Tuesday, August 01, 2006

Back and Fat

Why is it that vacations are always 1) too short 2) filled with fattening food and 3) ultimately more exhausting than your life before vacation? My short hiatus was all of these and more! I'll try not to whine about how much weight I gained since it was totally my decision to drink a half a case of Raspberry Lambic with my friends and eat french fries at nearly every meal. I have so little self-restraint when it comes to what feels good at the time. Vacation was fabulous. Now I have another (beach!) vacation upcoming at the end of this month, so it's time for salads, starvation, and drudgery at the old gym. Yee-haw.

Yesterday I saw one of the sickest patients that I have ever seen. OtherDoc admitted one of my infertility patients to the hospital over the weekend with fever and abdominal pain. OtherDoc put her on IV antibiotics and (I think) sat on her, praying I would come back before she died. She had a huge tubo-ovarian abscess. Eleven centimeters by seven centimeters, and she was out of her head with temperatures up to 104 degrees. I took her to surgery with a general surgeon, and thank goodness that I did. Her belly was encased in adhesions (scar tissue). We worked for over an hour to just get far enough into her belly to look for her tube. All of her anatomy was distorted. I never even saw her uterus or ovary, just felt them through masses of scar and bowel. We removed as much of her fallopian tube and all of the pus and abscess as we safely could, put in a drain, and closed her incision. Today she is better...no fever, decreasing white count. She will live. She had previous surgeries in the past, gallbladder, right kidney removal as an infant, and previous removal of her right tube and ovary due to ovarian torsion 2 years prior. She has never been pregnant, and now never will be able to conceive on her own. The only culture that has been positive so far has been for the STD trichomonas. She has only had one monogamous parter, and was recently negative for any STD in my office. Translation? Her (likely non-monogamous) husband may be the reason that she can never have a baby. It's terrible, and I am dreading this conversation with both of them. I'm waiting until she is well enough to come out of the ICU, likely some time tomorrow. Most of the time, being an OB doc, I get to deliver happy news to patients, but the flip side is that I sometimes have to deliver the most devastating news. Blech.


Sid Schwab said...

Yep; can't get along without general surgeons. It wasn't rare that I helped a Gyn with similar situations. Enjoyed it because my Gyn colleagues were always so appreciative.. Early in my practice, less than busy, I even helped on a few c-sections. Now THAT was fun: the good news part of your job.

dr. whoo? said...

Thank goodness for general surgeons! The one who helped me is definitely an experienced and skilled surgeon, and even he thought that her belly was a nightmare. I was so glad to have his available expertise. I know when I am out of my depth.

Guinness_Girl said...

That's awful, K! (Yes, I found you, ha ha ha) ("ha ha ha" should be read in evil voice). Congrats on your blog!!!