple times, and I was on call for him, the delivery fell to me.

As for counseling, I tell my patients, starting at 24 weeks, about coming directly to the hospital if they think they have ruptured membranes or contractions or bleeding, but it didn't stop #2 for staying at home for 14 hours ruptured before she finally came in...we can only do so much!

Grumpy, M.D. said...

Makes me glad for my humble, quiet, little neurology practice.

Don't know how you guys do it, but I respect you.

The Mommy Doc said...

My first witnessed birth was an emergency c-section. Mom had been pushing (I was on FP service) for some time and head was down when all of a sudden, baby started throwing some pretty scary heart rhythms. Call went into the local OB who showed up 10min later w/ mom already in OR. At the time, I couldn't appreciate what he was doing as I had never seen a normal C/S before. But in retrospect, WOW. the first cut thru the abdomen I think was already down to the uterus. Next cut was thru uterus. The FP began pushing the baby up from below, OB grabbed him, and "pop",.....happy birthday. To this day, I am in awe of what the OB and FP were able to do.

Joy@WDDCH said...

Wow wow wow wow!

You're my hero!

Prisca: said...

wow. amazing!!!