Thursday, April 24, 2008

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?

Sunday, April 20, 2008

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!

Saturday, April 12, 2008

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 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!