Happy Mother's Day

Happy Mother's Day to all of you Mothers, would-be-mothers, and glad-you-aren't-mothers, We had a great active weekend here. CindyLou had her 4th birthday party (dinosaur theme, of course, every girl's dream), and the Bean was baptized this weekend. I also was on call, but so far the call gods have been kind to us! May has been a crazy month, with lots of travel, and busy-ness in general. I am hopeful for the summer. I am looking to interview with other practices in the coming weeks. I am also going to meet "the other woman" this weekend at a mutual friend's wedding. Give me the strength to be civil and polite to this person with whom I regard with contempt. Apparently they are going to become engaged soon. It blows my mind how my friends can call her a "nice person" when I know and she knows that she is a home wrecker. Hopefully I won't get drunk enough to tell her what I really think of her! Today I am thankful for my perfect babies. They are truly the best Mother's Day presents of all!

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!

Home again, home again...

jiggity jig. Only I went on vacation to *become* a fat pig, rather than to *buy* a fat pig. We had a wonderful, whirlwind, exhausting trip to Florida to visit with both my family and Mr. Whoo's family. Bean had sufficiently recovered from the pox to be his normal, sweetheart self, and I think this is the first time that CindyLou actually could appreciate being on vacation. We beached, we swam, we went to kid-friendly museums, went to the river to fish, and we ate...and ate...and ate! Having to drive long distances with an 8 month old and a nearly-4-year old was, erm, challenging, at times. However, I don't know how our parents did it without today's modern conveniences like DVD players. Mr. Whoo and I actually did our best to break out the DVDs as a last resort. We played the license plate game (Mr. Whoo and I) and I Spy with CindyLou, and she really enjoyed it. A steady supply of Gold.fish crackers for CindyLou, and an arsenal of new and interesting toys to play with for (backward-facing) Bean kept me quite busy. Oh, and pumping in the car to be able to make fresh bottles for the Bean was quite a joy, as well. I'm sure some truckers got a really good look at the girls at a few points. Tres exciting for them, I am certain. Ha. Weight gain verdict...6 lbs for me 8 lbs for Mr. Whoo. Time to consider to think about maybe at some point trying to exercise. Mr. Whoo and I have made a commitment (after seeing my mother's house and all the food that she hoards) to do our best to clear out our freezer and pantry and to only buy essential perishables. We are so bad about holding on to food, then buying more.

We've been back for a week. Of course I paid in spades at work for being on vacation with a really booked office schedule and a rash of deliveries the moment I arrived back in town. Not a single one of my patients delivered while we were on vacation! I am, of course, on call this weekend. Unfortunately, my day started with having to tell a forty-something patient that she has at least stage III cervical cancer (hydronephrosis). It is really terrible, but she hasn't had a pap or pelvic in over 10 years. It is so frustrating to see an advanced cancer that may have been prevented with routine screening. It is my 3rd cervical cancer that I have diagnosed this year, all were due to delaying routine screening. Go get your annual exams, ladies, you don't want to get the kind of news I had to give this family today. I am also in the midst of compiling my oral board list, re-applying for hospital privileges, and had to bring home patient charts to write since I was so busy in the office this week. Oh, I also need to dictate. And we haven't unpacked yet (!) But, for now, the sun is shining, the trees are in bloom, and my family and I are going to sit on the patio and grill lunch...and then go run to work it off, that's the ticket! Have a 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.

Check, check, check, check it out...

Lots of things swirling around, but nothing cohesive...hence, bullets, it is!

~I turned another year older this week, and I was pretty surprised to see that a couple of my favorite bloggers had a birthday this week, as well. Pisces rule...woot! So funny, since we're supposed to be all reclusive and whatnot.

~Last week I pretty much had a baby a day, so I was pretty busy. No birthday babies for me, though. Too bad for them. Hee.

~I'm looking at other job opportunities in other areas, just as a back-up plan, and I am meeting with the physician director later this month. Here's hoping they want to keep me around, 'cause I really don't want to move.

~I discovered Project Playlist last weekend, and have been slowly adding songs to my list. If you want to check it out, just scroll all the way to the bottom of the page and click the play button. It is fairly eclectic, but I am loving listening to it. I need to make a CD out of my playlist!

~We are doing some sleep training with Bean. It is time to move from Mommy's bed to Bean's bed. He's doing really well going to sleep in his bed, but he still wakes to eat in the night. It works for at least 6 hours a night, then it is time to nurse and cuddle. Is it wrong that I just am not ready to give it up yet? They are only babies for such a short time.

~I've been playing around on Facebook more than I should. I heart Oregon Trail.

~My grandfather is quite ill, and has started dialysis this week. He has multiple medical problems, and I know, I *know* we don't have much time. I saw him last week and we are taking the kids to see them this weekend as well. The hardest part is that he is still so mentally sharp, his body is just failing him. I am just trying to soak up all the time that I can, and I hope that CindyLou may remember him, even just a little bit. He is such a great man, and I am not ready to let him go. Sniff.

~I am loving Amer.ican I.dol this season, and I heart them a little bit more for featuring the Graham Colton Band as one of their "goodbye" songs (Best Days - the last song on my playlist if you wanna listen). I will go out on a limb and predict the finalists to include Dav.id Ar.chuleta, Davi.d C.ook, Br.ooke Wh.ite, Sy.esha Mercado, Micha.el J.ohns, and Carl.y Smi.thson.

Sorry for the short, sweet post, but I haven't the ability to mold and shape the roundy thoughts filtering through my brain right now. Hope all is well in your respective worlds. Happy weekend!

Wake Me Up Before You Go, Go

In my younger years, when this song first came out, I sang the next line, "...don't leave me hanging on a lively yo-yo." Hee. What exactly a "lively" yo-yo is, I cannot describe. What can I say? I wasn't the champion lyric interpreter that I am today. This song got stuck in my brain because, you guessed it, someone woke me up before he went (went). Mr. Whoo had an early morning service commitment that required him to be up and out of the house before 5:30 am, and CindyLou took that as a clue that she needed to be awake, too. Telling a 3 year old that it's too early to be awake just doesn't fly when Daddy is already up, showered, and out of the house, so no sleeping in for me! I am soooo sleepy, but Mr. Whoo and CindyLou are napping, and the Bean is happily awake. No rest for the wicked! He and I are hanging out, watching Tivo'd Ameri.can Id.ol. (We are just at the end of the group sing, and....Jazz Hands! Hee. The Bean seems to favor Michael J.ohns, maybe he has an ear for this sort of thing?)

It has been a harrowing week. I have had a couple of really sick patients. One patient had HELLP with platelets dropping into the teens before she finally turned the corner. The other patient got a high spinal instead of an epidural (!) and we were *this close* to having to intubate her. Luckily, the worst of it was that she felt particularly crappy and was incredibly numb from the chest down for nearly 3 hours. Basically she labored right down to the perineum before she could feel too push. She had a happy, healthy baby, didn't feel a thing for another 2 hours, and, thankfully, has no residual effects from the misplaced anesthetic. Yikes. I feel like I have worried enough this week to sprout several gray hairs. It also seems like all of my March babies are preferring to be born in February instead! I am on call this weekend, so I am hoping the next couple of days are more low key.

I've been thinking of what my ideal practice would look like, as my contract is coming due in the next year. Something like a true group practice (shared OB patients, but individual GYN pts), with 4 or 5 docs, each with one 24 hour "labor deck" call during the week (which would include all labors/inductions/rounding for the entire group for that day, with no office duties), the day post call off, maybe doing surgery during your call day, and doing office the other days of the week, taking weekend call every 4-5 weekends. Sounds nice, but I am unsure if it exists in a workable form. We love just about everything about where we are now except for the call coverage (or lack thereof) and the office manager, of course. I am going to initiate some discussion now, so that we don't have to scramble at the end of the contract for a new place to go, should it come to that. Hopefully it won't, and we can work out an acceptable deal. On that note, Bean just filled his pants...during Paul.a's new video. Another sign of his ear for talent? I think, yes. Have a great week!

A Good Day's Work

Some days this job is frustrating, irritating, exhausting, and difficult, other days this job is exhilirating, wondrous, amazing, and wholly satisfying. I was fortunate to have such great day in the not so distant past. It was edifying to feel as if I was doing exactly what it is that I was made to do. The morning started out like most others, rushed and sub-frantic, prepping kids for school, consolidating bottles and pump parts, and departing for work just not quite in the nick of time (ie. just enough to be about 5 minutes late). This day the gods were smiling upon me, and the operating room was behind by about 10 minutes as well, so my surgeries were not delayed due to my tardiness. It was also fortunate that the OR was running a bit behind, as I had a moment to check up on one of my patients that was admitted overnight for observation.

This young girl (YG), a long standing patient of mine, seems to carry the very weight of the world on her shoulders. She was pregnant with her fourth child, six years after her youngest child; a child that was very much wanted, as she had prolonged interval between pregnancies. The day we diagnosed her as pregnant she cried in dismay rather than joyful tears. YG, you see, has severe depression. The depression had been somewhat controlled by several medications that she had weaned in anticipation of the pregnancy, but now that the pregnancy had arrived, she feared the long road ahead without the medications that worked best for her symptoms. Of course we attempted a different, safer, regime to continue throughout her pregnancy, but it was not as effective. The pregnancy was long and fraught with many tearful visits, poor weight gain, and many fears, as her previous delivery had been by emergency cesarean, and she desperately wanted to VBAC. She also approached her due date with apprehension, as she had an induction of labor with all of her previous deliveries, and, while I explained that natural onset of labor would give her the best chance of a successful VBAC, she dreaded the unknown sensation of a spontaneous labor. This initiated no fewer than 14 triage visits in the the weeks leading up to her due date.

Fast forward to this morning, where she had been admitted for irregular contractions early in the morning. Before my surgery began, I checked her cervix, and it was 3 cm, a change from her office visit earlier that week, but not by much. Labor and delivery was full, and the nursing staff was a little short, so we continued to "expectantly manage" her, we felt, very early labor. The thing about VBACs in my hospital is that the OB must be on hospital campus during the duration of the labor, for saftey reasons. So she and I were there, both waiting.

My first surgery was a hysterectomy on a 4 pound fibroid uterus, a little tricky, as it was quite enlarged, but extremely satisfying, and only 100 cc of blood loss! I saw YG walking the halls in between my cases, and hoped for cervical change, for both her sake and mine! My next case was a repeat cesarean section. It was truly a beautiful moment, as the baby was delivered, both mom and dad could see her lifted from the womb, they had chosen music to play in the OR, and they cried along with the perfect baby girl. Say what you will about cesarean deliveries (and this patient was offered VBAC, as well, but she declined emphatically, citing 72 hours of hard labor and little cervical dilation in the previous pregnancy) the birth was still beautiful, and it made me very happy to be a part of it. After the cesarean, I scurried up to check on YG, now contracting every 2-3 minutes, and dilated to 4-5 cm. She requested and recieved her epidural, water was broken and internal monitors were placed, and I went back down for the last case of the day, a short and sweet endometrial ablation.

After my third surgery, I grabbed a little lunch and retreated to the doctor's lounge to catch up some dictations, anticipating a somewhat long wait for YG's baby. I was surprised to get a text page, a mere hour later, that she was 6-7 cm and feeling pressure. I quickly wrapped up my dictations, and luckily so, as in the next 5 minutes I got the "get here now" page. I sprinted up the stairs and into the labor room to see that the "get here now" was a bit premature.

I was already gowned and gloved, so I settled in to help YG with her pushing. Something for which, I admit, I am not often present. It has always bothered me a bit when the nurses get a little yelly with their counting, all in the patient's faces and tell them to "get mad" to push their babies out. I just don't feel like "getting mad" and pushing out your baby jibe all that well. This labor nurse, despite the whole "get mad" business, was really very sweet and supportive, which YG needed most of all. I tried to get YG to listen to her body and let the pressure she was feeling guide the baby out.

After about 45 minutes of good pushing, the crown was visible, with thick, wavy hair, half-dollar size at the introitus, and I knew that this baby was going to be a very nice size. YG was starting to doubt herself, and I told her that her baby was going to be delivered at 3:45pm (in about 10 minutes). She laughed, a rare sound, and renewed her efforts. After a few more pushes, I eyeballed the nurse to get ready for a possible dystocia, and YG concentrated all of her energy to deliver her baby to the world. The head delivered oh-so slowly, I reduced the first nuchal cord on the perineum, felt the shoulders give a little catch which resolved with only McRobert's and a little bit of suprapubic pressure, and reduced the 2 additional nuchal cords as the baby's body was delivered up to his mothers waiting arms at precisely 3:45pm. She had an intact perineum and only a small right sided periurethral tear. Her largest baby prior had weighed 7 pounds 11 ounces; this young man was 8 pounds 11 ounces! YG was ecstatic, and back on her old medicine regime. She has a long road ahead, but she seems hopeful and empowered by the birth of her new son.

So a VBAC, a hysterectomy, a c-section, and an endometrial ablation, all before 4 pm. All in a good day's work, helping different women in different ways. This is what keeps me going through the less savory aspects of my job. Weird for me not to whine, for once, huh? Have a great week.

Bleargh.

So much for posting 4 times a month. It's been almost a month since I had a minute to sit down, and, unfortunately, the only reason I have this minute is because the entire Whoo household has been stricken with a nasty little GI bug. It started out with the Bean. I picked him up from daycare on Thursday and he promptly annointed me with copious amounts of vomit. He continued puking for the next 24 hours. Poor little man, they just look at you after puking like "help me!" Mr. Whoo stayed home from work with him on Friday. I was on call for the weekend, and by Sunday the Bean seemed to be feeling fine. That's when CindyLou picked up puking, followed shortly by myself. She and I puked all last night, and now Mr. Whoo is starting to get the chills and nausea, and, we just got the call from the daycare that Bean picked up vomiting again this morning (odd after almost 2 days with no sickness!) We are a sad little family today. Just pitiful. CindyLou and I slept in, and have just ventured on to ginger ale and crackers. Hopefully we are turning the corner soon!

In work related news, I had this lofty goal of not having any inductions this month. (To be honest, that is my goal every month, but with just a handful of patients due, all relatively healthy with few risk factors, I felt I'd actually be able to accomplish it, for once!) Well, that came back and bit me big time, as of this morning I have 2 40+ week patients with severe oligo, and another 39 -weeker threatening pre-ecclampsia. All three are now on the books for induction, thankfully not today, since I'm most uncomfortable straying too far from my bathroom! Also in the works in the coming months, I have 2 sets of twins on the way. I keep waiting for the 3rd set to complete the trifecta. I have noticed a little more activity on the billing front with respect to OMFH. I have a meeting scheduled to go over financials, so I'm sure she's scrambling to set things right. My application for oral boards is looming due at the end of this month. I am scared to take these boards! Any good advice for review courses? I was thinking of trying to do one before I have to turn in my list, so someone can look it over.

Sorry so short, but feeling sick and looking at computer screens does not go well together! Thanks to all that have been checking in on me. I will try to be more present in the blogosphere in the coming weeks.

P.S. Hah! This is my 100th post. A post about puking, how un-monumentous!

6 Months

The Bean is six whole months old today, and I find myself feeling as though I have blinked and missed it! He is growing up so very fast. With CindyLou, I remember always looking forward to the next big milestone...I couldn't wait for her to smile, sit, crawl, walk, etc. With Bean, I find myself feeling the opposite, he is hitting milestones and *I'm* not ready for it yet. I suppose it is because I have hindsight from watching CindyLou, knowing how fast she is growing up (and she tells us every day), coupled with the fact that Bean is, in all likelihood, our last baby. Whatever it is, I'm not ready.

Bean is such a happy baby, though. He loves to play, he is starting to clap his hands, and he really loves singing (lucky for him!) He weighs a little over 15 lbs., which, I know, is still pretty small compared to most kiddos. He is starting to eat "real" food, too. So far we have tried (and liked) rice cereal, sweet potatoes, and applesauce. Teething has been in full force for a few weeks, now, there is much drool and chewing involved, but no visible teeth yet. Bean has nearly mastered the tripod sit, but still hasn't shown much interest in rolling a lot (he's done it once or twice) or trying to crawl. He loves the exersaucer and still hates sleeping in his own bed (the record thus far is 4-5 hours). We are still nursing/pumping, and I don't see him giving that up any time soon...quite the boob man. He does something that I have never seen a baby do in my life; he scratches the living daylights out of his teeny head, sometimes drawing blood. We've tried baby oil, bathing more and less frequently, hypo-allergenic soap, lotioning him (head included) within an inch of his life, and of course, keeping a hat on his head and his nails as short as possible. He still goes after his scalp with both hands and digs as if it kills him. Anyone else have this problem? Our pediatrician has not been overly helpful in this arena.

Today is the first day I have had off of call since 12/30/07 (last year! Ha!) It goes without saying that our house has transitioned from utter disarray (the "normal" state of being) to uncontrolled chaos. It makes my brain hurt, and Mr. Whoo and I have been up and working since early this morning. Laundry, folded but not put away, had been residing upon our bedroom floor for far too long; so, I took it upon myself to finally place the clothes in their proper homes. Whilst putting the Bean's laundry away, I realized how many outfits in his drawers were clothes that he has outgrown. I pulled sweet baby onesie after sleeper after teeny booties and hats out to place in storage bins and just had to sigh. I know that if we do our jobs as parents correctly, our children will grow, leave us, and one day begin the cycle anew, having children of their own, but no one told me how it makes your heart ache, just a little.

We are planning to take the kids out to a movie this afternoon, so I've not a lot of time to post individual responses to all of your wonderfully helpful comments to my previous post, but I will, I promise. You are all the best, and I really appreciate every person's input. I had a bad feeling about going in to a situation like this to begin with (spouse being the office manager) but felt, at the time, that the good aspects outweighed the bad. My contract is coming up in about a year and a half, so I am taking some steps now, as suggested. More on that in the comment section, maybe later tonight. Again, I cannot thank you all enough, your feedback keeps me sane! I hope that you are having a wonderful winter weekend!

So ya say you wanna Resolution, weellll you know...

we all wanna change the world. Happy New Year, everyone! I am fervently attempting to keep up all resolutions, at least until the end of the month, ha! Some are going well:

-drink more wine, check! I'm liking Syrah, right now.
-blog more, check!
-play more/make friends, check! I got a Nin.ten.do DS for Christmas, and I am addicted to Brain Age and Zelda already. Today I went on a play date with CindyLou and got to chat with her playmate's mother for the afternoon. Woo!
-tell manager where to stick it, check! (Um, well, sort of...more on that later.)





Some are not going so well:

-take less call. Well, OtherDoc is on vacation for the week, so I am taking call for him. I actually have had call all weekend by myself with the kids, as Mr. Whoo was out of town in a wedding. Luckily it has been the "q" word...shhh don't tell anyone!
-lose weight/cook real meals. HA! That is all.
-be an understanding physician. I'm just being bitter, I guess, but I am O-V-E-R the calls for pain meds. I got a call from a pregnant person requesting meds for a migraine, and, as this was a legit request, I phoned the pharmacy. The pharmacy informed me that this particular patient had 2 different narcotic scripts filled in the last week from different physicians, so I opted not to call in the third script. I guess that's what I get for giving someone the benefit of the doubt!

As for telling my office manager where to get off, please allow me to elaborate. (Beware, a long, practice-related rant follows, likely supremely boring for most, but for my fellow OBs/physicians in practice, I'd love some feedback.) I know that I am still yet a novice, in my toddlerhood of practice, if you will. I will be the first to admit that I know very little about the "business" of medicine. I accepted a hospital-employed position for this very reason. Even though I am an employee, and get a paycheck regardless of the revenue I generate (in theory); I still need to generate enough to cover my expenses in order to "earn my keep," so to speak. When I first started out, I (naively, I admit), trusted that my office manager would assist me with any coding/billing of charts and/or surgeries in order to get paid the maximum amount for the work that I was doing. In residency, I had a cursory overview of coding, and I know a little, but I need to take a coding course (in my spare time, of course).

My office manager, however, had no such interest in making certain that I was billing to capacity, since she was too busy making certain that her husband (OtherDoc) was getting all he could. I was (and still am) considered second priority. I found out, almost a year after I had started practice, that my office manager hadn't been billing circs for me. When I asked her why, she said it was because I didn't pull face sheets on the patients. This is fairly standard procedure, and easy enough to do, except *she never told me* this was necessary for reimbursement. She had to know that I was doing them, she just didn't care to point it out until I asked. I know for a fact that OtherDoc does not pull facesheets (I've asked), nor does he do anything special to document his procedures. Our office manager (his wife) just checks his patient lists on the computer and does it for him. She, in theory, could do the exact same thing for me, but she doesn't. Instead of letting me know, however, she let me just "lose" revenue that I was honestly earning. Let me state that I do *know* that it is ultimately my responsibility to make certain I was being reimbursed, but I was naive. I just didn't realize that was good for the gander (in our office) did not apply to the goose!

There are numerous other instances of the gross inequality in our practice, like when she told the front office staff that OtherDoc was first priority when it came to scheduling, or when she flat refuses to let patients transfer from OtherDoc to me (illegal, anyone?) and insists that I (or my nurse) write all insurance letters myself while she writes OtherDoc's for him. I have become aware and wary of her motives, and have accordingly made adjustments. It really sucks to have an office manager that not only couldn't care less about how my practice is going, but openly attempts to sabotage it.

At any rate, I have been in a constant battle with the front office staff (no doubt due to her behind the scenes machinations) over the scheduling of patients. I have been trying to cut my patient schedule back to no more than 35 patients in a full day (down from nearly 50 a day). When I returned to work after the Bean was born, I wrote out a detailed, day-by-day (even hour-by-hour) outline of how I wanted my schedule to flow and gave it to her. I didn't expect it to happen right away, because I knew I had been booked through December before I even left on maternity leave, but I figured that things would start flowing by the end of December/early January. This past week, not once, but twice, I had 8 patients scheduled between 8:45a and 9:45a and 7 patients scheduled between 1p and 2p. This is extremely problematic, as it is damn near impossible to see that many patients in that amount of time, and therefore puts me far behind both morning and afternoon, eating substantially into my "lunch hour" (in which I chart, sign off labs, field office phone calls, eat, and pump) and keeps me up to an hour later in the office in the evening (exactly what I didn't want when I came back). I also asked for a 15 minute block of time in which to pump in the afternoons, which has increasingly been forgotten, forcing me to pump anyway and fall even further behind.

When I brought the scheduling discrepancy to the office manager's attention, she blithely replied, "Well, the girls are doing the best that they can. Doctor's offices run behind all the time, people expect it." To which I bluntly, and probably not very nicely, stated in no uncertain terms that I wanted my schedule the way I had requested (back in September!) and did not want patients overbooked on my schedule at the discretion of the front office staff. I realize that, compared to OtherDoc's schedule, my schedule looks like a cake walk, but I am *not* OtherDoc, I am a wife and a mother and I do patient care differently than he, and I deserve to practice the way I want to practice up until the time that it is shown that I am financially sinking faster than the Titanic.

After my short tirade, she countered, "Oh, and I've been meaning to tell you. We can't bill for your pre-op visits, so you should really quit doing them, and when you code your visits, the time limit means nothing (level 1, 2, 3 visits, etc.) in order to be compensated you have to have pages and pages of documentation." Say *what?* First of all, I think that the pre-op examination (an appointment the day or two before surgery to sign consents, answer questions, and do a physical exam) is crucial in many respects, not to mention the medico-legal aspect, and I don't care if it is included in the surgery fee, I'm still going to do them, thankyouverymuch. And huh? on the coding levels based on time spent in counseling? Is this something recent or is she smoking crack? I know that my attendings in residency used the same forms that I use (complete with review of systems, etc.) and were able to bill high level visits based on that documentation alone. At any rate, I said my piece, but I know it will be at least a week before anything gets done (if it ever does) since she and OtherDoc are now on vacation.

So I guess I am just wondering if I am being a completely naive Jackhole for wanting the things that I want for my practice? What is the average amount of patients seen in *your* office on any given day? 20? 40? 60? What is the proper role of the office manager? What about coding? What is standard practice? Am I expecting too much? So many questions...if anyone has any insight, it is much appreciated. Whew, now I am tired! Thanks for "listening."

I Resolve...

...to drink more wine.

...to have more fun.

...to stop worrying so much about whether people like me or not.

...to find a way to take less call.

...to pass the oral boards.

...to take advantage of breastfeeding and lose some serious weight before weaning.

...to say "no" more often to unwanted obligation.

...to say "yes" more often to invitations to play.

...to tell my office manager where to stick it (ok, not really, but still.)

...to make great memories with my kids.

...to preserve said memories in some sort of album.

...to appreciate my husband more.

...to take care of my appearance (nails, hair, clothes, lotion, general pampering.)

...to be a better friend.

...to find some local friends (so lonesome, this life).

...to plan more family trips.

...to be an understanding physician.

...to take good care of patients without being a pushover.

...to blog at least 4 times a month (it is therapeutic).

...to learn something new.

...to finally get my closet organized.

...to cook more "real" meals.

...to be a good example and role model for my impressionable (and smart) little girl.

...to be the woman that deserves the wonderful life that I am so blessed to lead.

Now, if you don't mind, I'm going to start a little early on resolution number one! Happy New Year, everyone!

Merry Christmas to All

....and to all a good night! I'm too sleepy to make a coherent post, but I hope that everyone had a wonderful Christmas Day. It is hard when a holiday falls midweek, I don't *wanna* work tomorrow! Wishing you all (including myself) a silent (read, page-free) night.

Feliz Naviblah

So where was I? Oh yes, Thanksgiving travel with an infant. The day started out well enough. We had splurged on the extra luxury of actually departing from the teensy tiny airport in Whooville, as opposed to driving 2 hours to BigCity to fly out as per usual. The flight left around 9, so we got to the airport and checked in around 8. No baggage to check (thanks to Mr. Whoo), but I did have my (oh so stylish) breastpump, a diaper bag, and a 14 pound infant in the baby bi.jorn. The first two puddle-jumping flights were great. I had a bottle of freshly pumped milk so that I didn't have to get half naked in one of those itty bitty planes. Bean had his second breakfast and filled his diaper in that order, and all was right with the world. We arrived in the BigCity airport with just enough time to change Bean's pants and for me to grab a quick bite to eat. Our next flight was scheduled to go out on time (a first for me on this particular carrier with the letters N and W prominent in the name). Then it all started to unravel.

The flight was full, not unexpected for the day before Thanksgiving, so I had to check the breastpump planeside and the diaper bag was too fluffy to fit under the seat so I took as much as I thought I would need (diaper, blanket, burp cloth) and jammed the bag into the overhead compartment. I was seated near the front of the plane, window seat, next to a rather portly gentleman. Being of an ample posterior, myself, we were very, ahem, cozy (read jammed together with very little room to move). Bean was sleepy and cranky, so most of my attention was focused on getting him settled. It took a while to notice that we were taxiing a little longer than usual. Then the announcement from the pilot, inclement weather in our destination was forcing them to delay departure for approximately 30 minutes, so we were going to sit on the runway until we could take off. Ummmm, WTF? They didn't know that the weather was bad before they jammed us on the plane? The cessation of movement awakened the Bean, so my last weapon in the arsenal, the almighty boob, was offered in the most awkward and uncomfortable way....ever. We got through the wait on the tarmac, and he fell blissfully asleep once we were in the air. The remainder of the flight passed uneventfully, until we reached the destination. Then, for some undisclosed reason, we then proceeded to circle the city, unable to land for an additional hour and a half. I *had* to pee, and Bean needed a new diaper. When it became evident that we weren't landing any time soon, I braved the airplane bathroom, infant in tow. Of course I was very near the front, and the bathroom was all the way in the back, so I did my best not to whack each and every aisle seated passenger with either my arse or my baby's feet. Peeing in that laughably small restroom with the baby in the baby bi.jorn was effort enough, but changing a diaper in there? Damn near impossible. I put the burp cloth down for a minute on the only available counter space (the sink) only to have it get sopping wet. Bean screamed throughout the whole ordeal, for extra fun, and I was near tears myself by the time we had finished. I did my best to avoid the disapproving eyes as I headed back toward my seat with my overtly vocal, unhappy child, wedged myself back in between the window and Mr. Portly, offered Bean the other boob, and willed the plane onto the runway, like, yesterday.

We did finally make it to the ground, a grand 10 minutes after my connecting flight had departed. (No, of course, I wouldn't have the *good* fortune of the flight being delayed!) I want to know, if the weather was so terrible, why flights were still leaving on time?? It was about 1:45 pm (felt like midnight) and the next flight out wasn't available until after 7 pm. With the darkening skies and this carrier's oh so stellar reputation, that wasn't a gamble that I was willing to take. I had been scheduled to arrive at my destination city at approximately 2:30 pm, my sister in-law, niece, and nephew were to pick us up, and then we were to drive 3 hours north to the Grandparent's house. I phoned my sister-in-law and we both agreed that she could drive to my present airport and pick me up before my next flight even left (ha, ha!) So we estimated that she was a little less than 2 hours away, so I took myself to the Chili's and ordered fajitas and a margarita. All was right with the world once again....until Bean blew out his diaper and needed a full wardrobe change, bunting and all.

Flash forward 3.5 hours when my sister-in-law finally arrived, having underwent a small circle of hell, herself, involving ice storms, driving rain, and holiday traffic to get to the airport. As we settled in the car, I thought, surely, things would get better from there. Fate laughed loud and long at that assumption. The weather went from driving rain to freezing rain to blizzard-like snow, the traffic got increasingly snarled, and the three children got increasingly testy. What should have been a 4-5 hour drive turned into an 7 hour drive. We had reached a tenuous peace, with all three children finally asleep. We turned the radio to an all Christmas music station, and proceeded to laugh about how horrific the entire journey had been. Just after we had reached the last 30 minute leg of the trip (through snowy, country back roads), my nephew began to cry to get out of the car seat. Then my niece awoke and cried because she was still sleepy, my poor SIL was doing all she could to see the road through the blizzard, and there was no placating the children. As we turned onto the final road to the Grandparents house, Bean awoke to complete the trifecta, the screaming escalated, the road was icy, we were behind a car going precisely 2 miles an hour, and playing in the background? A cheerful "Feliz Navidad." Delirious from prolonged travel with children, my SIL turned the volume up over the throng of screaming voices, and we sang along at the top of our lungs....either to save our sanity, or because we had completely lost it, I am still unsure. We slid past the driveway just after midnight, arriving safely but insane, a mere 16 hours after the journey had began (it takes 11 hours to drive the distance between our houses). I vow to never, ever, fly anywhere ever again. That is all.

Going It Alone

December the first. Wow. I know that you are all dying (dying! I say) of suspense with respect to how solo call with an infant worked out for me. Chaotic? Anxiety producing? Strangely manageable? The answer is: All of the above! Fortunately for me, OtherDoc had "brought the house," so to speak, the week prior to his departure, so the weekend was eerily quiet with respect to laboring patients. I had lots of phone calls to field and triage patients to work up and manage, but actual admissions and labors were scarce. Unfortunately this lulled me into a false sense of security, because at 2 am on Monday morning I got the call that one of OtherDoc's patients had shown up to L&D in labor. Oh, and by the way, she is 8 cm dilated. Ack! There was no time for me to call my backup plan for childcare, since she lives a good 20 minutes from us, and by the time she got here the baby would likely be making an appearance. So I bundled up a very confused Bean, put him in the car, and away we went. Luckily for me it was a relatively slow night, and the nurses were thrilled to see him and watch over him.

I arrived just as the patient was starting to push, and my stomach knotted as I saw the verrrry sllloooww emergence of the baby's head. It was a hallmark shoulder dystocia presentation, and I locked eyes with the nurse, who knew automatically my suspicion. She moved quickly to get the bed down and the patient into McRobert.s. She also called an additional nurse for help. Sure enough, the anterior shoulder was wedged tightly against the pubic bone. Supra pubic pressure didn't budge the stuck baby. I reached posteriorly to try to deliver the posterior arm...no dice. By now, time seemed to have completely stopped. I could hear the blood rushing in my ears as the adrenaline surged, threatening to overcome my systematic approach to the delivery. Next step, I began rotation of the infant 180 degrees. Mercifully the anterior shoulder rotated free and the baby was delivered...a little purple but screaming. All 9 pounds and 13 ounces of him! Later the nurses told me that it was only 2 minutes total from head to body, but it felt like an eternity. I have had a few worse dystocias, where I have had to break clavicles, etc. but it never ceases to be scary. Bean, however, oblivious to the drama happening just steps from his cozy perch, slept sweetly the entire time we were in the hospital. What a kid.

We went back home for a couple more hours of fitful sleep before Monday began properly. Monday, by far, was the worst day. Hectic rounding, two laboring patients, busy office, an admission for a post operative abscess on one of OtherDoc's patients, and an eventual vag delivery and C-section for failure to descend (The baby never moved past 0 station despite 1 hour of "laboring down" and 2+ hours of pushing, poor girl!) My nurse had to pick up Bean from the daycare, and I didn't get home until about 8pm. Tuesday was moderately better, since I never even made it to the office due to a surprise labor, a preterm patient of OtherDoc's with seriously whacked out liver enzymes (but no other signs of HELLP), and drain placement on the post op abscess.

Suffice it to say I was properly exhausted come Wednesday morning, but I was optimistic for a smooth travel day with the Bean. Ha. Since this entry has run on quite long enough. I'll save that story for the next post! For now, we need to start "Christmas-ing" the house, and CindyLou will not be deterred any longer. More later...

Standing my Ground

So, alas, all good things must come to an end, and I am on call once again. I am taking call for OtherDoc, as well, not only for the weekend but until I leave town for Thanksgiving on Wednesday; he is on vacation this week. I know that I have bitched multiple times over about how very much I dislike taking call for his patients, but get ready to hear some more.

I think, scratch that, *know* that the man is seriously overburdened with patients (60-80/day!!) and I am quite sure that I wouldn't know my own ass from a hole in the ground if I were that busy, but he lets his patients run his life...and now they are trying to run mine. He is more than, shall we say, liberal with narcotic pain medications. Aw, face it, he hands it out like candy! It never fails, as soon as I take over his calls the pages for narcs begin. I can't stand seeking. It truly makes my blood boil, but I calmly state that I will not prescribe narcotic medications to patients that I haven't seen or examined personally. (Even then I rarely give narcotic meds, truth be told.) You should hear the stories, and if you work in the medical field, you probably do. Today it was, well OtherDoc gave me a prescription for (name your favorite narc here) and said I could have a refill, but he didn't mark the refill, so you just need to call it in (sic!). Ummm, sorry honey, but no. I'd be happy to call you in some Nap.rosyn for your pain until you can get to the office to be seen, though. Silence...then click. Sigh.

Even better still, OtherDoc had scheduled an elective term primip for induction of labor earlier in the week. The reason for induction? Well, because he was going out of town, of course. Labor and delivery has been insanely busy, so this elective induction got bumped, not once, but twice due to people being in actual (gasp!) labor. The news, each time, was met with shrieks and screaming at our office staff and labor and delivery, but there was nothing that could be done to accommodate her for her very elective (and early, at 38 weeks) induction.

The patient then decided that she wanted me to induce her on Monday, since I was covering OtherDoc. Never mind that I have never once met this woman nor examined her. Never mind that I truly don't *do* truly elective inductions because of the risks associated with them. *She* had already started her disability leave from work, thus she needed to have the baby now. (Priorities much?) Other Doc actually tried to guilt me into doing it, too! Her due date isn't even until the end of the month!

Could you just imagine, should the induction go awry, the cross examination? Dr. Whoo, why was this induction scheduled? Oh, the patient was tired of being pregnant? Hmm, that's not an ACOG approved indication for induction. Had you ever met this patient prior to *pumping her full of drugs to hasten a premature delivery*? On and on and on! Oh, by the way, drop your license at the door on your way out. I'd be painted in the media as "just another doctor" trying to screw up how women give birth. ('Cause, you know, all evil OBs really want to do is c-sections...all the better to ruin your "birth experience" my pretties! Cackling! Evil! Laughter!) But, I digress...Guess what my answer was? That's correct! It was a resounding "No!" I will be seeing her for an office visit this week, however, if she decides to show up. We shall see.

I am disconcerted at how browbeaten I feel by patients on such occasions. It shouldn't be so antagonistic to practice good medicine. One of my favorite attendings used to say, "This isn't Burge.r K.ing; you can't have it *your* way!" Only more and more often, it seems, you can! I fear for the future of my profession. Dr. Google-topia is closer than we think. Eep.

In other news, Mr. Whoo and CindyLou are wending their way to the grandparent's house, far, far away. Bean and I will be flying to meet them on Wednesday, since I have very little remaining time off, what with maternity leave and all. Yes, I *am* taking call for myself and OtherDoc alone, with a baby, for four days...is that crazy? I think, yes. Happy Weekend!

Suspended Animation

That's what the weekends seem like when I am off call. I feel like I rush, rush, rush through the weekdays...labeling bottles, rounding on patients, surgery, office, child pick-up, sundry essential (and I am talking only essential) household chores from dawn until dusk. Then Friday hits, and I experience a euphoria (on the weekends that I am off call) that compares to no drug once the pager gets turned off. And then? I sit....and laze...and eat...and laze some more. Don't I have just as much (if not more) to do on the weekends as I do on the weekdays? You bet I do. For some reason, however, I have no spark or motivation to do *anything* but sit and eat and laze.

Undoubtedly college football plays a role in my sloth on Saturdays. Between Mr. Whoo and myself we have no less than 4 football teams for which we root on a regular basis, so someone we follow is nearly always playing in any given time slot. The football viewing extravaganza starts at 10 am for Gameday and lasts well into the evening should we be interested in a late night game. Of course the child care duties do take precedence over the football viewage. CindyLou gets to go outside with Mr. Whoo and run around, the Bean gets fed and entertained and changed regularly by yours truly, and we get through the day making half-hearted efforts at the laundry, dishes, and cleaning up after ourselves. The bare minimum effort, no more, no less. The result is by Sunday I am feeling so freakishly slovenly and lazy that I begin to hate myself just a teensy bit, but not enough to actually get a lot more accomplished. Add that to the fact that the ladies that clean our house every other week were out last week on vacation so our house hasn't been cleaned in 3 weeks and you can imagine the appalling disarray at the Whoo household.

The bad thing in all of this is that the clutter seeps its way into my psyche, making my head feel cluttered and disheveled as well. So I am faced with the overwhelming desire to power clean the house, and simultaneously crippled with the perfectionist's curse of wanting to do it all at once and to do it flawlessly, at that. It isn't hard to figure out that this is impossible in the best of circumstances, much less in a household with a 3.5 year old and a 4 month old mucking the routine about, so here I sit in suspended animation...knowing what I need to do, but unable to do it the way that I want to do it. Yes, I've heard of Fly.Lad.y and the clean sink rule and the 15 minute rule, which seem great in theory, but my pathological brain can't just stop at 15 minutes. If I can't get it all done, then I don't want to do it at all. Lather, rinse, repeat.

Oh, and the *eating!* OMG, I am a bottomless pit. I know I am breastfeeding, but this is ridiculous. I bet I could have lost so much weight if I took advantage of my milk-making revved-up metabolism. Instead I am plateaued, and still eating bad foods by the boatload. Someone stop me! I am powerless over food. There, I said it...what is the next step?

I am ever so grateful for the 4 days a month that I do get the option to do nothing at all, but I know I need to stop doing nothing and start tackling the to-do list on my days off. It is just such an unappealing prospect. With the holiday season looming ever closer on the horizon (seriously people, Christmas music? the day after Halloween? It is madness, I tell you) I guess I need to just suck it up and get it together. Right after I write this blog, I mean....oh, and after I read everyone Else's blog too....yeah, that's the ticket. ;)

A Baby a Day

...keeps the doctor exhausted! It has been a big week for babies here in Whoo-ville. This is the week after the full moon, and man has it felt like it! Many believe that the day of the full moon is the big day for baby-having, but it has been my reality that the moon driven baby boom tends to fall either the week before or the week after the full moon. I have also noticed that there seem to be more demises and miscarriages during the new moon, whatever that may mean, and miscarriages also tend to come in threes.

My first delivery of the week was a multi-gravid patient with a history of rapid labors. She called me around 10:45 pm with "vaguely uncomfortable" contractions, due to her history, I urged her to head in to the hospital, and I tried to get a little rest in anticipation of a late night trek to the hospital. Triage paged at 12:30 am stating the patient was 3-4 cm with contractions every 6 minutes, she was admitted and wanted to move around so she started walking the halls. At 1:30 am she was 7 cm, and I rose from my cozy bed and cuddly baby, dressed, and was out the door within 5 minutes. On the way into the hospital, labor and delivery paged (around 1:45 am) and reported the patient was 9 cm. I walked into the hospital at 1:50 am, the patient's membranes ruptured as I walked into her room. She gave a low grunt as I quickly gowned and gloved, the nurses barely got the bed broken down, and the beautiful baby girl was delivered in one slow, fluid, controlled push at 2:00 am. No lacerations, no pain meds, just a quick and easy labor. I was back home and in bed by 3 am, but, as is often the case after a delivery, the adrenaline was flowing and I had a very difficult time sleeping. The day in the office passed in a blur, and then it was off to a costume party with the kids in tow.

The following morning, the pager bleated at 5:00 am, yet another early morning labor...just in time for Halloween! This patient, too, was 7 cm upon arrival to the hospital, and dedicated to delivering without pain medication...but she certainly wasn't happy about it! She had an epidural for her prior labor, and she kept remarking that "it never hurt like this last time." (!) She did very well, stayed focused, and delivered a bouncing Halloween boy at 7:30 am. She only had one small first degree laceration that did not require repair. Unfortunately, the plastic drape fell during the delivery spilling all sorts of wonderful goop upon the floor of the labor room. Ick. I then sprinted for surgery and once surgery was over, I dragged myself home...not for a much-needed nap, but for a shower and a trip to the kids' fall festival at the daycare. Then it was time to prep for Halloween tricks and treats. Lots of pictures of the costumed children, and a trek around our very hilly, steep driveway-ed neighborhood. CindyLou got more candy than she could ever hope for, Bean rode agreeably in the stroller, and Mr.Whoo and I exercised more in that one hour than we had for at least 8 weeks prior!

The following day, I had a scheduled induction for a post dates pregnancy. When I checked the patient, there was an odd band of scar tissue around the cervix...likely from a previous cervical surgery. The cervix was very effaced and thin, but it was only a tight 1 cm dilated. I waited for the patient to get her epidural, then gently stretched the scar tissue from 1 to 4 cm. I then headed for the office. At 11:30, L&D paged stating the patient was 7 cm and feeling pressure. I wrapped up my waiting office patients, raced to the hospital, and caught a baby at 12:05 pm. I barely had time to eat lunch before the afternoon patients started at 1pm.

The week ended with a jam-packed Friday morning office schedule, topped up with an afternoon scheduled repeat C-section. Fortunately this went beautifully, and I had time to go back to the office to finish up a bulk of charting and paperwork before starting an unexpected weekend off call. I even got to "sleep in" until 7:30 this morning, when I was awakened by the Bean's overflowing wet diaper...fun! We have plans to take CindyLou and Bean to the "Bee Movie" today and tonight to watch FSU get destroyed by BC (all the while hoping that some miracle will happen to let us actually win the game). Wine may, scratch that, will also be involved. Also, woo hoo, I won in Lara's contest! I never win anything! My luck has got to be looking up! :)

Eight More Random Things About Me

This is long overdue, sorry Mark ! I think I did this one a while back, too. I'm out of the office this morning (1st true sick day that I've taken in about 8 years) with a high temp and pukiness from the mastitis (woo!) so this will be a good way to distract me from how crappy I feel.



1. When I first started medical school, I thought I wanted to be a dermatologist. Good hours, good pay, good lifestyle, etc. I had it all figured out...until I worked my first derm clinic. Granted, I did my medical training in a huge city with a lot of indigent care and really sick people, but the things I saw in that clinic grossed me out beyond measure. I came home itchy every single day, and before the rotation was finished, I picked up a nice case of ringworm to boot. Thus ended my grand career in dermatology. I think it worked out pretty well, but oh how I pine for 9-5 office hours.



2. I am powerless over potato chips. There, I said it. I can resist sweets, cake, cookies, and even ice cream, but I cannot resist any kind of chip. If I walk past a bag or a bowl, I must indulge. My favorites are sour cream and cheddar, with Doritos running a close second. Love. Sigh. And I wonder why the weight isn't coming off?



3. I love to sing, but I am not very good at it. Mr. Whoo and I sing to the kids all the time and make up goofy songs to current radio hits to make them laugh. When CindyLou was a baby, we sang "Let's Get it Started" and "Crazy In Love" (the uh-oh-uh-oh-uh-oh part, especially) with altered lyrics to her. We also sing a bath version of "Oh My Darling, Clementine" with body parts (such as "wash your bottom, wash your bottom, wash your bo-ttom, CindyLou.) With Bean, so far the favorite is "Ridin' Dirty" (but we sing "gotta catch him wet and dirty...") Dorks, I know!



4. I am the proud owner of a karaoke machine, and Mr. Whoo and have been known to take it with us when we travel and subject our friends to our caterwauling. Our friends usually join right in! My favorite karaoke machine memory is once, after I had gone to sleep, I woke up to hear the guys singing the theme song to "Growing Pains" on the karaoke machine. Priceless.



5. On a somewhat related note, I am the master of remembering lyrics. Seriously, I am the *true* reigning "Singing Bee" champion. Unfortunately, my expertise is somewhat limited to the songs of the 80s and 90s. I can get some popular 70s songs, but when it comes to disco, I am totally clueless. It amazes me that I can remember all of these lyrics, but can't easily cram new medical knowledge into my overstuffed brain. I do occasionally memorize facts to a tune. That seems to stay with me.



6. I am a binge shopper. I would say that 90% of the time, I'm not a big shopper. I dislike going to the mall. I do not get a rush out of buying new clothes. In fact, I could really do without clothes shopping altogether. (This is probably partially due to the gargantuan proportions of my posterior.) However, when I do shop (especially for things for the house), it is like I cannot stop. I blow a ton of money, suffer a shopping hangover, and don't shop again for months. Does anyone else do this?



7. Sometimes I feel like I have just a small tinge of psychic ability. Nothing that I can control consciously, but sometimes I just know things are going to happen. I also have dreams that come true on occasion. I wish I could tap into it more, but for now I guess it is like a step above intuition.



8. I can't even do a sick day right. I'm into my sick day one hour already, with a temp of 102 and a round of GI distress early this morning, and I find myself planning all the chores that I can get done today. It is pathological. My body wants to lie on the couch and watch "The Price is Right," but my mind is thinking about laundry. I just feel guilty about being sick. How sad is that?



I don't tag anyone since this me me is 3 months overdue, but I hope that this peek into my warped psyche was entertaining. Now for TPIR...or maybe some laundry.....