Tuesday, October 05, 2010

Crazy Life

October has a special place in my heart. The fall weather is my favorite, football is in full swing, and the school year is settling into a routine. This year, however, it is also my favorite because September is finally freaking over! In the past 4 weeks of call I have cared for, delivered, operated on, or diagnosed the following:

- A twin IUFD @ 18 weeks, followed by a retained placenta requiring a D&C.

- 3 post-partum hemorrhages, transfused a total of 9 units of blood between them, one of whom almost lost her uterus, but was saved by a B-Lynch stitch.

- An 11 pound shoulder dystocia (baby and mom were fine).

- A 30 week severe IUGR IUFD, barely able to be delivered vaginally due to a contracted pelvis.

- A multiparous unmedicated, "I'm physically here, but mentally I'm not," precipitous delivery followed by a shoulder dystocia, complete with tight nuchal cord x 2, baby with a very purple face, but no other sequelae.

- A newly diagnosed placenta previa, possible accreta at 28 weeks gestation.

- An 8 cm ectopic pregnancy.

- A cervical ectopic pregnancy.

- More preeclampsia than I have ever seen or care to see again.

- A full labor and delivery unit, laboring patients in triage, delivering in the ORs due to lack of beds.

- A 360 pound, 28 year old patient who had never seen a gynecologist with excessive bleeding and a 10 cm complex right ovarian mass.

It's been a rough month to say the least! Not to mention the day-to-day office grind, allergies, a sinus infection that won't go away, and a poor prognosis for a family member, recently diagnosed with recurrent, advanced malignancy. Every day I see something that makes me aware of how fragile our lives really are, and I am so thankful for all with which I have been blessed. So I am taking all that I've learned from the above experiences, gray hairs, angina, and all and pressing forward into October. It can only get better....right??


April said...

Wow ... rough month! I hope October is better for you :)

Bootlegger said...

I am a third year medical student and mother of 3. I LOVE LOVE OB/GYN but everyone tries to deter me telling me that I will never see my kids, etc.
Are you happy with your decision? Are you able to be the Mom you want to be (or almost)?

mamadoc said...

Mercy! Hope you get to feeling better real soon. Say, do you think preecalmpsia has a seasonal incidence? I swear it used to seem that way when I was an FP resident.

Kyla said...

What a month! I hope October is kinder to you...and to your patients!

Leslie said...

Wow! What a month. I don't think I have had quite that many mishaps in the last 2 years combined. I hope things get better for you.

Anonymous said...

Hope things slow down for you soon :)
Amy in OH

Pale said...

October must be going better ... it just has to, right?

Just a quick thought, in case it's useful to your patients:


A wonderful support resource/online community for baby loss parents.

And along those lines, since I'm posting that link ...


A wonderful blog and online resource/community for all types of family building challenges.


Anonymous said...

That is a little too much high risk for any physician. Perhaps a larger city might be better for your health. I don't see anything like what you have done so far in one month.

Anonymous said...

* B-Lynch is a nonsense. you just put a Rampleys atraumatic forceps on each uterine artery and wait for 15 minutes. Most bleeding stops.

* Preeclampsia deteriorates because you are using automated BP mesurement devices that under-record maternal BP by up to 40mm of mercury. Go back to mercury.

* Otherwise you seem to be moving your tacit and contextual knowledge well. It is only experience that works. Be grateful for your grey hair.

Anonymous said...

A tip I learned a few years ago (maybe you already know about this): give Cytotec 400mcg orally right after a second-trimester delivery. It has cut WAY down on retained placentas. Can only remember having to do one D&C for retained second-trimester placenta since starting to do this. Which is good because as you know, they are not always easy.

Keep up the good work!

And Bootlegger...no, you won't see as much of your kids as you would if you chose, say, PM&R or derm. Like I always say, don't do obgyn if there is ANYTHING else that makes you happy.

AtYourCervix said...

The B-Lynch stitch - is that the last ditch effort where you place suture across the whole uterus? I have seen that done once - she lost her uterus anyway.

I like learning the medical terms for things that you rarely use/see in OB.

I witnessed a very traumatic c-section with complications including a Bandl's Ring several years ago. Never forgot that term.

Morgan said...

I am very seriously considering obstetrics, but know that what I truly want most out of life is to be a mother. I don't want a large family but I feel like I need to be a very involved mom and I don't feel comfortable sacrificing a good family life for my career no matter how passionate about it I might be.

In a perfect world, I'd like to work as a part-time OB/GYN for a time and then up my hours as my family grows up. I've heard so many stories about the loss of personal life and time with loved ones but I don't see why I couldn't find a way to balance everything. Is it possible? After residency, is a 40-50 hour work week doable? I feel like I need honest info in order to make an informed decision that will lead to fulfillment and happiness.

Thank you for your blog and thank you for reaffirming that OB can be worth it!

Lempskies said...

From reading your blog you sound like a good OB.
I am so grateful to my OB. I have 3 kids & 3 miscarriages (two 2nd trimester losses). The SAbs were hard on us of course, but reading this post made me realize how much it affects the care provider too. My OB doesn't have a blog that I know of. I tell him I appreciate him, but I'll tell you too- THANK YOU for what you do. You have a tough job, but I bet most of your patients appreciate your competence & compassion.