Saturday, November 17, 2007

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; 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 that crazy? I think, yes. Happy Weekend!

Sunday, November 11, 2007

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. ;)

Saturday, November 03, 2007

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! 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! :)