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??
Showing posts with label on call. Show all posts
Showing posts with label on call. Show all posts
Tuesday, October 05, 2010
Tuesday, April 13, 2010
"Why is my OB always running so *late*?"
Recently one of my friends posed the question as to why her Ob/Gyn physician would routinely run at least 45 minutes late, with the caveat that she would be fired for doing the same to one of her clients. In typical fashion, I posted a long, rambly, and overly detailed answer in her comments section, after (thankfully) seeing a lot of other friends chime in on their personal experiences with their particular physicians. I realized that this is most likely a very universal wonder/complaint, so I am re-posting my response for you, my dear readers. I am sure you have pondered this at least once whilst sitting on an exam table, shivering in a paper gown.
Allow me to describe my day, in order to better explain why we may routinely run late. Today I am on call, and so, while I am responsible for all that happens on labor and delivery, in the office, I do have patients scheduled. The majority of patients are OB visits, most of which rarely take more than 5-10 minutes tops for routine appointments. We also will see check problem patients (early pregnancy bleeding, labor checks, blood pressure issues, hangnail, etc.) So, our scheduling staff (none of whom are medically inclined or have any clue what we do on a day-to-day basis) has most "on call" schedules looking something like this:
8:30 OB patient 1:15 OB patient
8:45 OB patient 1:30 OB patient
8:45 OB patient 1:45 OB patient
9:00 OB patient 1:45 OB patient
9:15 OB patient 2:00 OB patient
9:15 Problem 2:15 OB patient
9:30 OB patient 2:30 Problem
9:45 OB patient 2:45 OB patient
9:45 OB patient 2:45 OB patient
10:00 OB patient 3:00 Problem
10:15 OB patient 3:15 OB patient
10:30 Problem 3:15 OB patient
10:45 OB patient 3:30 OB patient
10:45 OB patient 3:45 OB patient
11:00 Problem 4:00 Problem
So, we have anywhere from 5 to 7 patients scheduled in an hour, and if everything is hunky-dory, there are no issues, long litanies of questions, no problems, or complications, I can generally run on time for these appointments (and by, "on time" I mean that once the patient checks in (usually running at least 5 minutes late, themselves) the nurse talks to them, does any necessary screening labs, checks their weight, urine and BP, listens to fetal heart tones, brings me the chart, which I then review, I am seeing them at *best* 15 to 20 minutes past their original appointment time).
Then, add in the inability to predict labors (I had a couple of laboring patients today) and scheduled procedures (I had 2 cervical ripenings and a C-section scheduled-not by me-at 7:30 am and then another scheduled C-section at noon. Unfortunately, one of my laboring patients delivered at 12:15, smack in the middle of when I was supposed to do my noon C-section, so the section was put on hold until after the delivery. So, by the time I finished the (complicated) scheduled C-section, did all the necessary charting and orders for both deliveries (mind you, not having any time for lunch) I was able to get back into the office by 3 pm. If I am lucky (today I was), my colleagues will have mercy on both the patients and me and pick up a few charts to see patient or two in between their already over-packed schedules. If I am not, then all of the patients scheduled from 1:15 are still waiting to be seen at 3 pm.
So, (whew) does this make it a little more clear why we are not running on the spot of time? It is completely different than making one appointment (that you probably schedule yourself, when it is convenient for you, allowing for travel time, and keeping in mind how long you expect most meetings to go) with one client for the span of 30 minutes or an hour, so the two are really just not comparable...at all. Hope that this helps the next time you are waiting for your physician. P.S. If you grow to expect the long waits, start bringing entertainment (iPo.d, magazines, books, cell phone bejeweled or solitaire) or little projects you can do (bills, checkbook, cleaning out your purse), and know, it really could be worse. Back in Whoo-ville, OtherDoc's patients would wait for him for upwards of 3 hours...now *that* is ridiculous. ;)
Allow me to describe my day, in order to better explain why we may routinely run late. Today I am on call, and so, while I am responsible for all that happens on labor and delivery, in the office, I do have patients scheduled. The majority of patients are OB visits, most of which rarely take more than 5-10 minutes tops for routine appointments. We also will see check problem patients (early pregnancy bleeding, labor checks, blood pressure issues, hangnail, etc.) So, our scheduling staff (none of whom are medically inclined or have any clue what we do on a day-to-day basis) has most "on call" schedules looking something like this:
8:30 OB patient 1:15 OB patient
8:45 OB patient 1:30 OB patient
8:45 OB patient 1:45 OB patient
9:00 OB patient 1:45 OB patient
9:15 OB patient 2:00 OB patient
9:15 Problem 2:15 OB patient
9:30 OB patient 2:30 Problem
9:45 OB patient 2:45 OB patient
9:45 OB patient 2:45 OB patient
10:00 OB patient 3:00 Problem
10:15 OB patient 3:15 OB patient
10:30 Problem 3:15 OB patient
10:45 OB patient 3:30 OB patient
10:45 OB patient 3:45 OB patient
11:00 Problem 4:00 Problem
So, we have anywhere from 5 to 7 patients scheduled in an hour, and if everything is hunky-dory, there are no issues, long litanies of questions, no problems, or complications, I can generally run on time for these appointments (and by, "on time" I mean that once the patient checks in (usually running at least 5 minutes late, themselves) the nurse talks to them, does any necessary screening labs, checks their weight, urine and BP, listens to fetal heart tones, brings me the chart, which I then review, I am seeing them at *best* 15 to 20 minutes past their original appointment time).
Then, add in the inability to predict labors (I had a couple of laboring patients today) and scheduled procedures (I had 2 cervical ripenings and a C-section scheduled-not by me-at 7:30 am and then another scheduled C-section at noon. Unfortunately, one of my laboring patients delivered at 12:15, smack in the middle of when I was supposed to do my noon C-section, so the section was put on hold until after the delivery. So, by the time I finished the (complicated) scheduled C-section, did all the necessary charting and orders for both deliveries (mind you, not having any time for lunch) I was able to get back into the office by 3 pm. If I am lucky (today I was), my colleagues will have mercy on both the patients and me and pick up a few charts to see patient or two in between their already over-packed schedules. If I am not, then all of the patients scheduled from 1:15 are still waiting to be seen at 3 pm.
So, (whew) does this make it a little more clear why we are not running on the spot of time? It is completely different than making one appointment (that you probably schedule yourself, when it is convenient for you, allowing for travel time, and keeping in mind how long you expect most meetings to go) with one client for the span of 30 minutes or an hour, so the two are really just not comparable...at all. Hope that this helps the next time you are waiting for your physician. P.S. If you grow to expect the long waits, start bringing entertainment (iPo.d, magazines, books, cell phone bejeweled or solitaire) or little projects you can do (bills, checkbook, cleaning out your purse), and know, it really could be worse. Back in Whoo-ville, OtherDoc's patients would wait for him for upwards of 3 hours...now *that* is ridiculous. ;)
Saturday, January 23, 2010
Workin' on the Weekend
Ah, weekend call. When I was in residency, the nurses would refer to it as the "3-day hostage crisis." I find this hilarious. And, in many aspects, true. In my former job, weekend call just seemed like a continuation of a long parade of call days that flowed seamlessly, one into another. I resented being held from my life on the weekends just as much as I resented the weekdays. Now, weekend call is a distinct, and separate being.
Weekend call for me consists of Friday, Saturday, and Sunday, starting at 7 am on Friday morning and ending at 7 am on Monday morning. Definitely a long, lonely stretch. Blissfully, the Monday after weekend call is mine, all mine. So there is always a break on the horizon, which, sometimes, is the only thing that keeps me going! Hospitals have a different overall feeling on the weekends. The pace is slower (usually) and generally, not a lot gets done. This even extends to Labor and Delivery. While it is true, babies have no concept of weekends or evenings and tend to come whenever they damn well please, but there are no elective inductions, no scheduled C-sections, and most patients are eager to leave the hospital.
The best thing about weekend call, for me, is the ability to spend as much time as I need to on Labor and Delivery, without feeling rushed. Weekdays usually will have scheduled C-sections at 7 am or 12 noon (sometimes both) and inductions can range from 1 to 3 for our group, there are circumcisions to be done, patients to be rounded on, not to mention a full slate of office patients for the day. Getting it all done can feel impossible, even when there are other partners there to divide the work. Splitting work can also be stressful, wondering if all the patients were seen, or if someone got missed in the shuffle. On the weekends, there is something peaceful (or is it merely resignation?) about knowing that, come what may, *you* are the one responsible. Sometimes it makes me wonder if I would prefer being a "laborist," because I really love the ability to stay on L & D, close to the action.
Some mornings there are just a few patients to see, and I can sleep a little later, and spend a lot of time with each person. Other mornings, there are many patients to see, but the pace doesn't necessarily have to change. Following the cardinal rules of deference to the call gods, I never make a single plan for my call weekends. If it happens to be slow, we spend some lazy time as a family together at the house. If it is busy, then I can take up residence in one of the (really, way too nice) call rooms where I can read, flip channels, and watch laboring patients simultaneously, or I can hang out at the nurses' station, chatting and getting to know my co-workers (and usually get access to some really great food, the staff definitely eats well on the weekends!)
So, while I still get a little wistful when I hear of others' fun weekend plans on the weekend that I have to work, I am bolstered by the knowledge that my "day off" lies just on the other side of the weekend. I am further heartened to know that weekend call is only once a month, leaving 3 other weekends wide open for fun plans of my very own, without fear of the dreaded page from L&D. WTF is wrong with me? I never thought I'd see the day when I appreciated weekend call; I must be getting mellow in my old age! Working or not, I hope you all have a wonderful weekend.
Weekend call for me consists of Friday, Saturday, and Sunday, starting at 7 am on Friday morning and ending at 7 am on Monday morning. Definitely a long, lonely stretch. Blissfully, the Monday after weekend call is mine, all mine. So there is always a break on the horizon, which, sometimes, is the only thing that keeps me going! Hospitals have a different overall feeling on the weekends. The pace is slower (usually) and generally, not a lot gets done. This even extends to Labor and Delivery. While it is true, babies have no concept of weekends or evenings and tend to come whenever they damn well please, but there are no elective inductions, no scheduled C-sections, and most patients are eager to leave the hospital.
The best thing about weekend call, for me, is the ability to spend as much time as I need to on Labor and Delivery, without feeling rushed. Weekdays usually will have scheduled C-sections at 7 am or 12 noon (sometimes both) and inductions can range from 1 to 3 for our group, there are circumcisions to be done, patients to be rounded on, not to mention a full slate of office patients for the day. Getting it all done can feel impossible, even when there are other partners there to divide the work. Splitting work can also be stressful, wondering if all the patients were seen, or if someone got missed in the shuffle. On the weekends, there is something peaceful (or is it merely resignation?) about knowing that, come what may, *you* are the one responsible. Sometimes it makes me wonder if I would prefer being a "laborist," because I really love the ability to stay on L & D, close to the action.
Some mornings there are just a few patients to see, and I can sleep a little later, and spend a lot of time with each person. Other mornings, there are many patients to see, but the pace doesn't necessarily have to change. Following the cardinal rules of deference to the call gods, I never make a single plan for my call weekends. If it happens to be slow, we spend some lazy time as a family together at the house. If it is busy, then I can take up residence in one of the (really, way too nice) call rooms where I can read, flip channels, and watch laboring patients simultaneously, or I can hang out at the nurses' station, chatting and getting to know my co-workers (and usually get access to some really great food, the staff definitely eats well on the weekends!)
So, while I still get a little wistful when I hear of others' fun weekend plans on the weekend that I have to work, I am bolstered by the knowledge that my "day off" lies just on the other side of the weekend. I am further heartened to know that weekend call is only once a month, leaving 3 other weekends wide open for fun plans of my very own, without fear of the dreaded page from L&D. WTF is wrong with me? I never thought I'd see the day when I appreciated weekend call; I must be getting mellow in my old age! Working or not, I hope you all have a wonderful weekend.
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?
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?
Sunday, April 19, 2009
Revenge of the Pregnant Women
Oooooweeeeeeooooo. Scary, huh? Well, to a poor, unsuspecting, newly-recovered from the flu Ob/Gyn, it is the scariest prospect around. You see, for the first time (and I do mean, the very first time) in 4 years, I was oh-so-fortunate to have an entire 3 weekends off...in a ROW! The audacity! The outrage! Ohhhhh, and the payback. You see, 2 of those weekends were included on my vacation, which was less vacation, and more "how much activity can you cram into 10 days?" This was spent in the southerly regions and in Newville, the site of our pending relocation. The third weekend was Easter weekend, by some stroke of luck, I was able to convince OMFH to grant me the holiday off, to visit with Mr. Whoo's family in the Great White North. Easter weekend marked the beginning of the the Whoo Family's dalliance with "The Flu." It started with Bean, quickly moved to me, and took out CindyLou later on in the week. Mr. Whoo is the only one left standing, and he's starting to get that characteristic hacking cough. Surely, I thought in my fever-fogged brain, out of all that glorious time off, some of my patients would deliver in my absence. Much to their delight (and my relative dismay), they did not. Other Doc, throughout the whole of my vacation and time off, did not deliver a single patient of mine.
Instead, they all waited for me. So this week, between popping Day.Quil, Ny.Quil, and Mot.rin, I have been exceedingly busy. The day that I returned from vacation, I had an induction for post-dates (41 weeks and 6 days). She had received cervical ripening overnight and actually was really contracting well. About 5 minutes after I hit the floor, she SROM'd the thickest meconium fluid I had ever seen, this was followed by a 10 minute trip to the 60s for the fetal heart rate. I checked for a cord, couldn't find one, tried everything possible to get the kiddo to recover, and eventually went down for an emergent cesarean. The baby was out in less than a minute, and needed a little transition time, but ended up doing very well. Not the best way to start the morning. After finishing up the paper work and talking to the family, I saw a familiar patient roll up to the nurse's station...in obvious distress. She was supposed to have a repeat C-section later that week, but, she was in labor today. Back we went to the OR, where I delivered a 9.5 pound baby boy. I finally made it to the office that day around 3 o'clock.
The rest of the week continued in a similar fashion. There was a severe IUGR baby, born to a couple that struggled with fertility for a very long time. She was only 37 weeks, but the baby was measuring 32 weeks. We had watched the growth for the last few weeks, and it had steadily plateaued. The patient received only cerv.idil, but quickly labored and delivered a healthy, 5 pound baby girl. The placenta was incredibly calcified and quite small, so I felt confident the correct decision to deliver had been made. Unfortunately, there were a few inductions, one for preeclampsia and one for post dates that ended in late night cesarean sections. Both moms and babies did well, but I hate to have failed inductions. It makes me feel as if I have failed those patients.
Oh, and then the "weekend" came. My first weekend back since vacation, and, let's face it, I was already dragging from a busy week and a lingering illness, and OtherDoc had a similarly bad week. There were a million patients to round on, and about half a million circs (my favorite! Not.) I got the first call a little after midnight about patient at term with SROM. I had a little hope, as she did not want an epidural (score 1) and was only 2 cm when she was admitted (score 2!) Between my sick kids and being paged every hour from patients and from labor and delivery, very little rest was had between her admission and the call telling me that she was 8 cm at 4:00am. I arrived at the hospital right as she was beginning to push. Blessedly, it was a very nice, smooth delivery. No tears and a healthy baby. I'm sure my patients didn't appreciate being rounded on at 5 am, but I certainly wasn't coming back later! I did my umpteen circs, rounds, discharges, and spent the rest of the day trying, unsuccessfully to catch up on rest.
In the late afternoon, another "rule out labor" came in to triage. She had not changed her cervix, but she was post dates, and I decided to keep her for observation. I communicated several times with the nursing staff before I went to bed, and was assured she was "doing nothing." I took a Ny.Quil and was in bed no later than 10:30. Imagine my surprise when I received a page at 3:30 am telling me she was completely dilated. It was an all-too-familiar dash to the hospital in the middle of the night. I arrived, broke the bag of water, and she pushed out a beautiful 8.5 pound boy over an intact perineum. Once again, it was circs at 4:30 am, and rounds at 5 am. I have spent the rest of the day trying to recover. I am just now starting to feel human again. I really can't keep up this pace. I hope that I have done sufficient penance for my time off, and that the pregnant ladies are merciful tonight!
Instead, they all waited for me. So this week, between popping Day.Quil, Ny.Quil, and Mot.rin, I have been exceedingly busy. The day that I returned from vacation, I had an induction for post-dates (41 weeks and 6 days). She had received cervical ripening overnight and actually was really contracting well. About 5 minutes after I hit the floor, she SROM'd the thickest meconium fluid I had ever seen, this was followed by a 10 minute trip to the 60s for the fetal heart rate. I checked for a cord, couldn't find one, tried everything possible to get the kiddo to recover, and eventually went down for an emergent cesarean. The baby was out in less than a minute, and needed a little transition time, but ended up doing very well. Not the best way to start the morning. After finishing up the paper work and talking to the family, I saw a familiar patient roll up to the nurse's station...in obvious distress. She was supposed to have a repeat C-section later that week, but, she was in labor today. Back we went to the OR, where I delivered a 9.5 pound baby boy. I finally made it to the office that day around 3 o'clock.
The rest of the week continued in a similar fashion. There was a severe IUGR baby, born to a couple that struggled with fertility for a very long time. She was only 37 weeks, but the baby was measuring 32 weeks. We had watched the growth for the last few weeks, and it had steadily plateaued. The patient received only cerv.idil, but quickly labored and delivered a healthy, 5 pound baby girl. The placenta was incredibly calcified and quite small, so I felt confident the correct decision to deliver had been made. Unfortunately, there were a few inductions, one for preeclampsia and one for post dates that ended in late night cesarean sections. Both moms and babies did well, but I hate to have failed inductions. It makes me feel as if I have failed those patients.
Oh, and then the "weekend" came. My first weekend back since vacation, and, let's face it, I was already dragging from a busy week and a lingering illness, and OtherDoc had a similarly bad week. There were a million patients to round on, and about half a million circs (my favorite! Not.) I got the first call a little after midnight about patient at term with SROM. I had a little hope, as she did not want an epidural (score 1) and was only 2 cm when she was admitted (score 2!) Between my sick kids and being paged every hour from patients and from labor and delivery, very little rest was had between her admission and the call telling me that she was 8 cm at 4:00am. I arrived at the hospital right as she was beginning to push. Blessedly, it was a very nice, smooth delivery. No tears and a healthy baby. I'm sure my patients didn't appreciate being rounded on at 5 am, but I certainly wasn't coming back later! I did my umpteen circs, rounds, discharges, and spent the rest of the day trying, unsuccessfully to catch up on rest.
In the late afternoon, another "rule out labor" came in to triage. She had not changed her cervix, but she was post dates, and I decided to keep her for observation. I communicated several times with the nursing staff before I went to bed, and was assured she was "doing nothing." I took a Ny.Quil and was in bed no later than 10:30. Imagine my surprise when I received a page at 3:30 am telling me she was completely dilated. It was an all-too-familiar dash to the hospital in the middle of the night. I arrived, broke the bag of water, and she pushed out a beautiful 8.5 pound boy over an intact perineum. Once again, it was circs at 4:30 am, and rounds at 5 am. I have spent the rest of the day trying to recover. I am just now starting to feel human again. I really can't keep up this pace. I hope that I have done sufficient penance for my time off, and that the pregnant ladies are merciful tonight!
Friday, October 10, 2008
In the Middle of the Night
It's time for my husband's annual "man weekend" with his high school buddies. For almost a decade, he and his friends find a cabin in the woods somewhere and behave (I am assuming from the pictures) as 10 year olds...that drink. Junk food, video games, and staying up way too late are part and parcel of the festivities. They look forward to it every year, and I'm happy to have him go. (The wives have a "girl weekend" in the spring, just to be fair.) So when I found out that he would be out of town for a weeknight (when I am on call for my patients), I thought to my naive little self, what's the worst that could happen? Ha. Ha. HA!
So I went about my regular single parenting duties in the evening relatively unscathed. Picked up the kids, got dinner on the table while Bean protested loudly that it wasn't fast enough for him, wrestled two squirmy kids through bathtime, and got everyone tucked in by a reasonable time. Then I prayed really hard that I could make it through the next 12 hours without having to leave the house. The peace lasted roughly 3 hours. The first warning bell came as a page from triage. A 38 weeker, possible early labor, contractions 20 minutes apart. The triage nurse said she was pretty sure the patient was "not doing anything" but we decided to observe her and let her walk for an hour. My second warning came at 1 am. The patient had indeed changed her cervix from 1 to 3 cm. A definite keeper. "Ok," I pleaded with the nurse, "PLEASE keep her comfy and pregnant for the next 5 hours so I don't have to pack my kids up in the middle of the night to come to the hospital." The nurse was fairly confident that the patient was not contracting regularly, and could probably coast until morning. I settled into an uneasy rest...until 2:30 am. I returned the page, thinking that I was going to have to drag in to cover for the patient's epidural. Imagine my surprise and dismay when the nurse answered the phone with "She's 9!"
Shit. Shit. Shit. It was off to the races...throwing on scrubs, rousting the kids up in their PJs, and flying down the highway in the middle of the night. "At least it will be fast," I chanted to myself as I sped to the hospital. I deposited the kids with one of the nurses and stepped into the delivery room just before 3 am. The patient was completely dilated and ready to push. She hadn't even had a chance to get *any* pain medicine, epidural or otherwise, due to how quickly she had progressed. So, the patient started to push, and *then* all hell broke loose. The first push sent the fetal heart tones down to the 30s. Ummm, surely that wasn't right! I placed a scalp lead to get an accurate tracing...still in the 40s-50s. Scalp stim...up to the 60s. Oxygen, reposition, knee chest. Nothing would bring the rate back up. The baby was at zero station. Too far up for vacuum or forceps. We tried a few pushes, but the head wasn't descending fast enough and the heart beat was a slow tick, tick, tick of a baby running out of time. After a quick verbal consent, we called the OR to let them know we were coming down for a crash section. "We aren't ready!" they said. They had another case going and needed to call in a team. "No time for that," I said, "This baby needs to come out now."
We ran the patient to the OR. The staff assembled a rag-tag team of recovery room nurses, opened the crash section cart, and haphazardly prepped. There was no time for a foley or to count instruments. Every second felt like an hour, though only 5 minutes had passed from calling the section to draping the patient. The patient went to sleep, and we got the baby out in less than a minute from the skin incision. She looked like a *million bucks*! She squalled as soon as she left the womb. She was pink! and happy! and had Apgars of 8 and 9! and didn't look at all like her strip suggested. I had truly feared the worst, the last terminal decel that I had seen like that, the baby had anoxic seizures after delivery. Luckily, this baby was great. The collective sigh of relief was audible in the room as I placed her on the warmer. The rest of the surgery proceeded smoothly, and I was happy to let the family know how well she had done.
As for the kids? I ran back up to labor and delivery to find them happily snacking on graham crackers and juice. CindyLou was entertaining the whole floor, and she kept saying how she wanted to be a doctor "just like mommy." (Oy.) We got them gathered together, I thanked the nurses profusely, and drove back home. "I like to go to your work, Mommy" Cindy Lou chirped, "It's still *night time*!" Once at home, the kids went back to bed without a fuss, and I crashed into the best 2 hours of sleep of my life.
The moral of the story? I survived! It could have been the worst case scenario, but we all made it. The kids did fine, the patient did fine, the baby did fine. It could have been a disaster, but it wasn't. I am ever so grateful for that, and never have I been so convinced that I *never* want that to happen again! Scary things do happen in the middle of the night, and sometimes the outcomes are not as good. I'm thankful for the nurses and OR staff that did what they could to make the surgery happen quickly enough. I'm grateful for the compassion the nurses showed to me and my children by caring for them when I had to care for someone else. Most of all, I am so thankful that my kids were able to take it all in stride and go with the flow. They are pretty amazing. I hope you all have a wonderful weekend, and are not bothered by scary things in the middle of the night.
So I went about my regular single parenting duties in the evening relatively unscathed. Picked up the kids, got dinner on the table while Bean protested loudly that it wasn't fast enough for him, wrestled two squirmy kids through bathtime, and got everyone tucked in by a reasonable time. Then I prayed really hard that I could make it through the next 12 hours without having to leave the house. The peace lasted roughly 3 hours. The first warning bell came as a page from triage. A 38 weeker, possible early labor, contractions 20 minutes apart. The triage nurse said she was pretty sure the patient was "not doing anything" but we decided to observe her and let her walk for an hour. My second warning came at 1 am. The patient had indeed changed her cervix from 1 to 3 cm. A definite keeper. "Ok," I pleaded with the nurse, "PLEASE keep her comfy and pregnant for the next 5 hours so I don't have to pack my kids up in the middle of the night to come to the hospital." The nurse was fairly confident that the patient was not contracting regularly, and could probably coast until morning. I settled into an uneasy rest...until 2:30 am. I returned the page, thinking that I was going to have to drag in to cover for the patient's epidural. Imagine my surprise and dismay when the nurse answered the phone with "She's 9!"
Shit. Shit. Shit. It was off to the races...throwing on scrubs, rousting the kids up in their PJs, and flying down the highway in the middle of the night. "At least it will be fast," I chanted to myself as I sped to the hospital. I deposited the kids with one of the nurses and stepped into the delivery room just before 3 am. The patient was completely dilated and ready to push. She hadn't even had a chance to get *any* pain medicine, epidural or otherwise, due to how quickly she had progressed. So, the patient started to push, and *then* all hell broke loose. The first push sent the fetal heart tones down to the 30s. Ummm, surely that wasn't right! I placed a scalp lead to get an accurate tracing...still in the 40s-50s. Scalp stim...up to the 60s. Oxygen, reposition, knee chest. Nothing would bring the rate back up. The baby was at zero station. Too far up for vacuum or forceps. We tried a few pushes, but the head wasn't descending fast enough and the heart beat was a slow tick, tick, tick of a baby running out of time. After a quick verbal consent, we called the OR to let them know we were coming down for a crash section. "We aren't ready!" they said. They had another case going and needed to call in a team. "No time for that," I said, "This baby needs to come out now."
We ran the patient to the OR. The staff assembled a rag-tag team of recovery room nurses, opened the crash section cart, and haphazardly prepped. There was no time for a foley or to count instruments. Every second felt like an hour, though only 5 minutes had passed from calling the section to draping the patient. The patient went to sleep, and we got the baby out in less than a minute from the skin incision. She looked like a *million bucks*! She squalled as soon as she left the womb. She was pink! and happy! and had Apgars of 8 and 9! and didn't look at all like her strip suggested. I had truly feared the worst, the last terminal decel that I had seen like that, the baby had anoxic seizures after delivery. Luckily, this baby was great. The collective sigh of relief was audible in the room as I placed her on the warmer. The rest of the surgery proceeded smoothly, and I was happy to let the family know how well she had done.
As for the kids? I ran back up to labor and delivery to find them happily snacking on graham crackers and juice. CindyLou was entertaining the whole floor, and she kept saying how she wanted to be a doctor "just like mommy." (Oy.) We got them gathered together, I thanked the nurses profusely, and drove back home. "I like to go to your work, Mommy" Cindy Lou chirped, "It's still *night time*!" Once at home, the kids went back to bed without a fuss, and I crashed into the best 2 hours of sleep of my life.
The moral of the story? I survived! It could have been the worst case scenario, but we all made it. The kids did fine, the patient did fine, the baby did fine. It could have been a disaster, but it wasn't. I am ever so grateful for that, and never have I been so convinced that I *never* want that to happen again! Scary things do happen in the middle of the night, and sometimes the outcomes are not as good. I'm thankful for the nurses and OR staff that did what they could to make the surgery happen quickly enough. I'm grateful for the compassion the nurses showed to me and my children by caring for them when I had to care for someone else. Most of all, I am so thankful that my kids were able to take it all in stride and go with the flow. They are pretty amazing. I hope you all have a wonderful weekend, and are not bothered by scary things in the middle of the night.
Sunday, July 13, 2008
It's the Most Ex*haus*ting Time of the Year
Ah, yes, OtherDoc's vacation is once again upon us. My days are spent running frenetically back and forth between labor and delivery and the office (seeing mostly his 4 billion prenatal patients), trying to figure out what the hell is going on with any problem patients (he doesn't chart a freaking thing), and deflecting pain medicine requests and ridiculous after hours calls (such as last night 11:40pm "*giggle* I don't know if this is an emergency, but I have a rash and it is getting itchy! Can you tell me what it is? I know I'm not due for two weeks, but can't I just be induced tonight?") My nights are peppered with pages from triage, roughly every 2-3 hours, with patients in labor, hoping to be in labor, who have a hangnail, or nothing better to do at 3 am, and if I'm really lucky, a dash to the hospital for a c-section or a delivery. I've delivered 9 babies since Monday, and there is one in early labor right now. I think I have had at least one delivery every single day except for Friday.
Also, dumbass that I am, I have decided to chose this same 2 week period to attempt a no carb diet, as a "jump start" to losing weight. I'm not very sure if I have made it clear in the past, but I freaking adore carbs. Were it up to me, I would never eat meat again. I would eat spaghetti every single night if it were socially acceptable and Mr. Whoo would let me. I'm going through withdrwal like a proper junkie, headaches, shaking, terrible cravings, etc. , and even though I have lost 6 pounds (and holding at this point) I am in such need of food comfort that it is a struggle to stay on the wagon. I would also like to drink a couple of gallons of wine, but, since I'm running to the hospital all hours of the night, definitely not a good plan, plus, not low carb, either.
I am also in the process of weaning. Bean has become less and less interested in nursing of late. I can only get him to really focus early in the mornings, and even that is inconsistent. I cut my AM pumping session first, followed by my pre-bed pumping session last week, and I am down to only pumping at work during lunchtime. I'll probably drop that session this week. I've survived so far with only a mild case of mastitis. Part of me is sad to let it go, but Bean seems really ready, and I don't mourn the loss of pumping sessions for certain. I always had a goal to make it for a year, and Bean's birthday is on Saturday (can you believe it??)
The job hunt is still on (especially after putting up with all of the BS this week). We are actually considering moving closer to family and friends, to a place we would never have considered in the past, but now it seems to be all that we are thinking about. I've had a few promising leads and conversations, but any interviewing will have to wait until this crazy month is over.
Last but not least, I'm spending any spare time completing my case list for Oral Boards. I have all of my OB and GYN cases entered, but am struggling to get the office cases picked out and entered (too indecisive). I have my case list construction seminar this week, and it will be a welcomed break from all the insanity. I hope that they don't expect the entire list to be finished! I'm a little worried about the breadth of my case list (92 GYN cases, 110 OB cases) because I had a 7-8 week maternity leave in this last year, and I had also cut my patient load before delivery, so I was only getting back to full speed on OB for the second half of the year. The list is due on August 1, so I want it to be done quickly after I return from the seminar.
Well, enough whining for one post! Mr. Bean just crawled into my lap to snuggle. Aw. Hope you are having a wonderful Sunday!
Also, dumbass that I am, I have decided to chose this same 2 week period to attempt a no carb diet, as a "jump start" to losing weight. I'm not very sure if I have made it clear in the past, but I freaking adore carbs. Were it up to me, I would never eat meat again. I would eat spaghetti every single night if it were socially acceptable and Mr. Whoo would let me. I'm going through withdrwal like a proper junkie, headaches, shaking, terrible cravings, etc. , and even though I have lost 6 pounds (and holding at this point) I am in such need of food comfort that it is a struggle to stay on the wagon. I would also like to drink a couple of gallons of wine, but, since I'm running to the hospital all hours of the night, definitely not a good plan, plus, not low carb, either.
I am also in the process of weaning. Bean has become less and less interested in nursing of late. I can only get him to really focus early in the mornings, and even that is inconsistent. I cut my AM pumping session first, followed by my pre-bed pumping session last week, and I am down to only pumping at work during lunchtime. I'll probably drop that session this week. I've survived so far with only a mild case of mastitis. Part of me is sad to let it go, but Bean seems really ready, and I don't mourn the loss of pumping sessions for certain. I always had a goal to make it for a year, and Bean's birthday is on Saturday (can you believe it??)
The job hunt is still on (especially after putting up with all of the BS this week). We are actually considering moving closer to family and friends, to a place we would never have considered in the past, but now it seems to be all that we are thinking about. I've had a few promising leads and conversations, but any interviewing will have to wait until this crazy month is over.
Last but not least, I'm spending any spare time completing my case list for Oral Boards. I have all of my OB and GYN cases entered, but am struggling to get the office cases picked out and entered (too indecisive). I have my case list construction seminar this week, and it will be a welcomed break from all the insanity. I hope that they don't expect the entire list to be finished! I'm a little worried about the breadth of my case list (92 GYN cases, 110 OB cases) because I had a 7-8 week maternity leave in this last year, and I had also cut my patient load before delivery, so I was only getting back to full speed on OB for the second half of the year. The list is due on August 1, so I want it to be done quickly after I return from the seminar.
Well, enough whining for one post! Mr. Bean just crawled into my lap to snuggle. Aw. Hope you are having a wonderful Sunday!
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, bitch...ad 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! :)
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! :)
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