Still alive, still snarky, still slacking on the blog. I miss you guys! The time just keeps passing and passing, and I keep meaning to blog, and, before I know it, it is bedtime and I am too tired to post. Bad bloggger. No cookie!
Speaking of no cookies, I am starting a physician-directed weight loss program for the next three months. I am in desperate need of someone else to kick my ass. I had all of my fasting bloodwork drawn this week. I am hoping that the raw numbers will jolt me from my post-Halloween candy daze. Mmmmm, Kit Kats......
We are having too much fun as a family, now that I am not on call. We've been to the circus, and the pool, and the beach and to the store. We are having friends over and sleep overs and lots of good family time. I love hearing my kids shout "Mommy!" with joy when I come home (nearly every night...at a decent time!) from work. Life is good.
On the work-front, I have had some good deliveries. My favorite was one where the baby was really. not. happy. with labor. Lots of decels, angsting at the nurses station. The patient was a multip, so I was hanging on by my toenails to try to get her a vaginal delivery, while trying to keep from having angina, myself. The cool part came when I went to check her cervix to make the final C-section call. I felt her cervix change from 4 to 6 to 8 to complete in the span of about 20 minutes. She delivered a fit and fiesty baby boy (OP) with about 30 minutes between thinking I was going to have to call a section and delivery. Too awesome.
I have more eloquent posts swirling about the cortex, but the bottom line is, I am well, the family is well, and I love my job. I will be back soon. Happy November!
Friday, November 06, 2009
Saturday, October 03, 2009
Overheard in a Beauty Salon
Who knew that having more free time would be counter-productive to blogging? The hardest thing for me is being able to let enough time elapse between bloggable events and actually writing about them, so as not to violate privacy issues. This post, however, happened somewhere that my profession should very rarely come into play, a hair salon. I'm not the first to bemoan the loss of a hairdresser when moving, and, while I held out as long as I could, the root situation was becoming very serious. I got a recommendation from my good friend who lives here in Newville. She's usually brutally honest, and her hair always looks fabulous, so I trusted her opinion. The hairdresser, herself, was fine. Despite trying to sell me on some "organic, sulfate free" shampoo (to a Suave-type girl) at twelve bucks a bottle, she was professional and did a nice job. The fun started when she set me aside for my highlights to process.
As many stylists do, she had stagger-scheduled a client to come in during the time that my highlights were processing. The second client, SC, breezed in and perched in an adjacent seat, waiting for her turn in the chair. "You aren't *pregnant* any more!" exclaimed the stylist to SC. "Nope, delivered 8 weeks early!" SC countered brightly. Needless to say, my interest was piqued, and while I don't make it a habit to eavesdrop, we were the only 3 people in the shop, and they were not discussing things quietly. It wasn't SC's story that surprised me, it was her incredibly flippant tone. I discovered, through their conversation, that SC had developed pre-eclampsia during each of her pregnancies, and this pregnancy was no exception She was admitted to the hospital, where those "incompetent doctors" had the gall to check her blood work every 6 hours and put her on this "vile medication" just in case she had seizures. SC didn't understand while they just didn't "take the baby, already." Finally, she says, after 2 days, her platelets *finally* started to drop, and the decision was made to deliver. She was angry, actually angry, that the baby was delivered after midnight so she couldn't have the "cool birthday date" that she had wanted. Oh, and where was the baby might you ask? He was still in the NICU (no big deal) because he was still apneic, of course. She had just delivered the week prior, by C-section, was obviously in HELLP a very short time ago, and she had driven herself to her hair appointment because she "couldn't stand" the way she looked. She was *glad* she delivered early, because she had only gained 20 pounds, and she was also glad she had "tan lines" so the doctor could see where her bathing suit hit so as not to go above it.
As she went on and on, you could have knocked me over with a feather. I was just shocked and appalled at this woman, so nonchalant about her premature baby, apneic in the NICU, and so unconcerned about her own health, that she was out driving to the hair salon a week after a c-section and HELLP syndrome so she could *look better.* I was blown away at the priorities here. The rest of the hair appointment passed without incident, but I was left to ponder how very differently patients can view their medical situations from their physicians. I am sure that her physician agonized over the decision to deliver her son so early, yet SC had wanted it all done even earlier. I also found it amusing that I cannot escape my profession, even in a place where most go to relax. Have you ever been appalled by an overheard conversation? Maybe next time, I'll bring my i.Pod.
As many stylists do, she had stagger-scheduled a client to come in during the time that my highlights were processing. The second client, SC, breezed in and perched in an adjacent seat, waiting for her turn in the chair. "You aren't *pregnant* any more!" exclaimed the stylist to SC. "Nope, delivered 8 weeks early!" SC countered brightly. Needless to say, my interest was piqued, and while I don't make it a habit to eavesdrop, we were the only 3 people in the shop, and they were not discussing things quietly. It wasn't SC's story that surprised me, it was her incredibly flippant tone. I discovered, through their conversation, that SC had developed pre-eclampsia during each of her pregnancies, and this pregnancy was no exception She was admitted to the hospital, where those "incompetent doctors" had the gall to check her blood work every 6 hours and put her on this "vile medication" just in case she had seizures. SC didn't understand while they just didn't "take the baby, already." Finally, she says, after 2 days, her platelets *finally* started to drop, and the decision was made to deliver. She was angry, actually angry, that the baby was delivered after midnight so she couldn't have the "cool birthday date" that she had wanted. Oh, and where was the baby might you ask? He was still in the NICU (no big deal) because he was still apneic, of course. She had just delivered the week prior, by C-section, was obviously in HELLP a very short time ago, and she had driven herself to her hair appointment because she "couldn't stand" the way she looked. She was *glad* she delivered early, because she had only gained 20 pounds, and she was also glad she had "tan lines" so the doctor could see where her bathing suit hit so as not to go above it.
As she went on and on, you could have knocked me over with a feather. I was just shocked and appalled at this woman, so nonchalant about her premature baby, apneic in the NICU, and so unconcerned about her own health, that she was out driving to the hair salon a week after a c-section and HELLP syndrome so she could *look better.* I was blown away at the priorities here. The rest of the hair appointment passed without incident, but I was left to ponder how very differently patients can view their medical situations from their physicians. I am sure that her physician agonized over the decision to deliver her son so early, yet SC had wanted it all done even earlier. I also found it amusing that I cannot escape my profession, even in a place where most go to relax. Have you ever been appalled by an overheard conversation? Maybe next time, I'll bring my i.Pod.
Thursday, September 03, 2009
Cool....and not so cool.
Every day in the office is a day to hear something new. In OB/Gyn, the work is pretty much the same, wherever you go (at least in the US). Annual exams are annual exams. Prenatal visits are pretty standard. Common problems are approached in much the same way in one office as another. The patients are the ones that make it different, interesting, and even, sometimes, really fun.
I am still getting acclimated to the new group setting. It is a little strange to work within a group dynamic when you are used to essentially a solo practice. You have to give up some control (difficult for a control freak). It is much harder to know the patients well and remember every detail about their history, and it is also challenging to work within the boundaries of other physicians' comfort levels. Before, any call that I made...testing, induction, observation, only had direct bearing on the patient and on me. Now, I have to consider group gestalt. I am getting there, and the time off is well worth the trade-offs thus far.
I am seeing quite a different patient population in Newville, a bit more urban and sophisticated. Ways in which this is cool...
~The patients are well educated, they are aware of their bodies and have done a lot of research into pregnancy and what is happening in each trimester. I rarely am telling them things they did not already know. Makes my job a bit easier.
~The happiness! I got to see a woman, coming in for a regular annual exam with an incidental finding of a positive pregnancy test. She was ecstatic. Her husband feigned needing a glass of water and hyperventilating. The cuteness was killing me. (I am used to tears and hysterics over an unplanned pregnancy!)
~The responsibility. These patients are amazingly compliant, and hold their and their baby's health in high regard. There are very few smokers, and I have yet to see Mountain Dew in a toddler's bottle. Unbelievable.
Ways in which this is not cool...
~The, um, "sophistication." I have met several young women for their first exams (17-21 years old), who qualify their number of partners as "really low." However, when pressed further for ballpark numbers, they toss out a number like, oh, 10-12. (!!!) Whoa.
~The bossiness. Never have I been instructed on how to treat a patient for a certain condition so often. Sheaves of information printed from the internet. "Drive-through" attempts at obtaining treatment. Sorry, honey, this isn't Bur.ger K.ing and you cannot "have it your way!" Yikes.
~The nonchalance. I kid you not, I had a woman that texted on her phone throughout her entire annual exam. Breast exam, pap, and pelvic. Holy cow! I wanted to know what she was texting..."now my breasts are being checked. Now the speculum is going in?" "Pap smears suck?" WTF?
All in all, I am settling in nicely here in Newville, and I am so happy to be back to loving my job once again. That being said, I am gearing up for my first full weekend of call (and a full moon to boot). Since I've not had a weekend call since July, we'll see how sunny I am come Monday. I wish you all the happiest of Labor Day weekends! Thanks for not giving up on this blog!
I am still getting acclimated to the new group setting. It is a little strange to work within a group dynamic when you are used to essentially a solo practice. You have to give up some control (difficult for a control freak). It is much harder to know the patients well and remember every detail about their history, and it is also challenging to work within the boundaries of other physicians' comfort levels. Before, any call that I made...testing, induction, observation, only had direct bearing on the patient and on me. Now, I have to consider group gestalt. I am getting there, and the time off is well worth the trade-offs thus far.
I am seeing quite a different patient population in Newville, a bit more urban and sophisticated. Ways in which this is cool...
~The patients are well educated, they are aware of their bodies and have done a lot of research into pregnancy and what is happening in each trimester. I rarely am telling them things they did not already know. Makes my job a bit easier.
~The happiness! I got to see a woman, coming in for a regular annual exam with an incidental finding of a positive pregnancy test. She was ecstatic. Her husband feigned needing a glass of water and hyperventilating. The cuteness was killing me. (I am used to tears and hysterics over an unplanned pregnancy!)
~The responsibility. These patients are amazingly compliant, and hold their and their baby's health in high regard. There are very few smokers, and I have yet to see Mountain Dew in a toddler's bottle. Unbelievable.
Ways in which this is not cool...
~The, um, "sophistication." I have met several young women for their first exams (17-21 years old), who qualify their number of partners as "really low." However, when pressed further for ballpark numbers, they toss out a number like, oh, 10-12. (!!!) Whoa.
~The bossiness. Never have I been instructed on how to treat a patient for a certain condition so often. Sheaves of information printed from the internet. "Drive-through" attempts at obtaining treatment. Sorry, honey, this isn't Bur.ger K.ing and you cannot "have it your way!" Yikes.
~The nonchalance. I kid you not, I had a woman that texted on her phone throughout her entire annual exam. Breast exam, pap, and pelvic. Holy cow! I wanted to know what she was texting..."now my breasts are being checked. Now the speculum is going in?" "Pap smears suck?" WTF?
All in all, I am settling in nicely here in Newville, and I am so happy to be back to loving my job once again. That being said, I am gearing up for my first full weekend of call (and a full moon to boot). Since I've not had a weekend call since July, we'll see how sunny I am come Monday. I wish you all the happiest of Labor Day weekends! Thanks for not giving up on this blog!
Friday, August 07, 2009
Stuck, stuck....STUCK!
As my time in Whooville was drawing to a close, I found myself in a very harrowing situation. As per usual, I was extremely busy delivering all of OtherDoc's patients, as well as my own patients during his vacation. (I never understood why he wouldn't limit the number of OB patients he would take when he knew he would be gone for half the month...oh, right, all about the dolla bills, y'all.)
There was a young patient (YP) that I had seen in the office earlier that day, she had been contracting, and while she was not yet dilated, she was beginning to soften and efface. I wasn't too surprised to see her later that evening at L&D. She was extremely uncomfortable, contracting every 2-3 minutes, and had dilated to 2 cm/90% effaced. It had been a long day, so I assumed that we would get her comfortable (she was requesting an epidural) and then she could labor through the night. The day shift left and the night shift came, and sometime in the middle of her bolus for her epidural, YP began to get a little out of control....like "I'm in transition" out of control. If you've never seen it, it is kind of like that seen from the Exorcist, minus the rotating head. I checked her, and surely enough, she was 8 cm. She had gone from 2 cm to 8 cm in the space of about an hour and a half. So much for the game plan.
The patient progressed quickly from 8 cm to complete, and that, dear friends, is when the fun began. As the patient began to push, the baby began to get unhappy. The more she pushed, the more unhappy the baby became. There were persistent and prolonged, deep variable and late decelerations. After tolerating the strip as long as I could, I talked to the patient and talked to the OR. preparing for a C-section. One problem, the anesthesiologist was not in house. Just at that moment, the baby decided to express her extreme displeasure with the proceedings by dropping her heart rate. To the 60s...one minute, two minutes, reposition, oxygen, scalp stim...no response. Three minutes, four minutes, more maneuvers, still no response. The patient was pushing with all of her might, her family was a step a way from hysterical, the baby was in trouble, and there was no anesthesiologist. The vertex was just barely at +2 station, so I attempted an emergency vacuum delivery. I pulled once...no descent...I pulled twice...small descent...I cut an episiotomy and pulled one final time to no avail. We had to go to the OR, and we had to go right then, anesthesiologist or not. At that point the baby had been in the 60s for about 10 minutes. "Please don't let my baby die." were the last words I heard before we left the floor.
We ran to the OR, and I told the CRNA to put the patient to sleep, anesthesiologist or no. I remember that the staff was moving as slow as molasses, even though I had relayed the urgency of the situation. We splashed the belly with betadine, draped her, the CRNA put the patient to sleep, and I went from skin to baby in under a minute. The nurse had to push up from below, and it was difficult to elevate the head out of the incision, but, thankfully we finally got her unstuck. All 9 pounds 8 ounces of her. She was a little pale and a little floppy, but pinked up almost immediately to get Apgars of 6 and 9. She was ok. Mom was ok. The nurses and I were puddles of goo. The adrenaline surge was so strong I was shaking.
I think the anesthesiologist finally got there as I was replacing the uterus. Thank God we didn't wait for him. After the C-section was over, I repaired her episiotomy. It didn't seem quite fair to be sore both places, but she had a happy, healthy baby. I kept turning the situation over and over in my mind. How could I have changed it? What could I have done to avoid the outcome? I felt like I had failed her in so many ways. It seemed incongruous when the nurses told me how "awesome" I was, and how the family cried and hugged me after the surgery. Afterwards, both mom and baby did wonderfully well. It was better than I could have ever hoped for, and an experience that I never, ever want to repeat.
There was a young patient (YP) that I had seen in the office earlier that day, she had been contracting, and while she was not yet dilated, she was beginning to soften and efface. I wasn't too surprised to see her later that evening at L&D. She was extremely uncomfortable, contracting every 2-3 minutes, and had dilated to 2 cm/90% effaced. It had been a long day, so I assumed that we would get her comfortable (she was requesting an epidural) and then she could labor through the night. The day shift left and the night shift came, and sometime in the middle of her bolus for her epidural, YP began to get a little out of control....like "I'm in transition" out of control. If you've never seen it, it is kind of like that seen from the Exorcist, minus the rotating head. I checked her, and surely enough, she was 8 cm. She had gone from 2 cm to 8 cm in the space of about an hour and a half. So much for the game plan.
The patient progressed quickly from 8 cm to complete, and that, dear friends, is when the fun began. As the patient began to push, the baby began to get unhappy. The more she pushed, the more unhappy the baby became. There were persistent and prolonged, deep variable and late decelerations. After tolerating the strip as long as I could, I talked to the patient and talked to the OR. preparing for a C-section. One problem, the anesthesiologist was not in house. Just at that moment, the baby decided to express her extreme displeasure with the proceedings by dropping her heart rate. To the 60s...one minute, two minutes, reposition, oxygen, scalp stim...no response. Three minutes, four minutes, more maneuvers, still no response. The patient was pushing with all of her might, her family was a step a way from hysterical, the baby was in trouble, and there was no anesthesiologist. The vertex was just barely at +2 station, so I attempted an emergency vacuum delivery. I pulled once...no descent...I pulled twice...small descent...I cut an episiotomy and pulled one final time to no avail. We had to go to the OR, and we had to go right then, anesthesiologist or not. At that point the baby had been in the 60s for about 10 minutes. "Please don't let my baby die." were the last words I heard before we left the floor.
We ran to the OR, and I told the CRNA to put the patient to sleep, anesthesiologist or no. I remember that the staff was moving as slow as molasses, even though I had relayed the urgency of the situation. We splashed the belly with betadine, draped her, the CRNA put the patient to sleep, and I went from skin to baby in under a minute. The nurse had to push up from below, and it was difficult to elevate the head out of the incision, but, thankfully we finally got her unstuck. All 9 pounds 8 ounces of her. She was a little pale and a little floppy, but pinked up almost immediately to get Apgars of 6 and 9. She was ok. Mom was ok. The nurses and I were puddles of goo. The adrenaline surge was so strong I was shaking.
I think the anesthesiologist finally got there as I was replacing the uterus. Thank God we didn't wait for him. After the C-section was over, I repaired her episiotomy. It didn't seem quite fair to be sore both places, but she had a happy, healthy baby. I kept turning the situation over and over in my mind. How could I have changed it? What could I have done to avoid the outcome? I felt like I had failed her in so many ways. It seemed incongruous when the nurses told me how "awesome" I was, and how the family cried and hugged me after the surgery. Afterwards, both mom and baby did wonderfully well. It was better than I could have ever hoped for, and an experience that I never, ever want to repeat.
Wednesday, July 22, 2009
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