Well, tonight, thank G*d it's them, instead of you...

Does anyone else think that "Do They Know It's Christmas?" is the most uncharitable "charity" song around? It's downright laughable! So much so that I can't help but wonder if there isn't meant to be some sort of sardonic undercurrent beneath the song's earnestness. I mean, there's the most awful line, the line mentioned above, then, later on, we raise a glass to everyone, including "them, underneath that burning sun." ACK! Mix in some "clanging chimes of doom" and "bitter sting of tears" and, well, I admit it, I laugh my *ss off every time I hear this song. Probably not what "Band Aid" was going for, but I digress...

The true meaning for my title really pertains to how I feel when one of my partners is on call and it isn't me. I thank G*d it is them instead of me; because we have been insanely busy. Last call I delivered 8 babies in a 24 hour shift and admitted 9, 10, and 11 in labor. All of the rooms were full and our overflow was spilling into other rooms in the hospital. I have no idea what was going on nine months ago, people, but holy geez, the babies can stop coming any old time! We are T-minus 10 days from Christmas, and I didn't have enough to do, so I thought I'd sit down and let you know that I am still alive...and mostly well...and still wishing to win the lottery so I can become independently wealthy and play internet games and get buff and be the envy of the botox set (without using botox) and never, ever be on call again. I don't think Santa can deliver that kind of present, unfortunately.

This is going to be a magical Christmas for the Whoo family. Bean is 4 and CindyLou is 7 and both are steeped in the wonder and magic of the season. Their joy and wonder is palpable. I love it. It brings a tear to my eye. We only have so many magical Christmases with them, and I happen to be on call on Christmas-flipping-Eve this year. So my Christmas wish is that none of my patients get a special Christmas delivery in the wee hours of Christmas Day morning, so I don't have to miss out on the magic this year...hopefully Santa can manage that. Merry Christmas to all 2 of you still reading out there, may your holidays be Merry, Bright, and Doom Free! :)

Far from Fine

I am blessed. I have a great family, healthy children, a loving marriage, a career that I (mostly) love, and many good friends. But I still have things that I worry about, there are still things that are far from fine with me. Despite a 22 pound weight loss on my previously mentioned program (woo!), I am still obese and now that I am "graduated" from the program, I find the bad habits slipping back in and pounds creeping slowly back on. I eat when I am stressed. I am stressed a lot. Therefore (logic 101) I eat a lot. I wish I ate a lot of vegetables, or even a lot of fruit, but mostly I eat a lot of pasta. It must release some kind of serotonin, because it calms me like nothing else can (except wine, and I *really* don't want to go down that slippery slope, you know?)

I'm worried about our country's path, our future, my children's future. What the hell is going on with our politicians...all of them? Our government is so perverted from what our founding fathers originally envisioned. It is almost laughable, but worse, it is scary. I am scared to death about freedoms and rights that are being stolen from us right beneath our noses in the interest of some kind of unrealistic, Utopian "greater good." Many of my friends "get it," but there are also many that don't understand what I am saying or seeing, and it drives a wedge in these friendships.

I am worried about the future of my profession. I can see what is coming down the pike in the coming years. It is ugly and is going to get uglier, and I'm pretty sure that physicians had a hand in sealing the demise of our profession as we know it by being the types of people that physicians are...altruistic to a fault. While I'm doing what I can on a local level, I feel helpless to change the runaway freight train that is the bureaucracy surrounding what should be built on a case by case (patient to physician) basis.

So, I fret, and rage against the machine, and beat my head against the wall trying to get people to understand what they refuse to try to understand in both my personal and professional life, and I eat. I recognize that I am self-medicating...but what? Frustration? I'm not clinically depressed. I do have some anxiety and OCD tendencies, but nothing that has been interfering with my daily life. I am just using food as a crutch, instead of healthy sublimation like exercise, I am raising fork to mouth to push down my feelings, my fears. It isn't working for me. So today, after having pasta for breakfast after a particularly harrowing weekend call, I got off of my arse and went for a walk. The hardest step is the first step out the door. Right?

To Get to the Other Side

There are times in life when everything seems to fall right in to place, and then, there are times like now. I can see the shimmering oasis of a new life, just on the horizon. A better call schedule, closer to family and friends, a chance to work in a collegial (not competitive) environment, more time with my precious kids and husband, and a chance to grow as a physician. Between the oasis and where I stand, however, is a treacherous, rock-filled, rapid river, swirling and threatening my ability to ever reach the opposite shore.

Obstacle #1 - Our house is on the market, and we have shown it at least a dozen times. Yet, despite positive overall feedback, not a single offer. I don't mean to boast, but our house is a beautiful house. I love it. I was ready to buy it the second I walked through the front door, and I can't believe that everyone else that sees it doesn't feel the same way. We never thought we would have to sell this house. Maybe we should have thought about selling it before we bought it. If we don't sell before we move, we'll have a hefty house payment, along with any rent payment we need to pay in Newville. This alone will be a financial strain.

Obstacle #2 - Mr. Whoo has yet to find a job, nor procure an interview in Newville. Granted, he has only starting looking in earnest recently. However, he is looking for work in the finance world, which isn't the best place to be seeking employment given the current state of our economy. We have been fortunate that he was able to quit his job last fall when our family really needed it, but now we worry that the employment gap may cause an impetus with new employers. Plus, without an additional income after the move, there will be more financial strain on our family. (See Obstacle #1)

Obstacle #3 - My current place of employment is not letting me go without a fight. There have been veiled and outright threats of lawsuits and damages and liabilities for me leaving earlier than my contract had mandated. There is also the matter of giving back a portion of student loans paid by the hospital. The fact that we would have to pay back was not unexpected, however, the amount that we calculated is about half of what the hospital estimates. We are procuring the services of a contract negotiator and a lawyer, who seem to believe we have a case for inducement, but I'm having angina just thinking of it. Not to mention the fact that, if the hospital's calculations are correct, they want us to pay up in less than 2 months. Add more financial liability to the swirly, cold, and fast water.

Obstacle #4 - Emotionally, I am wrung out. I am completely exhausted, and barely hanging on by my fingernails to make it to the date I indicated I was leaving. Being on call, continuously, with only 4 days off per month (plus vacation time), has left me completely burnt out. I find it hard to drag myself to work and muster compassion for my patients. They deserve better than the doctor I am right now. My health, mental and physical, is suffering. The remainder of my contract is a mere six months, and by finishing it out, I can alleviate much of the financial burden of the above obstacles...for the price of my very sanity. I want to cry just thinking of it.

So, I sit here on the bank, pining for the oasis, and unsure how to navigate the obstacles that lie before me. Oddly, I am reminded of the "old school" computer game, "The Oregon Trail." When faced with a river, you can try to ford the river, float the river, or hire someone else to help you across. Right now, I am pining desperately for someone to throw me a life line, or at the very least, a strategy for surviving these treacherous waters. The best advice I can relate to our readers is to know what you are getting in to before you sign a contract. There is no such thing as a perfect job, and if it seems too good to be true, it, in all likelihood, *is* too good to be true. Caveat emptor...and pass the caulk.

*cross posted at Mothers in Medicine

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!

Is Mercury in Retrograde or Something?

Hello all, what a crappy week it has been. Is anyone else having "issues" this week? My week actually started out on a pretty good note. One of my patients, pregnant with twins, began to develop preeclampsia. We made the decision to augment labor (she was already contracting and 3 cm), and late in the evening I got to do my first vaginal twin delivery since residency. I was nervous because I am used to doing twin deliveries in the OR as a "double set up," just in case there is a need to emergently deliver the second twin by C-section. In Whoo Hospital, there are no ORs on the L&D floor, so the deliveries are done in the room, and, should an emergency arise, you have to go down several stories to the OR. In a situation where minutes and seconds are precious, this is a daunting thing, especially as the night wore on and I realized that she would deliver in the dead middle of the night (aka skeleton crew time). Luckily, it was the smoothest twin delivery I'd had or seen in a long time. The first baby had no complications on delivery, the second baby stayed vertex, we broke the second bag of water, and baby number two was born about 5 contractions and 2 pushes later. Both babies and mom did wonderfully well. It was truly an amazing experience, and I was happy to be a part of that.

After that, though, it all went downhill fast. Of course, due to the middle of the night delivery, I got very little sleep. Therefore I overslept, and was later than I wanted to be getting to the hospital. Waiting for me there was a consult for the ever dreaded "pelvic pain." Before I get roasted about pelvic pain, let me emphasize that yes, it exists. Yes, there are gynecologic causes. Yes, it is not always supratentorial (all in the patient's head). But this patient definitely had supratentorial pelvic pain. She was already on a cocktail of narcotics and benzodiazepenes, and she spoke of severe excruciating pain in the calmest of voices, her pulse at 60, blood pressure at 90/60. Her exam was completely normal, as were her labs and imaging studies. She blithely asked me to "go ahead and do a hysterectomy while she was "here" (IE admitted to the hospital for pneumonia)." I blithely declined, set a follow up appointment in the office, offered medical suppression for her cycles (got denied), and asked her to sign a medical record release to obtain information from her prior ("out of state") physician.

Already in a *fantastic* mood by this point, I proceeded to the office. Where my right hand woman, SuperNurse, had slipped on the ice in the parking lot and (unknown at the time)broken her leg. For a while she tried to walk on it, but we all finally convinced her to go get xrays. So then, I was stuck with NotSoSuper medical assistant, who may well be the laziest person on the face of the earth. Any one who has worked in an office knows that the nurse who assists you can make or break the flow of your day. This day was definitely broken. The afternoon dragged on with the most draining kinds of patients around including such hits as "every organ system bothers me, can't you just wave a wand and fix it?" and, after a "routine" annual, a 20 minute nervous breakdown over the (unfounded) perception that her female anatomy was somehow horribly disfigured, and she wanted vaginal reconstructive surgery, not one but two Op.rah inspired "natural hormones" consults, and, last, but certainly not least, a patient with known cancer, sent to me by her radiation oncologist for a "skin tag" removal, that I am almost 100% certain is a vulvar carcinoma. Good times, good times.

Then, after a long, hard day already at 5pm, I log on to the internet to learn that one of my friends that I knew from middle school, high school, and college had taken their own life, and leaves behind a small child. I was shocked, then dismayed, and am still very sad over the whole thing. Just terrible news. Mr. Whoo had his community service club meeting, so I kid wrangled alone for bedtime and bath time. Exhausting. To top all of the rest of the day off, after being unnecessarily snarky when I had meant to be funny, I had a misunderstanding with one of my friends, feelings were hurt (I believe on both sides), and now I am getting the technologic freeze out which isn't very pleasant, either.

I am still struggling with the license application for obtaining my medical license in New State. So far I am out almost $1000 in various fees and I haven't even submitted the application proper (which will be $5000 +). We haven't sold our house yet, we haven't begun packing, I'm still over weight and not losing, despite my best efforts, and for extra fun, I have decided to cut all alcohol consumption for the month of February. Oh yes, and I am on call this week and all weekend long. So yeah, my week has pretty much sucked! How about you all? Am I the only one?

Annoying Things

I think I've been more than a tad touchy these last few weeks, as I contemplate major upheaval in my career and family life, so maybe I am noticing things that bother me more often. Never the less, I am going to post annoying things that people say and do that really piss me off, since it wouldn't be *professional* to say it to their collective faces.

~ Any referring physician (ER, family medicine, pediatrician, all are offenders) that tells their patient with unexplained lower abdominal or pelvic discomfort and a normal exam and ultrasound that 1) "You must have had a cyst that ruptured." or 2) "You probably have endometriosis."

First of all, sometimes, you can just have pain in a certain area with no pathologic explanation. Some people have pain when they ovulate, or right before their period, or when they move the wrong way, or have sex 3 times a day, every day (yes, one patient referred to me for vaginal irritation and pain admitted to this...hmm, wonder why you are so sore???) Second of all, there are a whole bunch of different things that reside in the lower pelvis, including bowel and bladder, both of which can be causes for significant pain in their own right. Why every woman with low abdominal pain must have a "female issue" is totally beyond me.

It isn't that women with pelvic pain shouldn't be referred, they absolutely should be seen and worked up by a specialist. However, I have found that these two phrases mentioned above are physician code for "I have no idea what is causing your pain, but instead of saying that, I'll scare you into thinking you have ovarian cancer or a chronic disease." Because that, my friends, is what the patient hears, and is scared to death until they come see the GYN, so much the better for all involved.

~GYN consultation in the hospital "for pelvic exam." I kid you not. Apparently I have been doing it all wrong, doing my own cardiac exams and lung exams on my patients when I should have been consulting cardiology and pulmonology. How silly of me! What, the patient hasn't had a pap in 4 years, has a broken femur, can't move her hip, and is on her period? Why *don't* we "just do it while she is in the hospital?" Freaking fabulous idea. Thanks, alot.

~"Annual Exams" that really aren't annual exams. By that I mean, I made an appointment for a routine health screen, but what I really meant was that I just had my pap and breast exam at the health department last month, *however* I think my boyfriend is cheating on me, and I need tested for all STDs, and it has made me really depressed (I think it is my hormones), and by the way, I have no libido....can you please fix me in 15 minutes??

~Referrals for a "dropped bladder" (gotta love that technical term) on patients that weigh 350+. There isn't a surgical procedure in the world that can combat the overall gravitational forces working on those bladders. Never mind that most of these patients also have multiple medical problems, making surgery a veritable nightmare to begin with, and if you mention losing weight to help with their incontinence they wonder aloud why you "can't just fix it?" Oy.

~When men come into the exam room with their wives/girlfriends, etc., proceed to speak for them the entire visit, ask to "look in there" when you are doing the pelvic, and then finally, when you have your hand on the door, reveal that the "real" reason they came was because he thought there was something "wrong with her" because she doesn't want sex as much as (the guy) does. Gee, I just can't imagine why she isn't all over you, buddy. Nice.

~People who tell patients (pardon the poor grammar, but this is verbatim) "Just call your doctor if you have a question, that's what they are there for." (or the variation, "that's what you are paying them for."). Actually, your physician is "there" to provide health care and ensure that you (and, if pregnant, your baby) are well.

They are not "there" so you can page them at 1:40 in the morning (this is an actual call here) when you notice that your right breast is just slightly larger than your left, and you wanted to be certain that was "normal." Also, "you" are very often *not* paying your physician to answer after hours phone calls, and neither is your insurance company. They are answering your questions *for free* on their own, scarce, precious home and family time. (Oh, what, you think that answering ridiculous phone calls are just "part of the job?" Then why do lawyers get to bill by the hour, phone call, and email? Why is a physician's time and expertise any less important?)

So quit thinking that doctors are automatons with no lives, that never sleep, who "deserve" to work for free, and live only for the next breathtakingly inane page about your deep ruminations about your inner workings, You're wrong. And amazingly inconsiderate. If you aren't bleeding, losing appendages, or dying, save your calls for office hours, please.

~Finally, the most annoying thing of all...being on call for the whole. long. holiday weekend. There's nothing quite like having someone wish you a great "weekend off" when you know you'll be living at the hospital and fielding midnight phone calls while every other American in the free world is getting their drink on, living it up with parties, picnics, festivals, and sleeping in. Bitter, bitter, bitter am I.

Luckily for me, (and you, I imagine) a change will soon be coming. And not a moment too soon. Thanks for letting me get it off my chest...oh, and have a great Labor Day weekend. Heh. :)

Apathy

It's what's for dinner! (Quite seriously, we've ordered every form of takeout you can imagine this week!) It is the theme of the week. I just can't get excited or motivated about a darn thing. I assume that this is a typical problem, adjusting back to the daily grind after some much needed time off; I just can't seem to get back into the groove. At the heart of the matter, I'm aware, is the cold hard fact that I am tired of being tired. I find myself mentally withdrawing from my current place of employment. It isn't hard when you are welcomed back to the office with 8 patients scheduled in your first hour of the day. I'm over getting fired up about it. I've drawn out templates, been nice about it, stomped my feet about it, and taken it to the office manager that hates me, and nothing has changed. I know very much where I stand in this office. The writing is on the wall.

I know that staying in this position is no longer a viable solution, and while I know this will open up the chance for a much better life for me and my family, I am very sad about my patients. I am going to *miss* (most of) them a lot! Of course, I haven't told anyone that I am even looking for another position, and hope not to be forced to do so until I have a reliable back up option in place. You know, just in case they tell me to go ahead and get lost when I do reveal that I am seeking another opportunity. I find myself seeing my annual exams, and writing for a 12 month follow up visit, knowing full well that I'll likely already be gone. I feel so *deceptive*. I want to tell them to start looking now for a new physician. I'm so torn between my desire to get the heck out of dodge and make my life better, and the guilt I feel about leaving my patients. I've already gotten an attractive offer, but the catch is that they would like me to start in the early part of 2009. Ack! I'm not ready! I'll still have pregnant patients due then! How can I leave them mid-pregnancy? Don't get me wrong, I suffer no delusions that I am so awesome that all of my patients will be just crushed when I leave. I am *just* the doctor to the vast majority, I am certain, but I do know a few that will be crushed. The worst thing is that I let this guilt come to be on par with my family's need for a better lifestyle. My husband tries to reason that it is "just a job," but, to someone in medicine, it really is so much more.

On so many levels, I'm past ready to move on. I know that the decision I am making will be the best one for my family. I think the apathy that I am feeling is a resistance to the change that is coming. If I don't get things ready for leaving, like putting the house on the market or making the proper preparations to leave one practice for another, then it isn't truly real. It *is* real, and I need to embrace it. There is much to do...so I think I'll sit here and play on the Internet for a little while longer. Queen of procrastination, am I. If anyone out there has been in a similar situation, I'd love some advice on how you handled transitioning out of a busy practice. This is brand new territory for me, since leaving residency was inevitable, so I never worried about the aftermath of leaving. Sorry for such a downer of a post! I use the blog to get things organized in my mind, and this has been weighing heavily all week long. More fun filled L&D hi jinks soon, promise!

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!

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?

9 months and mobile

The Bean just turned 9 months old. It seems that he has had quite the spurt of development in the last few weeks. He got 2 new teeth, he started pulling up, he started crawling "for real," and he started to cruise. Just like that! He is a "big boy." I'm not ready! He is my *baby.* In so many ways. He still prefers the mama. He still dive bombs the boobs. Such a boob man, is he. I am breastfeeding longer than I had with CindyLou. She had little interest in the breast starting around month 8. Mr. Bean, however, is all about the boob, and I fear that it will continue that way until I say, "No more." Gah. I look at CindyLou's almost-4-year-old self, and I can barely fathom my little Bean growing as fast as she. Alas, I know it is inevitable! I have made a makeshift baby corral in the living room. He is such the explorer, it is hard to keep him contained! I am ever so grateful for the daycare's ability to accommodate his growing need for exploration. My living room , unfortunately, is less prepared.

This week has been crazy, nuts. Not in a good way. Deliveries and rescheduling of patients...the bane of my very professional existence. My office staff insists on scheduling me 7 patients in an hour. I am not pleased. I find myself actively fantasizing about other jobs. Less call, more life. Less than 40 patients seen per day. I spoke with another hospital this week. I find myself looking more toward relocating than staying and making this place work. This is a change, but with OtherDoc's wife as an "office manager" and the writing on the wall WRT any immediate change in the office and/or call schedule (not happening). I find myself invigorated by the possibilities out there. I am young, female, American trained, with a decent (I think) personality, and a strong work ethic. There is a lot of opportunity out there for me. I hate the concept of moving again, but, it may be worth it if I can find a job with one day call per week, and one weekend call per month (instead of 4 paltry days off per month, pathetic). Thanks to all of you for still checking on me! More detailed bread and butter OB/GYN in the next post, promise. Happy Weekend!

A Pox Upon Our House

Oh, what a sense of humour the universe has! The health of the Whoo household has been less than stellar this past week. Last Wednesday, Bean had his 6 month shots (at nearly 8 months) and got diagnosed with an ear infection for which he started Augm.entin. Last Wednesday evening, I decided to get a sympathy ear infection and spent the next 3 days in the most pain I have had since labor, and I started Augmen.tin and any other decongestant I can find to clear the constant sensation of my ear being filled with fluid. Sunday, on call, with the ear infection, I delivered a baby at 6:30 am, shipped a 32 week pre-term labor patient to the high-risk hospital, rounded on various complications of the post partum variety including an adrenal hemorrhage and a vaginal hematoma, labored a patient all day long, sectioned her for failure to descend past zero station despite pushing for 2 hours, and admitted a complex ovarian cyst. Monday, noticed a couple of raised bumps on the Bean's head, chalked it up to his sensitive skin, and whisked him away to daycare. Got to clinic, saw the 7 patients that were scheduled between 9 and 10 am, and got a call from the daycare that Bean's rash was spreading. Mr. Whoo picked up Bean and brought him to the office, where it was obvious that he had the chicken pox. I felt like the worst mother in the world for not noticing it that morning. I took him to the pediatrician on my lunch break, who confirmed the diagnosis, and canceled the rest of the day in the office to care for my poor sick baby.

I took Monday afternoon and Tuesday out of the office (but not off of the pager, which continued to sound every 1-2 hours like clockwork) to care for the Bean, and went to see the ENT on Tuesday. He essentially told me what I had already deduced; I had an acute otitis with an effusion. The otitis was clearing but the fluid in the middle ear (which is giving me moderate functional hearing loss, BTW) could remain until almost a month. A fragging month! Feeling like I have fluid lolling all through the right side of my head, and torturing my family with the high tv volume, and muttering "Huh? What? 'Ay?" like a little octogenarian with her "listening cone" anytime someone tries to speak to me for another freaking month. Fan-tastic. He added a Me.drol Dose.pak for extra fun with steroids to my treatment regimen.

Wednesday I had a 12 hour surgery/work day, made stressful by a surgical complication on one of my favorite patients. Mr. Whoo stayed home with the Bean, and proved himself un-house-husband worthy by failing to have dinner ready when I dragged myself and an exhausted CindyLou through the door after 6 last night. Mr. Bean had a particularly fitful, itchy night last night, so either of us slept very well, and today I am again taking out of the office, but on the pager to care for him. Call me crazy, but I am running out of patience and sympathy for the patients that just have to be rescheduled *next week* due to the fact that their golden ticket, ahem, "free" medical card runs out at the end of the month. Go to the freaking health department for your pap, for goodness sake, it's still "free" (ie. I will be generously subsidizing 30% of the salary for which I work 24 hours a day/26 days a month, so that you can play Wii and smoke weed all day long and still not have to pay a whopping fifty bucks for a pap smear). I'm just about all out of doctorly concern, and eyeing up my liquor cabinet right this minute, even though it is not quite noon yet.

So that, dear readers, completes your lovely week-in-review from the Whoo household. So, how are *you* doing?

Ow ow ow ow ow...

This is the full extent of my vocabulary for the past three days. I have a rip roaring ear infection. I don't believe I've had one since I was a kid. Thank goodness not, because the only thing that hurts worse, my friends, is labor. No epidural for this kind of pain, either. I have been eight kinds of miserable these last few days. It started on Wednesday, after the Bean (finally) got his 6 month (!) shots. Coincidentally (or not) he was also diagnosed with an ear infection. That evening, I heard a rubbing noise in my right ear, followed by an immediate sensation of fullness that did not resolve. I took and antihistamine and a decongestant and woke up the next morning at 4 am with severe pain. As I lay in bed, trying not to move, lest the fluid crackle and make my ear hurt even worse than it already did, the pager went off signaling the arrival of a labor patient. Grudgingly I got up and showered, finding my movement extremely limited. I couldn't even bend over to wrap up my hair in a towel without twinging my ear so badly it wrought a stream of curses.

I arrived on labor and delivery, caught a very fast baby about 10 minutes later, and started to move slowly through my hospital rounds. I stopped a kindly family med doctor, whom I begged to check my ear. (You see, I must relate that ears completely squick me out. The fluid, the hair cells, the little bones that *articulate*, the membrane...ick, ew, and gross. Funny, I know, coming from a specialist in one of the arguably more gross professions around. To each their own.) I was just *convinced* some wandering spider had laid eggs in my ear and they were getting ready to hatch. My colleague allayed my fears, but told me that, indeed, my ear was "cherry red" with fluid bulging behind the TM. Great. I got an Aug.mentin script called in, finished rounds, and did a post-partum tubal on my morning delivery patient. Then I headed to the office, where I proceeded to throw a minor hissy fit because I had 21 patients scheduled in roughly 3 hours (of which there were at least 3 new patients, 3 problem patients, and an I&D of a perineal abscess on the list). My hissy fit was for naught, however, as about 10 patients later, I was called to attend another delivery. I happily canceled the rest of the day and rushed back to the hospital.

As I sat waiting, my ear pain kept escalating, throbbing, and ringing. The nurse caring for my labor patient was forever messing with the electronic charting and not helping the patient (a primip) to push in any significant way. The baby kept deceling and the nurse kept ignoring the strip and focusing on the computer, and my ear kept twinging. I did the best that I could to encourage the patient. Her family stood stock-still, lined up against the farthest wall of the labor room, and her nurse hadn't even turned on the baby warmer. At last, in just a hour of pushing (would have been less, had my nurse been more patient focused and less documentation focused) I delivered the baby through a triple nuchal cord and placed her on her momma's belly. Then, I handed her a sterile towel to start drying the baby, since the nurse was still ignoring us both in favor of the computer. Thankfully the baby pinked right up and no resuscitation was needed. I finished sewing the lacerations, and held my ear and moaned all the way home.

Flash forward 'till today, I have had over 48 hours of antibiotics, have been living on m.otrin and sud.afed, and I still don't feel any better. The whole right side of my head is clogged, my ear feels full of fluid that shifts and crackles, and oh, the pain is still there. No real fever, just hovering around 100.0, and I still have to hold my head perfectly still or pay the consequences. Now I'm googling Mastoid.itis and generally being a hypochondriac about the whole thing. Oh yes, and I am also on call. I can only pray that the call gods are kind to my suffering soul.

In other news, I updated my CV and sent it out to a few "backup plan" opportunities. Mr. Whoo says my health is suffering because of the lifestyle I have been living the last 3 years. Maybe he is right, because I feel 100 years old right about now. Hope you all are having a wonderful, spring-like weekend, wherever you are. I'm going to hold a hot pack to my ear and whine about it some more.

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! :)

Whoop, dere it is

Do you ever get inappropriate song lyrics stuck in your head on constant repeat? (Whoop! Shakalaka-shaklaka-shakalaka, whoop!) Just me? Damn. The inspiration for my chosen song of the weekend is not so funny, unfortunately. It seems that Bean may be in the early stages of whooping cough or pertussis. A child in the daycare was just diagnosed this week, and yesterday he started with the characteristic cough. Since he is such a little man, and has not completed his vaccinations yet, he is now on antibiotics to (hopefully) keep him from developing the paroxysmal coughing spells that are pathognomonic for the illness. Poor guy. He actually otherwise seems very happy. He is eating and sleeping well, so that is all that I can ask in this situation. Hopefully we have caught the illness in the mild stage in time for him not to develop the severe symptoms. Fingers are crossed.

Did I mention that I am playing single parent this weekend? Well, I am, and boy, is it rough. Mr. Whoo is off in the woods with his (boy)friends, acting like 13 year olds (video games, junk food, staying up late, oh and also with beer, lots of beer). They do this trip once a year, and I think it is great for their friendship, but man, it is difficult at home. When CindyLou was a baby, she decided to get her very first stomach bug when Mr. Whoo was off on his "guy" weekend. Bean just had to do her one better, I guess. You may remember at the onset of this blog that the wives started their own little get-away weekend. We didn't do it this year (logistics were tricky with pregnancies and whatnot), but are in the early stages of planning next year's trip. (A whole lot less video games, same amount of alcohol, and more spa time.) CindyLou and the Bean have actually been angelic, though, so I have been really lucky. She is off on a playdate right now, and he is sleeping somewhat peacefully in his swing. Hence, blog time! Woot!

I am taking a little longer to adjust back into a full work schedule than I anticipated. I am booked for new patients out into April, with women approaching me personally in the hospital and elsewhere (!) requesting to be seen sooner. I also am trying to decrease my patient load for less deliveries per month in hopes of eking out some sort of better lifestyle. I am going into the 3rd year of a 4 year contract, and I have a lot to consider. Now, with two children, I am finding that lifestyle is becoming increasingly important. I came in to this opportunity with the attitude that I could do anything for 4 years (just like residency). When I come out of this contract $200,000 of my student loans will have been repaid. (You read that figure correctly.) This is huuugge. I will not be "debt free" but the amount left over to pay after that is entirely manageable. I love the location and the patients. I do not love the call schedule...at all. I am still only getting 4 days off per month (every other weekend). I am on call 24/7 all week long and 2 weekends a month. This is too much. I was led to believe that call would be 1 in 3 when I arrived here. This never materialized, and I am somewhat bitter. My employer is looking to expand, and I am hopeful that adding one or two more OB physicians is in their sights in the coming years. If I could have a true 1 in 3 (or 4) call with 1 in 3 (or 4 )weekends, I think I could be a very happy camper. If this does not happen, I'm afraid I may have to start the process to look elsewhere. Bleah. I hate moving. I am trying to be patient.

I am glad to be back with my patients. It is awesome to get back into the OR, and catch some babies. One of my favorite patients is due this month, and I can't wait to deliver her second baby (I delivered her first about a year and a half ago). That is the part that I love about OB, the continuity of care and the relationship with the patient. It is such a privilege to be a part of such an intimate occasion as childbirth. I wish sometimes that I didn't love my job as much as I do. I wish it would be an easier decision to scrap years of training and debt and say "I'm staying with my babies." I just can't. I love my children immeasurably, but I know that the work that I am doing is more than a job, it is a calling; just as much as motherhood is a calling, and so I do my best to serve both of my passions in an equitable way. It isn't easy, and I will state now that I am choosing not to engage the work vs. stay home debate mongers here. A few of the comments I have received and chosen not to publish are hurtful, not only to me, but to women in general, and I will not allow this misogynistic rhetoric on my blog. If you are looking for a fight, please look elsewhere. We women are doing the best we can, and we don't need members of our own sex seeking to tear us down for the choices we make in life. With that, it is time to nurse the little man. Happy weekend, one and all...thank you for reading my stream of consciousness. :)

The Home Stretch

It seems as though, in these last few weeks of pregnancy, I should be surging toward the finish line with my last burst of energy...stretching forward and extending further than ever I have before. In actuality, I find myself barely limping (literally, stupid sciatic nerve pain) along, dragging my feet, and procrastinating the whole way. I haven't packed my hospital bag. The nursery really isn't ready. I'm really not mentally prepared for this new arrival, and yet I find myself hoping that he's getting here sooner than later!

Sorry for the long silence, but as per usual, I've been busier than ever at work and at home. I am covering call for my partner, as he is taking his annual 2 week long vacation (if this doesn't put me into labor, I'm not sure what will). We've had visitors for the last 3 weekends in a row, and while wonderful, it has been exhausting. I wanted to thank each and every one of you for all of your helpful comments, well wishes, and hints about flipping my stubborn breech baby! I promise, I've not been holding these comments hostage, rather, I've just not had a chance to get them all published until today. First of all, I did check the website to find it to be the same one I've directed patients toward in the past, I did do the knee-chest reposition manueuvers, the inclines were just too much blood rushing to my face, and I didn't have immediate access to a swimming pool deep enough in which to do handstands (without embarrassing myself at the public pool by having my stubbly legs waving about in the air, that is), but I did suspend my belly between two rafts in my daughter's oversized wading pool. I did not do moxibustion. I wasn't really sure where to get the candles and wasn't certain enough about the technique to order them from the internet. I barely have time to make my own OB appointments, so seeing a chiropractor was not a real possiblity, although I do have patients that have had success in this arena. As far as visualization/hypnosis stuff, I think it ended up more like begging, pleading, and cajoling the Bean...pleeeeaaaassssseeee turn around, c'mon, I'll buy you a pony, etc. The fact of the matter is, I don't think any of the traditional techniques had one iota of influence on my stubborn child. The evening before my second ultrasound, I could palpate his hard head right below my ribcage, and I had resigned myself to making the decision for version or elective section (because I am too a'skeered of the risks associated with vaginal breech births). Then, my 20 pound girlcat took matters into her own paws. She leaped upon my belly, positioning herself directly over the caput of my stubborn son, and proceeded to activate her very loud purrbox. She hatched my belly and purred for about an hour, and boy, did the baby respond! He wriggled and kicked like crazy, it was, at times, almost painful, but after that hour, I could no longer feel his head in my upper belly. The ultrasound the following day confirmed that I had, indeed, had a successful cephalic version via kitty, and vertex he has remained ever since. So much for traditional methods of flipping breech babies! If I were to try to rationalize why this worked when nothing else did, I guess I could say that it is close to vibroacoustic stimulation like we use to "wake up" sleeping babies on non-stress tests. Who knows? All I know is that he is now vertex, and getting way too chubbly (hopefully) to turn back around now.

As for his estimated weight, a good 7 pounds as of a little over a week ago, of course I'm taking it with a grain of salt. The limitations of ultrasound in predicting weight accurately in the third trimester are not lost on me, but what woman doesn't cringe a bit thinking about the possibility that, indeed, the measurement is closer to correct than not, or, worse still, is off by a pound in the positive direction? I'm trying not to think about it too much and trying to trust that I don't feel like I'm carrying an almost 8 pound kid at this point. We shall see. My BP has been holding steady 140s/80s, no protein, normal labs. I even lost a pound this week. (Whee!) This next week, we are going to try to take professional belly/family photos, so I must find some inoffensive similarly colored shirts for Mr. Whoo, CindyLou, and me. We have a to-do list a mile long. I thank you all once again for checking in on me and all of the encouragement. Now I must get into the hospital to round (I've started to deliver some patients whose due dates are *after* mine, and there is very little in my life as an OB/GYN that is more discouraging than that!), continue to wash baby clothes, and maybe, just maybe, pack my own hospital bag. Just like a real pregnant person.

Still alive, still pregnant, still whiny

Is it really June already? I'm not ready for it to be summer! The last few weeks have been (SSDD, I know) a whirlwind of work, catching babies, visiting family, and minor freak outs about the status of the medical blogging community in general and about my blog in particular. It is difficult for me to even see hits from the same *state* on my stat counter without getting antsy about being "found out." I debated stopping altogether, but I miss blogging and talking to you all out in blogland. I guess that I was never organized enough about blogging to figure out what I wanted this blog to be, a mommy blog? A doctor blog? Educational? Entertainment? To tell the truth, more than anything I approached it like my own personal journal, an outlet for all of the jumbled thoughts in my brain that I need to spill and sort out in black and white. A journal that talks back ! (The coolest part of all.) So, I think that is what it will continue to be, with major alteration of details surrounding the particulars of my job. I think I can live with that. We shall see.

So let's catch up. On a personal note, I am 32 weeks and 2 days. The Bean has hiccups regularly, and I am convinced that he is still in transverse lie. I've been measuring almost 2 weeks ahead for the last few appointments, and I am dying to know how much this kid is going to weigh. (Did I mention that I don't have free access to an ultrasound machine, so I am at the mercy of the insurance/physician order just like every other pregnant woman? Shameful. I'm dying over here.) The "due any day now" comments are coming fast and furious, along with the shock and mock horror when I tell them that I still have at least 8 weeks to go. People can be so jerky to pregnant women, it's unreal. It continues to be a real test to patiently listen and empathize with my whiny pregnant patients, being a whiny pregnant person, myself. More than once, when asked when their maternity leave should start, I've stifled the urge to quip "You can't stop working until *I* stop working." Ha. I would never say this out loud, but it's fun to fantasize about. I had a very busy delivery month in May, and I am looking forward to having only half as many patients due in June. Pregnancy symptoms include lots of contractions (but a negative fetal fibronectin, so all is well), sciatic pain, mild pubic symphysis diastasis discomfort, cankles, borderline elevated BP (130-140s/80s), and killer heartburn. I am happy to report that I am no longer puking, even on a weekly basis.

Remember the less than stellar med student that I posted about a while back as an example of what not to do? Not too long ago, that very same student cornered me in the Doctor's Lounge and proceeded to tell me how "shocked" they were at the grade that I had given them. (For the record, it was in the ballpark of an 85 percent. I felt that I was more than generous for the work the student did!) I got treated to a talk of woe, that they had really, really wanted to do OB/GYN and my grade didn't place them at the top, where they believed they should be. I also heard about how the grade I gave them was the worst grade they had ever received. (Which shocked the hell out of me, leading me to believe that this student must have been allowed to slide by with being "cute" and "sassy" because their clinical knowledge and work ethic was sub par, as far as I could see.) I was as gracious as I could possibly be, and stated that it was possible that I was a stricter grader than the student's prior preceptors, and I encouraged them to pursue recommendations and work hard in their 4th year electives in OB/GYN. Then I politely excused myself before their audacity completely caused me to lose all composure and give them a real piece of my mind. Now I wonder if it would have been better to just lay it all out for them, because, really, I am not doing them any favors, allowing them to think that they were the best student around, and I am just a mean, hard-grading jerk of a preceptor. (No, it isn't me, it's *you.*) I just suck at unexpected confrontation. I need time to formulate coherent arguments, otherwise, I tend to just make off the cuff, not so nice, and certainly not constructive comments. Ah well, just thought it would amuse y'all to hear the update.

I am off this weekend, and Mr. Whoo and I are about to tackle the master closet. A project a long time coming, accelerated by the fact that an entire rack of clothes fell off the wall this past week, requiring immediate attention. Sigh. Home improvement sucks.

2 Weeks Post Call and Whiny

(I know I've posted a similar whine in the past, but humor me, this is on my mind.) Yes, it is just as it sounds, I have been on call, 24/7, for the last 19 days. Granted, I haven't been in the hospital/office the whole time, but it takes such a mental toll! Call as a private practice doc isn't anything like call when I was a resident. In residency, being "on call" means being in the hospital for 24 hours (and, prior to the 80 hour restrictions, up to 36 hours) at a time, working with a team of other residents/attendings, and caring for multiple patients, including surgical, laboring, antepartum, and post-partum. It was grueling, but the time was finite. Even on the worst of days, there was a definite time when I could turn the pager off, and take time only for myself. On days that I was not on call, I was generally out of the hospital around 5-6 pm, with no fear of having to return to the hospital until the following morning, as another resident team was shouldering the workload.

Now when I am on call, it is all me, and only me, on call for all of the patients that I have ever seen, and, over the weekends, on call for all of OtherDoc's patients, as well. Most of the time the calls I get can be handled from home with a phone call, and I can go about the rest of my day. Of course for deliveries and surgical emergencies, I need to be in the hospital ASAP. The hardest thing for me is that I can never quite mentally disengage, as at any time, I have to be ready to race to the hospital. I can't ever go further away than 30 minutes from the hospital, and if I am doing something with my family, we often take separate cars, "just in case" I get called. The pager can go off at any time, and you just never know what is going to be on the other end of the line.

When I was looking for positions post-residency, this was not what I had in mind. I was somewhat mislead into believing that call was split Q 3, and weekend call was to be every third weekend. What actually happened was that I was on solo call for a whole year until I could beg, cajole, and finally convince OtherDoc to at least split weekend calls. The other hospital OB has no interest in sharing call whatsoever, and only wants call coverage for vacations. Now there are some perks for being on call so frequently. I do get to deliver most of my own patients, and when I get calls for problems, I know my patients' histories and personalities fairly well, and can advise them accordingly. I also have fewer patients to cover than a group OB would, so that means less trips to the hospital/phone calls/ etc. while on call. I think that in the next 2-3 years the hospital is looking to hire another OB/GYN, and I am desperately hoping that this person wants more of a life and will go for sharing weekend call, and possibly sharing weekday call, as well. As CindyLou and the Bean grow up, I want to be available for sport games, recitals, and school activities without fear of having to leave to the hospital. I knew what I was getting into as an OB/GYN, and honestly, I don't mind being on call for my patients, because I know that they need me and trust me. I just need to strike a better balance of being available, mentally and physically, to my family and friends as much as I am for my patients.

I am now 27 and 2/7 weeks pregnant, and I am starting to physically slow down. Some days I feel just like a little old lady, whining about my "sciatica." Ha! I am rather short in stature, so the belly is quite "out there" and it is already inviting "due any day now" comments, which is maddening. My office has actually started to pare my schedule, and now, instead of 40-50 patients on my full days, I am averaging closer to 30-35 patients on a full day. This is infinitely more manageable, especially when it comes to charting, but now that I am moving slower and a little more tired it still takes all I have to get through those full days in clinic. My "half-days" are still averaging upwards of 20-28 patients, which is also difficult, but so far I am making it work.

It's funny (read kinda sad), because my patients are always commenting that it must be "so much easier" for me to be empathetic to my pregnant patients, as I am pregnant, myself. I am finding the exact opposite. It is hard for me to commiserate with the patients angling for time off work, complaining about common discomforts, and lounging about muttering about how *tired* they feel. Some days it takes all that I have not to tell them to "suck it up and deal!" It isn't a fair attitude to have, because I *do* know how miserable pregnancy can be, and misery is relative. Just because I feel like I am *more* miserable than they, doesn't mean that my patient isn't experiencing more misery than she ever has before. I do find it interesting that the majority of my patients that are having an "easy" pregnancy do not work, and those that are having the most complications are the working mothers.

For now I am going to close this post, because the whining is starting to annoy *me* so I know it must be most unpleasant for all 6 of *you* still checking back to see if I am still alive. I have some really good cases to discuss as soon as appropriate time has lapsed, so I will try to get around to updating in less than 2 weeks time. Happy weekend to all!