Ob/Gyn Kenobi

Call Hierarchy of Needs

2012-01-23T08:44:00.006-05:00

Now that I am not on call, all day, every day, I have found there is a certain behavioral pattern emerging on my call days. Something similar to Maslow's "Hierarchy of Needs," if you will.

First Goal - Be able to leave the hospital. You may laugh, but some days it is d*mn near impossible to do. I am always figuring and re-figuring in my head if I am going to be able to go home that night, or if I will wind up being stuck until after office hours the next day.

*First goal bonus if I am able to leave the hospital before my children's bedtime, so much the better to actually *see* them.

Second Goal - Shower at home. This seems like an odd one, I know, but I *hate* to shower in the hospital call room bathroom. It just is not the same, and it also slightly squicks me out. So if I achieve the first goal, I proceed immediately to goal number 2 as soon as I step foot in the door.

Third Goal - Eat. This rule has stayed the same since residency, "eat when you can."

*Third goal bonus if I actually getting to eat with my family or if I am not eating something like Ramen noodles.

Fourth Goal - Spend (somewhat) quality time with family (while obsessively keeping one eye on the computer L&D and ER census for potential roadblocks to goal number five).

*Fourth goal bonus if I am able to tuck my children in for bedtime and maintain a normal evening routine before getting called back to the hospital.

Fifth Goal - Sleep in my own bed. This one is a bit more elusive, as you can imagine.

*Fifth goal bonus if I get to sleep in my own bed *all night long.* (HA HA! Almost never happens.)

**Extra bonus if I get no pages while I am sleeping in said own bed, and wake up the next day frantically checking my pager to be certain the battery hasn't expired. (Again, elusive.)

Let's face it 5/5 goals happens once in a blue (full) moon. If I am able to achieve 4/5 goals, I feel pretty good about my call night. Satisfaction with the night decreases exponentially with each goal not met, naturally. Before I am derided, of course my ultimate and overriding goal is to provide quality care to my patients...and to sleep in my own bed. :)

**Cross -posted at Mothers In Medicine

Well, tonight, thank G*d it's them, instead of you...

2011-12-15T20:31:00.006-05:00

Does anyone else think that "Do They Know It's Christmas?" is the most uncharitable "charity" song around? It's downright laughable! So much so that I can't help but wonder if there isn't meant to be some sort of sardonic undercurrent beneath the song's earnestness. I mean, there's the most awful line, the line mentioned above, then, later on, we raise a glass to everyone, including "them, underneath that burning sun." ACK! Mix in some "clanging chimes of doom" and "bitter sting of tears" and, well, I admit it, I laugh my *ss off every time I hear this song. Probably not what "Band Aid" was going for, but I digress...

The true meaning for my title really pertains to how I feel when one of my partners is on call and it isn't me. I thank G*d it is them instead of me; because we have been insanely busy. Last call I delivered 8 babies in a 24 hour shift and admitted 9, 10, and 11 in labor. All of the rooms were full and our overflow was spilling into other rooms in the hospital. I have no idea what was going on nine months ago, people, but holy geez, the babies can stop coming any old time! We are T-minus 10 days from Christmas, and I didn't have enough to do, so I thought I'd sit down and let you know that I am still alive...and mostly well...and still wishing to win the lottery so I can become independently wealthy and play internet games and get buff and be the envy of the botox set (without using botox) and never, ever be on call again. I don't think Santa can deliver that kind of present, unfortunately.

This is going to be a magical Christmas for the Whoo family. Bean is 4 and CindyLou is 7 and both are steeped in the wonder and magic of the season. Their joy and wonder is palpable. I love it. It brings a tear to my eye. We only have so many magical Christmases with them, and I happen to be on call on Christmas-flipping-Eve this year. So my Christmas wish is that none of my patients get a special Christmas delivery in the wee hours of Christmas Day morning, so I don't have to miss out on the magic this year...hopefully Santa can manage that. Merry Christmas to all 2 of you still reading out there, may your holidays be Merry, Bright, and Doom Free! :)

She's Complicated

2011-09-23T17:35:00.009-04:00

A commenter from the post below states that I'll not likely elicit sympathy by stating that women can be difficult patients, who require significant amounts of communication. The question is also raised why I would "generalize" 100% of my patient population, as surely, if there were no women to treat, I could no longer be an Ob/Gyn (sic). I find it overall amusing that anyone would believe the post below was written, in any way, to garner sympathy, and I also find it a bit irksome to be told that I "shouldn't generalize." I'm not. I am speaking from my own personal experience. Perhaps I should expound upon this point.

I went into Obstetrics and Gynecology precisely because I enjoy caring for the(complicated, difficult) female patient. I would not do anything else, but I would be absolutely lying if I said it wasn't without its difficulties. For the record, I happen to find male patients, no offense guys, infinitely more simple in many ways, but less likely to follow any directed care of a physician unless there is fear of loss of life or, ahem, other *important* functions. In my interactions with male patients, there was little extraneous conversation, merely exam, diagnosis, suggestion for treatment (which they may or may not decide to take, but they certainly weren't going to ask you any questions about it). Women patients, quite simply, are different. They do require a lot more communication; not just about the reason for certain symptoms that they may be feeling, but also for the rationale behind the treatments to alleviate the symptoms.

Usually, this is not a problem for me, being a woman myself, particularly verbose ("talks too much" was a very popular comment on my report cards sent home from school), and, not to mention, I happen to like explaining physiologic changes in a way that women can understand and to which they can relate. However, sometimes something as relatively facile as communication can cross the line. At times, it can be repetitive and monotonous (likely not so different from other jobs). At other times, I feel as though I am speaking a script, word for word. Sometimes, it can be frustrating (for both the patient and myself), because no matter how I frame the explanation, I cannot communicate my point. Most of all, it can become emotionally draining. Women routinely tell me things that would feasibly make most people's ears burn, make me worried for them, and sometimes bring me to the brink of tears. I have an impeccable poker face, but over time the walls get chipped away and I find myself unable to stop bringing my work home with me.

I suppose it is a good thing to be human, but in medicine it is important to remain detached in order to stay objective and to provide good care. It is a difficult balance between being connecting with the patient without becoming emotionally *involved* with the patient. This is difficult and soul-grinding, especially for those of us who have a tendency to try to "fix" people. It is a burden I more than willingly shoulder every. single. day, but honestly connecting with patients can be good for them and harder for me. I'm not willing to stop doing it, but to say that it shouldn't affect me emotionally is far more presumption than I would have the wherewithal to make from the outside looking in. In summation, saying that women are "difficult and complicated" patients is not meant as an insult or to "generalize" women, it is simply a statement that I find to be true, not only of my patients, but of myself, as well.

Ten Years

2011-09-11T09:30:00.007-04:00

Ten* years ago today, I was a harried and hurried OB/GYN intern, the only intern on the OB floor. Rounds ran long because of a long patient census, and we were late getting over to Labor and Delivery to "run the board" (aka, check on the laboring patients). I had four laboring patients, three patients to see in OB triage, and a 30 week pregnant woman just involved in an MVA on the way into the ER. I was just about to check on my first labor patient when the charge nurse came out of a patient's room. "A plane just crashed into the World Trade center!" The sarcastic comments followed, ranging from jokes about air traffic control to what substance the pilot was smoking. It mildly piqued my interest, but to tell the truth, I hadn't the time to sit and ponder the significance. I was halfway through my triage and labor checks when the second plane hit. Then, we knew, this was no accident, and I, like everyone else that day, was scared about what this meant. Ever in constant motion, I caught what updates I could from the patient's TV screens, as I went about the routine business of histories and physicals on a most unusual and frightening day. My chief resident and I went together to see the MVA patient, it was merely a fender-bender, no real trauma, and we hooked her up to the labor monitor to look for contractions. She gasped, suddenly, eyes wide in disbelief, locked on the television mounted on the wall in the corner of the room. My chief and I turned, to see the mighty towers collapsing into dust and rubble. I don't know how long we sat and stared, silent.

The rest of that day is a true blur. I delivered eight babies between 9 am and 5:30 pm that day, four inductions and four natural labors. I distinctly remember one young patient, just 17, crying after the delivery, not tears of joy or even pain from labor, but of sadness and terror. I couldn't help but think that the baby boom that day was simply a surge to replace the souls so tragically lost. I think the unit had a total of 11 deliveries that day. This year, they are 10 years old, nearly ready for 5th grade. In the days that followed, I was morbidly fixed to the TV and the news. My husband couldn't tear me away. I couldn't stop watching. It lasted for about 3 months, and then the shock was not nearly so fresh, and I could watch non-news programming once again. Five years ago, my husband was attentively watching the commemorative movie on television. I have no desire to see any films about that day. I didn't understand why five years was the magical number for it to be permissible to start turning a profit on such a terrible day in our lives and the lives of the victims. I could barely sit through the previews of United 93 without bawling. I don't need a reminder of the tragedy, as it is indelibly burned into my memory. I was fortunate that I did not lose a loved one or a close friend, and for that I am grateful. But we as a nation suffered the loss of, not only the lives of the victims and the heroes of that day (in itself a staggering loss), but the loss of life as we had so complacently come to know it. We lost innocence and we lost feeling secure, and I'm not sure that we will ever feel the same way as we did ten years and one day ago. Today, I, like so many of you, will ponder in silence and return to the day when we knew things would never be the same. Today I will remember to never forget.

*Originally posted on 9/11/06

Ob/gyns are terrible people who deserve to die, and other misconceptions

2011-08-16T19:57:00.011-04:00

Tempeh writes: Still, I hate to generalize, but I've met far more "toxic" docs in OB/GYN than in other specialties. I always find it odd. The majority of OB/GYNs with whom I have interacted (as a med student and through 3 full-term pregnancies) have been women, who are supposed to have better communication skills, higher pt satisfaction, etc. And they work in a field where most pts are healthy and, in the case of OB, happy to be in the office/hospital because they are pregnant or delivering. Why are they so bitter as a group? It mystifies me. Maybe some of the very pleasant OB/GYNs amongst our MiM writers can shed some light on the specialty.

I'm not really certain if I fall into the category of one of the "pleasant" Ob/Gyns or not, but I will give this question a shot. Bitterness and Ob/Gyn, alas, does seem to go hand-in-hand. I believe that, first and foremost, it is an incredibly important, busy, special, and stressful job. True, most of our patients are healthy, but when they get sick, they can get sick quickly, and when healthy young women or babies get sick, injured, or die on our watch? That's especially devastating. I can't think of a single person that went into Ob/Gyn as a bitter person who hated women, but at the end 4 years of constant sleep deprivation, sometimes another pregnant woman in labor is no longer a miracle, it just means more time spent away from fulfilling basic human needs like using the bathroom, or eating, or, most elusive of all, sleep! It is also seeing women, not only at their best but at their very worst, hours of staring at monitor strips, worrying about when to pull the trigger on a cesarean delivery, wondering, if it is too early that we will be blamed for "unnecessary surgery" and trying to get to our golf game or (god forbid) home for dinner, or, if too late, we will, much worse, have a sick or damaged baby (and possibly be sued for everything we have). Women can be very difficult patients, who require a lot of communication, not a problem for patients who are willing to return to discuss issues, more of a problem for people who wish to stuff a year's worth of problems into a 10 minute annual exam. It's persistent 36 hour shifts, often skipping breakfast and/or lunch, and 72 hour weekends (remember how much you hate call Fizzy? Would you be bitter if you did it all the time?) It's adrenaline burn-out, hours of nothing followed by a harrowing roller coaster. It's constantly being second-guessed, by our partners, other physicians, the L&D nurses, the patients, the internet, ourselves, even when we *know* we are practicing to the *standard of care* for our profession.

It's the malpractice, multi-million dollar coverage premiums to pay yearly, the threat of lawsuits for up to 18 years after the fact, shrinking reimbursement (universal for all physicians), trying to pay our staff and our overhead, having to fit more patients into the same hours in the day, trying to be a good doctor for them, trying to at least support our family since we can seldom be there to see them. It's medicine, surgery, primary care, and caring for two patients all rolled into one, and sometimes it eats at your humanity. Sometimes, you come home at the end of the day so emotionally exhausted that you have little to give to the rest of your family. Sometimes the sadness of discussing a cancer diagnosis, or miscarriage, or fetal death lasts for weeks or days. Sometimes it is impossible to *not* take your work home with you. Sometimes we care *too* much, causing us to start separating ourselves from our patients, building a wall, becoming callous, so the better to protect ourselves.

Sometimes we deal with the stress in inappropriate ways: too much wine, snarky humor, or snappish answers. Likely, many of us are clinically depressed. Many of us have little time to exercise (Rh+ and her most excellent example notwithstanding). Because women Ob/Gyns are women too, and usually mothers and wives, who feel guilty when we are at work and guilty when we are at home, just like other working mothers. Because, despite how much it sucks, we still really love our jobs, think pregnancy and birth is amazing, and wouldn't do anything else (even if we wish we could); because we care about mothers, women, and babies. Hope this answers the question in a non-bitchy way, please excuse the sentence fragments and horrendous grammar. I had a terrible, horrible, no-good, very bad day today, and seeing some of the commentary on Mothers in Medicine regarding my profession, usually a refuge, stung quite a bit, I must say.

The Pregnancy Companion

2011-08-13T12:00:00.005-04:00

The Pregnancy Companion is a pregnancy book co-written by physician and patient (and friends) Dr. Heather Rupe and Jessica Wolstenholm . In a market that is flooded with pregnancy advice books, what makes this particular book stand out from the rest? Well, actually, a couple of things! First and foremost, this book is written from a faith-based perspective, and the authors do a great job of weaving their faith, pertinent bible passages, and religious tenets within the chapters along with personal anecdotes and solid medical information. I'm hardly an expert on the pregnancy advice book market, but, I would imagine there is a paucity of advice books which incorporate faith. For Christians, it is comforting to have this additional guidance along the uncertain road that pregnancy (and pregnancy loss) can be. Dr. Rupe's medical information is solid throughout the book and written in such a way that it is easy to understand for people who do not come from a medical background. She writes in a fluent and easy way that flows off the page, and her counterpart, Jessica, draws the reader in much as a trusted confidant or long time girlfriend. Reading the book, you can easily read it cover to cover, or chapter to chapter, based on the stage of pregnancy/information you wish to obtain. In addition, the sections on pregnancy loss and personal anecdotes from both of the authors feel very personal, and create the impression in the reader that they are receiving advice from a trusted physician and a good friend. The Pregnancy Companion stands on its own as a complete pregnancy guide, complete with the requisite "month by month" stats and checklists, but this book goes even further, delving into the spiritual side of pregnancy, how it changes us, those who care for us, and how it can, if we choose to let it, bring us closer to God. Brava, Dr. Rupe and Ms. Wolstenholm, on your book, it is a truly wonderful reference to mothers and mothers-to-be.

Into the Fray

2011-08-08T16:39:00.004-04:00

So, I admit it, I've missed you. A lot. I've been trying and trying to stay away, but, blog, I just can't quit you! So, hello to all of those of you who know my name, I hope you'll see that even though I'm human, I am still a d*mn good physician who cares about her patients, even when the day to day grind predisposes to bitterness and sarcasm. I desperately owe my good, bloggy friend Dr. Rupe a book review, and, being just a bit OCD, I didn't feel like I could properly do it until I had the chance to read the entire book (not easy in this crazy life). Good news! I've read it (and loved it) and will post a glowing review worthy of it ASAP. I still have no idea how in the world that she was able to co-write the book, when I've barely had time to read it! Many apologies, Dr. Rupe, I wanted to do your work justice!

You won't be surprised that not much has changed around here. Work is crazy, my children are sweet, lovable, and growing up too fast, my husband is a saint, and OMFG it is blazing hot! I'm working a lot, but just came off what may have been my best weekend call of my whole entire life (got to sleep in my bed all three nights, that will never happen again)! I also dropped 20 lbs since April ( I'm thinking, mostly water weight from sweating my *ss off all day long). Most of all I have missed writing, want this outlet back, and thank you for still being out there to listen to my ramblings. Please know that everything posted about clinical situations on this blog is altered to protect every patient's privacy. More soon...

Like a Hurricane

2011-04-25T09:04:00.005-04:00

So, yeah. That, apparently, is my new nickname on Labor and Delivery. Hurricane Whoo. Because it is more than just a "black cloud." Because just about every time that I happen to be on call, it's bound to be a sh*t storm. It has gotten to the point, so I am told, that the entire nursing staff offers up a collective groan when they hear that I am the physician on call. Yikes. They hasten to add that they still love me, though. HA! Apparently babies and pregnant ladies love me, too. A lot. The last weekend that I was on call, I delivered 12 babies admitted 2 more in labor before I was finished. It makes the time fly by too quickly, and I hate to find myself wishing my life away. To say that work has been busy would be an understatement, add to that increasing children activities (soccer! Daisies! tumbling!), the arrival of warmer weather, and the presence of a pool at our ready disposal, and my blogging has languished in the corner for more than two months with hardly a glance in its direction! Sorry about that. It's not you, it's me.

If you have been reading for a while, then you may know that my blog started as a primarily anonymous outlet (and boy, have I used it to vent!), save for a few people (Mr. Whoo and one friend who also happened to have an anonymous blog). Well, it so happens that those few people told a few more people, then I told a couple of people, and made a couple of bloggy friends, who were then my face.book friends and boom! Not so super-anonymous any more. This was not a big deal, as it was still mostly amongst my circle of friends, from whom I lived far, far away, and trusted to know me as the person behind the words. Then I moved, and I was closer to some friends, and those friends knew friends, and friends of friends, who also went to the practice where I am working. This is where I keep running into an ethical dilemma. Some people reading this blog know who I am, where I live, and where I work, but are not my close personal friends (friends of friends of friends). Given the atmosphere surrounding the Internet, face.book, and social media with respect to physicians in general, this makes me a bit edgy. Let's face it, I'm not the type to mince a lot of words on this blog, and this is who I am when I am being me. (Because this is my blog, dammit!) My professional persona is not nearly as raw. In fact, if you asked most of my patients, I do believe the word "sweet" would come up more than once. (STOP LAUGHING!! It's totally true!)

At any rate, now I am unsure of my reading audience, and I find myself trending more and more toward self-censorship, which I hate. I just keep wondering if the patient sitting across from me is wondering if I am filing her experience for a blog post for another day. I don't want this to interfere with my relationships with my patients. It was never meant to be a blog that my patients, who knew me as a professional, would read. Maybe that is narcissistic. For all I know, my patients could care less about my ramblings in cyberspace. Patient confidentiality has always been, and will always be protected. Any clinical scenarios that I post are altered from actual occurrences, I imagine I will be posting less of these in the future, as well. So, this blog will be evolving as I try to navigate this slippery slope. Bear with me, readers, and thanks for sticking with me this far...

Office Dos and Don'ts

2011-02-04T14:05:00.007-05:00

When I am not on call and juggling office visits and catching babies, I am still working in the office seeing both OB and GYN patients every single day of the week. I realize that most of you spend only a fraction of that time in any physician's office, and frankly, we can tell. Here are some helpful hints to make your day at the GYN go a bit more smoothly:

Ob/Gyn Office *Dos*
1. Do make an early appointment. Whenever possible, make your appointment the first appointment of the morning or the first appointment after lunch. Trust me on this one and see below.
2. Do arrive for your appointment at least 10-15 minutes early. I know, I know, why would you want to show up early when you just *know* you are going to be in the office for *hours* on end. Here's why: The Snowball Effect. Invariably, as is required by the office, your insurance, or pencil pushers from various state and local agencies, you will be asked to fill out some kind of form upon your arrival. These are usually not mind-shatteringly difficult, but they can take time. Then the receptionist has to verify your information, make sure your insurance is still good, find your chart, and send it down the line to the MA/RN who will be bringing you into the office. The MA then fills in any new information, takes your vitals, asks the reason for your visit, and takes you to the room. Imagine what happens when you are "just 15 minutes" late for your appointment, everything that has to be done gets done further and further away from your appointment time. Before you know it, you are in the exam room 30 minutes after your appointment time, and if you think your schedule is thrown off, multiply that by 12-15 patients in a half-day. If all of them are even 5 minutes late for their appointment time, it creates a significant backlog for the physician to overcome. We're good, but we can't reverse time. It's just not feasible.
3. Do know your personal and medical history. Be sure that you have approximate dates of any surgeries or hospitalizations that have occurred in the last few years. Know what body parts you do and do not have. Know what medications (and their doses) you are taking, for the love of all that is holy! I have no idea what birth control pills are in the pink rectangular package, and will not be able to divine it easily. Have a tentative idea of when your last period happened. I also have no idea what is in your medical history unless you bring your records to me to look at or have them sent to the office *before* your appointment, so please don't wave a dismissive hand and mumble something about how "it's all in there somewhere."
4. Do bathe. Applying soap and water to your body sometime in the 24 hours before the appointment is considered common courtesy. I really don't care if your legs or any other areas are shaved, hair maintenance really doesn't concern or bother me in the least, but the courtesy of bathing is much appreciated.
5. Do know what you want to accomplish. Write down the questions that you have or issues that you want to address at your appointment. In the hustle of the office routine, you will probably forget something. Keep a little list on a piece of paper or on your phone to review...and I stress *little.*

Ob/Gyn Office *Don'ts*
1. Don't make a routine appointment for an out of the ordinary problem. This, of all things, is my number one pet peeve when it comes to office visits. If you are feeling depressed, your libido is in the toilet, your uterus is falling out, or you feel like you are bleeding to death every month, even if it *is* just about time for your pap smear, please, please, PLEASE don't call the office to make an "annual exam" appointment. Believe it or not, GYN physicians do more than just pap smears. If you want to see the doctor for a problem, make an appointment for such. Here is something you may not realize: You do *not* have to disclose to the scheduler *what kind* of problem you are having! Simply stating you have a problem you would like to discuss with the physician is totally adequate and spares you any embarrassment you may feel. Annual exam appointments are usually given about 10 minutes, but problem appointments can be scheduled for 15 minutes-30 minutes. This means you get more time with your physician to discuss treatment options and formulate a plan to get you feeling better. In the same vein, don't save up all of your problems for your annual exam; there is only so much we can do in an annual exam. Change your birth control? Yes. Change your birth control, cure your depression, diagnose your infection, and evaluate abnormal bleeding? Not so much. Scheduling the appropriate kind of appointment sets up a "win/win" situation for all involved.
2. Don't expect to get an immediate answer/treatment/cure after one visit. Some problems (like infections) are easy to solve, but some problems are more complex and require data gathering and imaging studies. Your initial appointment may need to be followed by a secondary appointment in order to assimilate information and assess treatment efficacy. You may not have all the answers after seeing your physician one time, but I can assure, you will be headed in a definitive direction for treatment.
3. Don't be rude to the office staff. They are there to do a job, and when you get seen, how you get seen, and certain office policies (like late policies) are totally out of their control. We all work together as a team, and you can bet that if you are a raging b*tch to my MA, I am going to hear about it before I step foot in the room. I can't guarantee a warmed speculum in those cases, either (I KID, NO HATE MAIL, PLEASE!!) On the flip side, if our staff is rude to you we want to know about it, so please share your experience with us.
4. Don't expect your physician to (do even more) work for free. Trust me when I say that much of the "behind the scenes" work that we do goes uncompensated. It is common courtesy to inform you of your lab results over the phone (usually our nurses or clinical staff will do this), however, if you want to discuss the interpretation of your labs or formulate treatment plans based on the lab results? Make an appointment. Physicians' clinical opinions are based upon what we spent years learning; this is our professional service, and we deserve to be compensated for services rendered.
5. Don't attempt to dictate your own treatment. Dr. Google is great for answers in the middle of the night, but printing sheaves of paper dictating how you *think* you should be evaluated/treated is incredibly off-putting. I value an educated patient, and appreciate when my patients "do their homework." This is not the same thing as demanding of a physician a specific test or treatment that you happen to think you may need. We want to collaborate with you about your care, and have spent years of training learning how to do this. Our knowledge is not so easily replaced by We.b.M.D. or W.ik.ipe.d.ia.

And two more months slipped away...

2011-01-05T13:30:00.007-05:00

Happy Belated New Year, blog and blog friends! I will spare you the "busy, busy" rigmarole because you've heard it all before. Needless to say, it hardly seems real that the last time I logged on to post anything on the blog was back in October! Life and time have continued to move forward at the speed of light. Over the holidays we (or, more precisely, our builder) finished building the house, we closed (i.e. hemorrhaged money), and then, for extra fun, we moved in...the week before Christmas. Why (you ask incredulously)? Because I'm insane (in the membrane...er, sorry), apparently, and, more accurately, because I already had requested that week off in order to (HA, HA!) relax the week before Christmas. To add to the fun (and this torture was completely self-inflicted, by the way), we just didn't feel *right* about depriving poor little CindyLou and Bean of a Christmas tree and decorations until the week before Christmas (think of the *children!), so we bought a tree for the rental, decorated it and the rental house (including the outside, of course!), undecorated, bought a new tree for the new house, and the decorated the new house once again. I cannot vouch for my mental stability, that bit of madness was unbelievably ill-advised. Regardless, despite several snags, we arrived safely and soundly in the new house before Christmas. Santa even found us and everything! Whew!

So now, I am digging out of boxes, cursing the paper clutter and all of the things that can't be thrown away, but do not yet have a "home." Paper clutter is my true nemesis. We all love the new house. It is so nice to be in a home that is truly "ours" from the very start. Cindy Lou's bedroom is bedecked in lavenders, pinks, and fairies. Bean's is bathed in blues, "Cars" characters, and, let's not forget, monster trucks. We are very happy here, which is good, because (hear this internets) I AM NEVER MOVING AGAIN! (I hope.)

Work is going well, getting back into full swing since the holidays. I find I have so much less to complain about these days. Likely because I am not much on the front lines any more (no more midnight phone calls about cough syrup selection), I am getting more sleep, and more weekends off to play and love on my sweet little family. I still have the occasional fist-clenching moments, like the two sisters, due a week apart. The younger went into labor first, even though the older was *due* first, and the older got so p*ssed off she *refused* to come to the hospital bedside to support her sister. I mean, *dammit* she *always* gets *her* way. (These are grown ass women we are talking about here, you wouldn't believe the adolescent machinations, mostly on the part of the older sister.) Younger sister's baby ended up having an unknown health problem after delivery, which would have made me feel like a criminal that I wasn't there for *my* sister during that time. Older sister's baby was born about a week later and was *perfect,* and I got the vague impression she was feeling quite smug and justified about that. Sad, sad, sad.

There was also the patient whose MIL jumped all over me when, after going to have a "for fun" ultrasound where the US tech said the cord *might* be around or near the baby's neck, I tried to explain that, if indeed the cord was around the neck, there was not a thing in the world I could do about it! I spent 30 minutes with the patient and her MIL, even obtained a (completely normal and beautifully reactive) NST. At the MIL's visit to my partner the next week (for her own medical care) she expressed to them how I just "rushed" them right through the appointment, and how her DIL needed "more TLC" from our practice. GAH! The unmitigated *gall* of that woman! I give up. Haven't seen her or DIL since, and I'm not crying about that one little bit.

So anyway, time marches on...double numbers are luck for me, so I think 2011 is going to be a good one. Maybe, just maybe, I can lose the rest of that weight, organize my life, de-clutter, become a great cook, run a marathon, found a charity organization, and still find the time to be the world's best wife, mother, and doctor. Hmmmmm, probably not! Good to be back, and I hope to write more in the coming year. Hope you are still out there and listening!

Crazy Life

2010-10-05T21:42:00.007-04:00

October has a special place in my heart. The fall weather is my favorite, football is in full swing, and the school year is settling into a routine. This year, however, it is also my favorite because September is finally freaking over! In the past 4 weeks of call I have cared for, delivered, operated on, or diagnosed the following:

- A twin IUFD @ 18 weeks, followed by a retained placenta requiring a D&C.

- 3 post-partum hemorrhages, transfused a total of 9 units of blood between them, one of whom almost lost her uterus, but was saved by a B-Lynch stitch.

- An 11 pound shoulder dystocia (baby and mom were fine).

- A 30 week severe IUGR IUFD, barely able to be delivered vaginally due to a contracted pelvis.

- A multiparous unmedicated, "I'm physically here, but mentally I'm not," precipitous delivery followed by a shoulder dystocia, complete with tight nuchal cord x 2, baby with a very purple face, but no other sequelae.

- A newly diagnosed placenta previa, possible accreta at 28 weeks gestation.

- An 8 cm ectopic pregnancy.

- A cervical ectopic pregnancy.

- More preeclampsia than I have ever seen or care to see again.

- A full labor and delivery unit, laboring patients in triage, delivering in the ORs due to lack of beds.

- A 360 pound, 28 year old patient who had never seen a gynecologist with excessive bleeding and a 10 cm complex right ovarian mass.

It's been a rough month to say the least! Not to mention the day-to-day office grind, allergies, a sinus infection that won't go away, and a poor prognosis for a family member, recently diagnosed with recurrent, advanced malignancy. Every day I see something that makes me aware of how fragile our lives really are, and I am so thankful for all with which I have been blessed. So I am taking all that I've learned from the above experiences, gray hairs, angina, and all and pressing forward into October. It can only get better....right??

Little Wonders

2010-09-03T10:05:00.005-04:00

I sat with my patient, a new mother, in the examination room. She was there for her first post-partum visit and we were discussing the events of the last few weeks. We chatted about breast feeding, birth control, lack of sleep, how annoying it is that men can sleep through *anything*, and then, I asked, as I always do, about how she was handling things emotionally. I always make it a point to screen for post-partum depression, many times, if you don't ask, they will not tell you how they are really feeling. This time, though she passed the screening for depression, she gave a laugh and said, "For the first time, I know why my mother is the way that she is." She went on to elaborate how she always made fun of how emotional her mother is, and now how she couldn't watch Kleenex commercials any more without bawling like a baby. It is so true. When we become parents we are forever changed, not only do we understand our parents better, but the way that we look at the whole world is different.

For me, it was the same. Before I became a mother, I loved to watch scary movies. The scarier the better. Imagine my surprise when, not long after Cindy Lou was born, and Mr. Whoo and I settled in to watch a horror flick when I realized that I had changed. I could not watch it, couldn't even get past the first 30 minutes. Why? Because there was a little girl child in it who was missing, and I couldn't handle thinking of a child (my child) being lost, scared, and alone. I never realized how many horror films use disturbing images of children before having a child of my own. It changed how I watch movies even now, far removed from the emotional lability of the immediate post-partum days. The same holds true for news stories involving children, footage of the 2004 tsunami devastated me, same for Katrina the summer after. The tears flow more freely now, happy, sad, and wistful. Most of all, music speaks to me, and often moves me to tears. There are certain songs I associate with different stages of my children's lives, and find myself tearing up just thinking of the lyrics. For Cindy Lou, it is "Baby Mine" and "Return to Pooh Corner." For Bean it is "Sweet Baby James" and "Little Wonders." Especially these lyrics:

"Our lives are made, in these small hours, these little wonders, these twists and turns of fate.
Time falls away, but these small hours, these small hours still remain."

So now I know how my mother felt when I was younger, when Cindy Lou turns to find me wiping away a happy tear or two and says, "Mommy, if you are happy, then why are you crying?" Perhaps it is because the transformative joy and wonder of having a part in creating these precious lives fills up our hearts until they break, just a little, from the magic of it all. How have your children changed the way you see the world?

***Cross Posted at Mothers in Medicine***

Aw, yeah!

2010-07-13T19:10:00.005-04:00

Hi! Don't you love how I swear that I'm back to blogging and then don't post for two weeks? Time keeps slip-sliding away, but the main reason is that I was on *vacation.* Woo hoo, right? There were good, bad, and ugly parts, just like any old fashioned family vacation. The good: time with family, spending time in, near, and on the water, reading books (for fun!), eating good food, and having absolutely no responsibilities, pagers, emails, or Internet access. The bad: family overkill, NO AC in our rental (and 90 degree temps, if you know me, you know how disastrous this was), mosquitoes the size of my pinky finger (and a blue million mosquito bites), not really having anything to *do*, eating way too much good food, and no Internet access. The ugly: 23 hours in the car (each way!), with a 6 and almost 3 year-old. Yes, you read correctly, a total of 4 of my vacation days were spent driving in the car, with my whiny, don't- know-how-great-they-have-it children, slowly going insane. I believe that the first "Are we there yet?" came about 17 minutes into the trip, so yeah. Fun times.

The hilarious thing is, Mr. Whoo and I were crazy enough to make this trip about 5 years ago, with our just over one year old, and swore we would never do it again. HAHAHA! See how time dulls the sense of abject horror? Well, time, and over $400 per person for plane tickets. The first time around, CindyLou was just a little over one year old, and, while we had a DVD player (the makeshift kind that would hang in between the front seats and plugged into the cigarette lighter), CindyLou had the attention span of a gnat, and would only watch *one* of the many DVDs we had brought for her pacification, er, viewing pleasure. Any other of the videos made her bored, or scream, so we lucky people in the front seat got to listen to Ses.ame Stre.et "Sing Along" approximately 4872 times. The first couple of times, it was cute. We sang along with the songs and giggled at CindyLou's response. The next few times, we grinned and bore it. The next 100 times after that we started making up rude lyrics to the songs and commenting the actors "Mystery Science Theater 3000"-style. Any time after that, we just became hysterical and delirious. Seriously, this 30 minute video was the funniest sh*t we had ever heard. To this day we have quotations from that show (both real and altered) that we use in every day life, including a very enthusiastic "Aw, Yeah!" which came from an owl-type character in one of the songs. At the end of that trip, we (for some reason) kept the DVD, but did not watch it again for 5 whole years (mostly because we could recite it by rote)....until this trip.

We were a good 6 hours into the first day of traveling in the car, the novelty had worn off, and the kids were no longer interested in the snacks, our conversations, or the scenery. We were each "taking turns" choosing movies or music, when CindyLou and Bean just could not agree on a form of entertainment. The situation was devolving, and no amount of Capr.i S.un or Gold.fish could keep our offspring from complaining about one another when Mr. Whoo suddenly got this evil smile on his face, looked at me, and mouthed "Sing Along." My response? "Aw, YEAH!" So we played it. Bean was enthralled, CindyLou was still enthralled, and Mr. Whoo and I were laughing so hard we cried. The rest of the trip, we tried to engage the kids in the old standards such as the "Billboard Alphabet" game, the "License Plate" game, and "I Spy." We tried to give them a little taste of what it was like to travel back in the dark ages before DVD players, iPods, and Ninten.do DS. I'm not sure how much they appreciate it now, but hopefully, in time, they will. It is funny how the things that drive you the most insane are sometimes the best memories that you have. So family vacations, gotta love them. Now I am back in the fray, and just waiting for the next extraordinary happening in an ordinary day. Aw, yeah!

Summertime....

2010-06-21T08:18:00.005-04:00

...and the living is, well, kinda crazy. Isn't that always the way? The more free time we seem to have, the more we fill it up with visits to the pool, spending time with grandparents, and trying to keep our kids from growing up so darn fast. I had to take a bit of a break from the blogosphere. I had gotten into a very bad habit of reading too many doctor-bashing blogs, and it was making me incredibly bitter and angry. Partially because of the blatant misinformation being bandied about, and partially because I know so many great, caring, and self-sacrificing people that are physicians, and to hear us all painted with such an ugly brush really p*sses me off. Not to mention how reading about how much people hate us out there was making me wonder why I was busting my *ss going above and beyond for people who didn't appreciate a d*mn thing that I did. So, I stepped away from the screen for a bit, and took the time to look around me.

In that time, life brought several patients my way that helped me to remember why my job is so important and yes, even still, appreciated. I did a 2 am emergency c-section on a woman who was actively abrupting at 35 weeks and helped save her life and her baby's life, as well. I helped two women, one with an early demise due to a fatal fetal anomaly, and one with a heartbreaking term demise to deliver and make it through the absolute worst days of their lives. I attended several "routine" deliveries and got to be a part of the happiest day in many women's lives (dreaded hospital setting and all). And I waited out a prolonged labor, complete with three hours of pushing and a pretty scary shoulder dystocia, and helped a first-time mother to deliver her healthy, 9 pound 15 ounce baby.

In the spaces in between, I got to celebrate CindyLou's 6th (!) birthday and her "graduation" from Kindergarten, enjoy some time with family and friends on the weekends that I have off, and I even successfully completed 2 weeks without eating any carbohydrates at all (and lost 6 more pounds, yay!) I think of this time last year, as we were preparing to make this move, and I was dreading July (as I always did, with OtherDoc's mega vacation looming in the foreground). This year we have vacations planned in July and Bean's 3rd (can you believe *that*?) birthday, and only 1 full weekend of call. I am finding my life again, and still getting to work in a field about which I am just as passionate, now with less burn-out! Whee! I also want to thank the sweet anon poster who asked that I not give up on the blog...don't worry! I may lose chunks of time in between posts, but I won't forget about you guys. I just have to find a way to make this blog funny again, and not so depressing and whiny! I will continue to fight the good fight for Ob/Gyns out there, and do my best to stop the rampant fear mongering by providing the example which contradicts the general blogosphere "rule." Good doctors do exist, we by far outnumber the "bad" ones, and we prove it every. single. day. Happy 1st day of summer, all! I am going to the pool. :)

Far from Fine

2010-05-03T11:40:00.005-04:00

I am blessed. I have a great family, healthy children, a loving marriage, a career that I (mostly) love, and many good friends. But I still have things that I worry about, there are still things that are far from fine with me. Despite a 22 pound weight loss on my previously mentioned program (woo!), I am still obese and now that I am "graduated" from the program, I find the bad habits slipping back in and pounds creeping slowly back on. I eat when I am stressed. I am stressed a lot. Therefore (logic 101) I eat a lot. I wish I ate a lot of vegetables, or even a lot of fruit, but mostly I eat a lot of pasta. It must release some kind of serotonin, because it calms me like nothing else can (except wine, and I *really* don't want to go down that slippery slope, you know?)

I'm worried about our country's path, our future, my children's future. What the hell is going on with our politicians...all of them? Our government is so perverted from what our founding fathers originally envisioned. It is almost laughable, but worse, it is scary. I am scared to death about freedoms and rights that are being stolen from us right beneath our noses in the interest of some kind of unrealistic, Utopian "greater good." Many of my friends "get it," but there are also many that don't understand what I am saying or seeing, and it drives a wedge in these friendships.

I am worried about the future of my profession. I can see what is coming down the pike in the coming years. It is ugly and is going to get uglier, and I'm pretty sure that physicians had a hand in sealing the demise of our profession as we know it by being the types of people that physicians are...altruistic to a fault. While I'm doing what I can on a local level, I feel helpless to change the runaway freight train that is the bureaucracy surrounding what should be built on a case by case (patient to physician) basis.

So, I fret, and rage against the machine, and beat my head against the wall trying to get people to understand what they refuse to try to understand in both my personal and professional life, and I eat. I recognize that I am self-medicating...but what? Frustration? I'm not clinically depressed. I do have some anxiety and OCD tendencies, but nothing that has been interfering with my daily life. I am just using food as a crutch, instead of healthy sublimation like exercise, I am raising fork to mouth to push down my feelings, my fears. It isn't working for me. So today, after having pasta for breakfast after a particularly harrowing weekend call, I got off of my arse and went for a walk. The hardest step is the first step out the door. Right?

Things I Say Every Day (Home Edition)**

2010-04-27T20:33:00.004-04:00

1. Good morning, sunshines!

2. I love you.

3. No.

4. What do you say?

5. Hmmmmm?

6. Put your clothes in the hamper.

7. Stop teasing your brother.

8. Stop torturing your sister.

9. Sorry, you cannot have mac and cheese for breakfast.

10. Sooooo, whatcha want to do for dinner tonight?

11. Thank you for (doing laundry, the dishes, going shopping) honey!

12. Are you ready for a bath time? A bath time party? This is old CindyLou (and Bean) ready to get that bath time started....

13. So, tell me about what you learned today...

14. I need some snuggles (or, the abbreviated, "snugs")!

15. I missed you today.

16. Did you set the DVR?

17. No, no, it is (CindyLou's/Bean's) turn to sit in the front of the tub.

18. Pick out the book you want to read tonight.

19. What was your very favorite part of today?

20. Good night, sleep tight, sweet dreams...see you in the morning.

21. Ahhhh, adult time!

22. We need to go to bed earlier.

23. I am going to bed early tomorrow.

24. I love this show!

25. Maybe we can work out....tomorrow.

Things I Say Almost Every Day**

2010-04-27T11:42:00.006-04:00

One thing that I love about my job is that it is ever-changing, and there are no two days that are exactly the same. That being said, I have my own daily script that I find myself reciting as I move through the more routine parts of my days in the office and on labor and delivery. My nurse could probably come up with a million more things (since she gets to listen to my spiel 30+ times a day), but these were the first off of the top of my head:

1. That's normal.

2. You're going to feel a little pressure.

3. Are you feeling any pressure?

4. Do you have any questions?

5. In a normal cycle, you have a rise of estrogen, then ovulation, then a rise of progesterone. If you don't become pregnant, then your progesterone level will fall and *then* you will have a period.

6. That's normal.

7. Take a deep breath.

8. Now, wiggle your toes.

9. No one will know your breasts better than you.

10. Tell me about what has been bothering you.

11. Is that interfering in your daily life? How?

12. The definition of menopause is no periods for one year.

13. It takes two 16 oz packages of cottage cheese to equal the Calcium in one 8 oz glass of milk.

14. You can do this.

15. Congratulations!

16. There are risks, benefits, side effects, and alternatives...

17. I'm sorry for your loss.

18. That can be normal.

19. I know it is counter intuitive to "relax" but try to make your muscles as loose as possible.

20. Do you understand?

21. Tell me what you know about birth control, then tell me what you would like to know.

22. That is a normal physiologic change of pregnancy.

23. I promise that you won't be pregnant forever (usually after discussing our elective induction policy of no earlier than 41 weeks gestation.)

24. How can I help you today?

25. I know this is scary, but I am going to talk you through it.

**Cross Posted at Mothers in Medicine**

"Why is my OB always running so late?"

2010-04-13T23:04:00.004-04:00

Recently one of my friends posed the question as to why her Ob/Gyn physician would routinely run at least 45 minutes late, with the caveat that she would be fired for doing the same to one of her clients. In typical fashion, I posted a long, rambly, and overly detailed answer in her comments section, after (thankfully) seeing a lot of other friends chime in on their personal experiences with their particular physicians. I realized that this is most likely a very universal wonder/complaint, so I am re-posting my response for you, my dear readers. I am sure you have pondered this at least once whilst sitting on an exam table, shivering in a paper gown.

Allow me to describe my day, in order to better explain why we may routinely run late. Today I am on call, and so, while I am responsible for all that happens on labor and delivery, in the office, I do have patients scheduled. The majority of patients are OB visits, most of which rarely take more than 5-10 minutes tops for routine appointments. We also will see check problem patients (early pregnancy bleeding, labor checks, blood pressure issues, hangnail, etc.) So, our scheduling staff (none of whom are medically inclined or have any clue what we do on a day-to-day basis) has most "on call" schedules looking something like this:

8:30 OB patient 1:15 OB patient
8:45 OB patient 1:30 OB patient
8:45 OB patient 1:45 OB patient
9:00 OB patient 1:45 OB patient
9:15 OB patient 2:00 OB patient
9:15 Problem 2:15 OB patient
9:30 OB patient 2:30 Problem
9:45 OB patient 2:45 OB patient
9:45 OB patient 2:45 OB patient
10:00 OB patient 3:00 Problem
10:15 OB patient 3:15 OB patient
10:30 Problem 3:15 OB patient
10:45 OB patient 3:30 OB patient
10:45 OB patient 3:45 OB patient
11:00 Problem 4:00 Problem

So, we have anywhere from 5 to 7 patients scheduled in an hour, and if everything is hunky-dory, there are no issues, long litanies of questions, no problems, or complications, I can generally run on time for these appointments (and by, "on time" I mean that once the patient checks in (usually running at least 5 minutes late, themselves) the nurse talks to them, does any necessary screening labs, checks their weight, urine and BP, listens to fetal heart tones, brings me the chart, which I then review, I am seeing them at *best* 15 to 20 minutes past their original appointment time).

Then, add in the inability to predict labors (I had a couple of laboring patients today) and scheduled procedures (I had 2 cervical ripenings and a C-section scheduled-not by me-at 7:30 am and then another scheduled C-section at noon. Unfortunately, one of my laboring patients delivered at 12:15, smack in the middle of when I was supposed to do my noon C-section, so the section was put on hold until after the delivery. So, by the time I finished the (complicated) scheduled C-section, did all the necessary charting and orders for both deliveries (mind you, not having any time for lunch) I was able to get back into the office by 3 pm. If I am lucky (today I was), my colleagues will have mercy on both the patients and me and pick up a few charts to see patient or two in between their already over-packed schedules. If I am not, then all of the patients scheduled from 1:15 are still waiting to be seen at 3 pm.

So, (whew) does this make it a little more clear why we are not running on the spot of time? It is completely different than making one appointment (that you probably schedule yourself, when it is convenient for you, allowing for travel time, and keeping in mind how long you expect most meetings to go) with one client for the span of 30 minutes or an hour, so the two are really just not comparable...at all. Hope that this helps the next time you are waiting for your physician. P.S. If you grow to expect the long waits, start bringing entertainment (iPo.d, magazines, books, cell phone bejeweled or solitaire) or little projects you can do (bills, checkbook, cleaning out your purse), and know, it really could be worse. Back in Whoo-ville, OtherDoc's patients would wait for him for upwards of 3 hours...now *that* is ridiculous. ;)

Answers for A

2010-03-29T09:11:00.004-04:00

I recently received a comment on the blog posing the following questions. At first, I was going to just correspond via email, but I thought perhaps my readership could also jump in on answering these questions from "A," a 3rd year medical student considering Ob/Gyn. So, thank you in advance for your help!

Hi Dr. Whoo,

I have thoroughly enjoyed reading your blog and appreciate the time and effort you put into your posts to provide us readers with a glimpse of your life. I am currently an MS III with only 6 months left to decide on what to do with my medical career. My top 3 choices are OBGYN, Anesthesiology and Psychiatry. I loved my OB rotation and feel that the field is a perfect blend of medicine, surgery, procedures and primary care.

Hello, A! Thank you for the nice words about the blog, I am glad to be able to provide a glimpse of life in the world of Ob/Gyn. I agree that Ob/Gyn is a perfect blend of medicine, surgery, procedures, and primary care. It is a really great field, but it does have its limitations.

However, I am afraid to commit to the field for the following reasons:

-Work hours. I cannot get a straight answer from the academic faculty on what to expect after residency. Most of them have flat out discouraged me from choosing OB, telling me that I should just do one of my other 2 choices. Is it possible to find a job working 60-65 hours/week and still come out with a salary of $250-$300k in smaller cities in midwest or the south? I just want to be well-informed of what to expect before I take the plunge to ensure that I don't end up hating my career .

HAHAHAHAHAHAHA! Ahem, I mean, ah, not likely right off the bat, at any rate. I think you can get the salary you want with more work hours, or the work hours you want for a lower salary, but it would be rare to find the above combination just out of residency. My average work week (5 person group practice) is right about 60 hours with weekday call, 110 hours for weeks where I have weekend call. As an employed physician, I make less than $200,000. My pay will increase with each employed year until I am able to "buy-in" to the practice. After that, my income will increase (but a large portion of it will go back into buying into the practice). After about 5 years of "paying my dues," I will be able to set my ticket for income. It just takes some time.

At my previous job, I made over $250,000, worked in a rural, under served area with high Med.icaid, and only had 4 days off per month, so 168 hours the weeks that I worked weekends, 120 hour weeks the weeks when I had the weekend off. Trust me, it is far better to make less money and work less hours, especially now when O.b.ama.care looms on the horizon. (Plus, think of the taxes you will be paying on a higher salary, you may get to keep more of your money working for a lower income.) So, while I am sure you can find some places where low work hours and higher income combines, that would certainly not be the norm until you establish a practice.

-Liability. How stressful is this aspect of OB if I choose to move to a state with Tort Reform or low liability?

Liability, Tort Reform or not, is always stressful in OB. It will loom over your shoulder with every decision you make, especially with respect to managing labor and delivery. Even when you uphold the standard of care, you can still be sued for bad outcomes, and all it takes is one case to destroy you financially, personally, and professionally. Malpractice premiums are fairly exorbitant in the field, as well. You may not be able to cover your malpractice costs if you have a poor payer mix, meaning more volume, which leads to more chances of things going wrong. Vicious cycle. Most of the time, it is just like static noise in the background, other times you hear the alarm bells clanging. You get used to it, but it is always there.

-I am a male (a minority in the pool of OB applicants). I have been told that being a male would make it difficult for me to find a decent job because practices tend to prefer women OB's (hence males have to settle for worse locations, work hours and call schedules). How true is this?

Well, to be honest, I am not sure, since I am not a male. (Any male Ob/Gyns out there want to field this question?) I know that in many of the positions for which I interviewed, they were very interested in procuring a female physician. One field that you may consider, if you are so inclined, is the field of Urogynecology. I think it is a 3 year specialty after residency. It is a more surgery-heavy specialty, and, in my experience, still fairly male-dominated. You still get some procedures, good primary care and a lot of good surgeries, no babies, so less liability, and likely better hours and compensation overall. I hope that these answers helped somewhat, and I hope my readers are able to clarify further some points I am not able to elaborate upon. I truly wish you the best of luck with the rest of your training, and in whichever specialty you choose to pursue.

Dropping In and Frustration

2010-03-11T23:32:00.006-05:00

Since my move from Whooville to Newville, I've had to make some adjustments to the new patient population. Perhaps the most frustrating of all, however, are the "drop-in" patients on Labor and Delivery. My previous hospital was a rural, community hospital. It was certainly off the beaten track, and the building? Was old. Really old. The L & D suites were certainly sufficient and functional, but luxurious? Not so much. You had to know where you were going to find the hospital, and it was quite the rare occasion to have patients just "drop-in" for care.

Not so for the new digs. This hospital is new. Pretty much Brand Spanking New, and posh, and beautiful, and, oh yes, right off of a major highway, visible for all the world to see. Which makes for the fascinating phenomenon that is the OB "drop-in" patient. "Drop-in" patients come to this hospital "because it is close," or "because it is nice," or "because it was on the way." So, what is so bad about working in a hospital in which everyone wants to deliver? Well, what is so frustrating is the women who *know* that they want to deliver at our hospital, but do not seek pre-natal care from physicians that cover our hospital. Therefore, any pre-natal labs or records, or history of complications are virtually inaccessible at the time that they come in for delivery. Often patients from the large, downtown academic center (who don't have insurance or have insurance not accepted by our practice) receive all of their pre-natal care "for free" at the downtown center clinics and the purposefully come to our hospital to deliver. The patients are often not troubled by this, and often seem mildly surprised that we "aren't all the same" and have no way to access their records. After all, they are getting exactly what they want. It is much harder for us, as physicians, however, to help these patients. Especially when it comes to their expectations for delivery. It is difficult to develop a proper rapport in the few hours that we have with them. I think that trust is so important in the delivery room.

Even more difficult are the transient patients who stop in on their way through town, like one patient who had absolutely no pre-natal care, and was on her way to deliver her baby somewhere "non-medical" when her water broke, and she decided to stop-in at our hospital. She had, indeed, broken her water, but she refused an ultrasound to assist with proper fetal dating because she was concerned that the "x-ray waves" would damage the baby. She then proceeded to refuse any medical assistance from the hospital at all for over 24 hours, tying the medical staff's hands, and putting them at risk for liability at the same time. Eventually, she agreed to augmentation of labor, and even requested epidural analgesia after a prolonged labor. With medical assistance, she eventually was able to deliver, but the baby boy had definite signs of septicemia (likely due to prolonged rupture of membranes) and ended up in the NICU for over a week. When all was said and done, the mother, upon release from the hospital, said that she and her infant would never step foot in another hospital again, despite the fact that it was with the hospital's help that her child was born and made well when he was sick. To this day I will never understand why she "stepped foot" in the hospital from the start, if she did not want any intervention that the hospital could offer. This case brought a lot of issues that plague the medical profession in this day and age to the forefront.

Thankfully, her baby, despite some health issues at birth (that likely could have been avoided with faster intervention) did well...but what if he did not do well? What if the infant did not survive? Then who is at fault? The hospital? The physician? The mother? These are the questions the haunt physicians' sleep at night. Obstetrical interventions are not only done to avoid lawsuits, they are done to protect the safety and health of both the mother and her baby. However, one bad outcome, one wrong decision, can result in catastrophic professional, financial, and personal losses for the physician. Is it any wonder that we are hyper-vigilant? Is it any wonder that we would jump at any opportunity to prevent a bad fetal outcome, even it it means surgical intervention risks for the mother? It is thanks to Jon Edwards and others like him that the cesarean rates are rising, VBACs are being refused, that patients are being over-monitored, and that interventions are becoming the exception rather than the rule. Without tort reform, without the ability of the physician to operate from another position than that of fear of a poor outcome, then I am afraid that obstetrical care will remain the same in this country for years to come. Please consider that your rage just may be misdirected.

Ob/Gyns are not evil

2010-02-21T10:02:00.008-05:00

Just because I'm an OB/GYN physician...

~ don't assume that I don't care about you as an individual.

~ don't assume that I'm out to cut your baby out of your womb in favor of getting home for dinner.

~ don't assume that I go home and roll around naked in piles of money.

~ don't assume that I view pregnancy or birth as an "illness."

~ don't assume that I don't know anything about "natural " (unmedicated) labor, transition, or alternate pushing positions.

~ don't assume that any inductions of labor that I schedule are done for *my* convenience.

~ don't assume that I will roll my eyes at your birth plan.

~ don't assume that my attempts to educate you about your pregnancy are "scare tactics."

~ don't assume that I am "what is wrong" with the way women give birth.

~ don't assume that the only way I know how to facilitate labor and delivery is through "unnecessary interventions."

~ don't assume that I am an unfeeling automaton who wants to "put you on the assembly line."

~ don't assume that I am "too busy" to take proper care of you.

~ don't blindly believe everything you see and read about my profession.

I've been doing some browsing through different labor/nursing/birth blogs, and, as it is wont to do, it depresses the living hell out of me. Partially because I know that I am not close to 90% of the descriptions I see from women out there, and partially because I'm starting to worry that maybe I am an exception and not the rule. In my current practice, I can see a definite split between the younger generation of physicians and the older generation. I certainly believe that through medical school and residency that I was taught a much more "collaborative" model of care than earlier generations. However, no one in my practice comes close to the urban legends out there perpetuated by the anti-medical world. I know I've ranted about this before, but it bothers me! So many physicians with whom I work have sacrificed *so much* for their training, for their ability to help people, just to be mistrusted and maligned by the population at large. Perhaps the most disheartening thing, is that there can be no real dialogue between the two philosophies, so jaded are our particular perspectives. Nothing I can say on this blog can convince you that I'm not a knife-wielding harpy, but if you were my patient, you would know.

P.S. I have been playing around, trying to start a facebook page for this blog. Any tips on how to make it better? I am poor at social networking!

New Sensation

2010-01-30T08:21:00.006-05:00

In my previous job, I essentially functioned as a solo practitioner, so I could be fairly certain that (like it or not) I would deliver nearly all of my OB patients. Not that I didn't wish sometimes that a few of them would happen to deliver on one of the 4 days that I was freed from the hospital. In many ways, knowing all my patients from beginning to end was really wonderful. I knew who was stoic and who was, er, well....not stoic. I knew who was a worry-wart, who never had a single complaint, who had a birth plan, and who wanted an epidural when they hit the front door. I knew who was having complications, how far along (ball park) they were, and sometimes could even remember how dilated they were at their previous checks (should they arrive in triage thinking they were in labor).

The very best part, however, was the relationships I developed with the patients during the span of their pregnancies. We got to know one another, build trust, and when the time finally came for delivery, the rapport was usually strong enough for us to communicate well during the process, and to celebrate together when the delivery was complete. Sometimes this could actually be somewhat detrimental, as getting "emotionally attached" to patients can be a hindrance to good medical care, but mostly, while I cared for women on a personal level, I was still able to objectively direct their care. Of course, I didn't "click" with every single patient (that is impossible) but I did feel like a level of trust and mutual respect was able to be fostered with many.

Now, in a much larger practice where there can be anywhere from 60-80 patients due in a single month, it is much harder to develop the same rapport. There are times when I haven't even had a chance to *meet* a patient before attending her delivery. We try to have the patients see every physician at least once, but sometimes it just doesn't happen. This makes it much harder to develop trust in one another, during a very crucial time. So far I have overcome this by taking some time when admitting the patient to review all the records (sometimes helpful, sometimes not, depending on who was doing the documentation) and to discuss the plan of care with the patient and their family members. It is strange to deliver someone that you don't know well, and though I did experience this with some of OtherDoc's patients back in Whooville, it was not on the same scale.

Another adjustment I have had to make, and I think I may have mentioned this before, is adjusting to the "way of the group." Before, the medical decisions I made about patient care were mine alone, now I have 4 other physicians that have to be somewhat on board with a plan of care. Not to mention the way that they handle gestational diabetics and inductions is very different than to what I had become accustomed in the prior four years. Plus, when I order certain tests, sometimes another physician is the one that gets the results and then makes the decision on how to proceed. Scheduling inductions is also tricky, sometimes I can't schedule them for myself, and worry that I may tick someone off by scheduling someone on their call day.

Through all of this, I have noticed a strange new phenomenon. It isn't consistent, but I am starting to be able to "feel" who I am going to deliver. I know, it sounds completely bat shit crazy, but it is the strangest sensation. I just get this little gut feeling with certain patients that I am going to be the one that does their delivery. It matters not if I happen to personally like the patient or if the patient is one with whom there is not a strong connection. There is no basis in anything concrete, and it sounds so new-agey and non-scientific when I write it out like that, but, so far, each time I have "gotten that feeling" it has been correct. Verrrrry interesting. I will continue to observe as time goes on. Has anyone else, patient or physician, experienced anything like that before?

The really nice thing about getting my bearings and settling in to the new job is how well I am clicking overall with the patients and the nursing staff at the hospital. It is so great to hear the nurses tell me that they like the way I manage patients, or to have a patient tell me "You were my favorite, I hoped it would be you delivering my baby!" Very satisfying, indeed. Happy weekend, all!

Workin' on the Weekend

2010-01-23T08:43:00.004-05:00

Ah, weekend call. When I was in residency, the nurses would refer to it as the "3-day hostage crisis." I find this hilarious. And, in many aspects, true. In my former job, weekend call just seemed like a continuation of a long parade of call days that flowed seamlessly, one into another. I resented being held from my life on the weekends just as much as I resented the weekdays. Now, weekend call is a distinct, and separate being.

Weekend call for me consists of Friday, Saturday, and Sunday, starting at 7 am on Friday morning and ending at 7 am on Monday morning. Definitely a long, lonely stretch. Blissfully, the Monday after weekend call is mine, all mine. So there is always a break on the horizon, which, sometimes, is the only thing that keeps me going! Hospitals have a different overall feeling on the weekends. The pace is slower (usually) and generally, not a lot gets done. This even extends to Labor and Delivery. While it is true, babies have no concept of weekends or evenings and tend to come whenever they damn well please, but there are no elective inductions, no scheduled C-sections, and most patients are eager to leave the hospital.

The best thing about weekend call, for me, is the ability to spend as much time as I need to on Labor and Delivery, without feeling rushed. Weekdays usually will have scheduled C-sections at 7 am or 12 noon (sometimes both) and inductions can range from 1 to 3 for our group, there are circumcisions to be done, patients to be rounded on, not to mention a full slate of office patients for the day. Getting it all done can feel impossible, even when there are other partners there to divide the work. Splitting work can also be stressful, wondering if all the patients were seen, or if someone got missed in the shuffle. On the weekends, there is something peaceful (or is it merely resignation?) about knowing that, come what may, *you* are the one responsible. Sometimes it makes me wonder if I would prefer being a "laborist," because I really love the ability to stay on L & D, close to the action.

Some mornings there are just a few patients to see, and I can sleep a little later, and spend a lot of time with each person. Other mornings, there are many patients to see, but the pace doesn't necessarily have to change. Following the cardinal rules of deference to the call gods, I never make a single plan for my call weekends. If it happens to be slow, we spend some lazy time as a family together at the house. If it is busy, then I can take up residence in one of the (really, way too nice) call rooms where I can read, flip channels, and watch laboring patients simultaneously, or I can hang out at the nurses' station, chatting and getting to know my co-workers (and usually get access to some really great food, the staff definitely eats well on the weekends!)

So, while I still get a little wistful when I hear of others' fun weekend plans on the weekend that I have to work, I am bolstered by the knowledge that my "day off" lies just on the other side of the weekend. I am further heartened to know that weekend call is only once a month, leaving 3 other weekends wide open for fun plans of my very own, without fear of the dreaded page from L&D. WTF is wrong with me? I never thought I'd see the day when I appreciated weekend call; I must be getting mellow in my old age! Working or not, I hope you all have a wonderful weekend.

New Year, New Me

2010-01-09T12:39:00.004-05:00

Year after year, I have seen resolution after resolution fall by the wayside. We always start the new year with the best of intentions, but, more often than not, our perfectionism gets the best of us. We inevitably fall off the wagon, then, once off, tend to wallow in the mud. I will say that I have not been perfect, but instead of wallowing, I have picked myself up and tried to be better. Since starting my new regimen, I have lost 15 pounds, 6 inches from my waist, and 4 inches from my hips. I also ran in my very first 5K (boy, is my body pissed off about that one!) So my resolution for 2010, is much the same as every other year. To be a better mother, doctor, friend, and person. But this time, when I inevitably fail, I won't give up on myself as a lost cause. I will dust off and persevere. I know I can do this, and so can you. 2010 is going to be a great year, and I hope to be able to share more stories with all of you.

I am six months into my new position, and I cannot believe the difference. I am still working very hard when I am at work, but when I come home, I am home! I see my kids, we do normal family-type things. We have *plans* each weekend! The days that I am on call, I expect to stay in the hospital, but luckily, those days only come one week day per week and one weekend per month. The past four years are becoming more of a dim and distant memory. I have no idea how I did it, besides sheer adrenaline. I remembered that when I thought that I might die in the last mile of the 5K that Mr. Whoo and I ran together. If I can survive those 4 years of stress, I can survive a measly 3.1 miles.

Recently, I discovered that a woman that I know from college is a patient of our Ob/Gyn practice. This is a bit of a sticky-wicket for me ethically. We weren't the closest of friends in college, but we knew one another well, she is my face.boo.k friend, etc. I find myself worried to death that something will go wrong with her pregnancy, and that she will feel like it is my fault. So far all is going well, and she is excited that I am part of the group taking care of her. I, however, am petrified. The closest thing I have come to before was being a physician for the nurses with whom I worked in the hospital. At least they knew me as a professional *before* becoming my patient! Anyone else out there with advice on how to handle being a physician for someone who knew you before you became a doctor?

P.S. Whoever keeps commenting with Asian characters/links/advertisments, would you please CUT IT OUT? I will not publish these comments, and they are cluttering up my message feed. Ugh.

The Almighty Call Gods

2009-11-30T15:30:00.005-05:00

Any one in medicine, or with a loved one in medicine already knows that we tend to be a superstitious bunch. Funny, since you would think that people, who are, in general, so scientifically minded, would scoff at silly ritual and the whims of fate. *Everybody* knows that you should never, ever say that you are having a "quiet" day or an "easy" case. And, what ever you do, you should not piss off the forces that are better known as the "call gods." When you are on call, especially in L&D, you never know what kind of call you are going to have. Some days and nights are smooth and easy, and some are absolute hell on earth. You can be certain, if you you are having the latter kind of call, that you have transgressioned against the call gods, and they are exacting their wrath upon you.

How exactly do you anger the call gods? I'm not entirely certain of all the ways one can anger them. One way is to plan to do something, anything at all, on the day/night/weekend on which you are on call. If you make plans other than sitting at the hospital on your call day, it tends to blow up in your face. Another way is to get too comfortable, especially at home. Woe betide the on-call physician who dares to try to change out of scrubs into pajamas, take a long bath, or, heaven forbid, take a nap, for the call gods will smite thee mightily. I think another thing that rouses the wrath of the call gods is becoming anything less than vigilant about scouting potential customers coming in through labor and delivery or the emergency room. Your radar must always be roving for potential impending disaster.

For whatever the reason, or, perhaps because they felt bad for destroying me over my last holiday call, a Labor Day weekend 13 delivery-palooza, the call gods were incredibly kind to me this past weekend. I started with a full census, delivered one baby at 3 pm on Friday, discharged every single patient from the census by Sunday, did one consult on Sunday, and delivered another baby at 2 am this morning. I slept in my own bed for 2.5 out of 3 total nights on call. It was the strangest, most unsettling feeling. I kept checking my pager and the computer. I kept waiting for the other shoe to drop, but truly, it never did. That is, of course, until this morning, feeling safe from the call gods' collective hearing, I happened to post to fac.eboo.k that I had an eerily slow call weekend. Oh how my hubris was heard and met with a swift and mighty justice. Not 30 minutes later, I received a call from a sick colleague, requesting that I cover call tomorrow night in exchange for them covering my week-day call next week. Of course, I agreed. I am not looking forward to the kind of payback that the call gods have in mind for me.

Heeyyy Iiiiiii, ooohhh, I'm still alive...

2009-11-06T16:06:00.002-05:00

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!

Overheard in a Beauty Salon

2009-10-03T09:19:00.003-04:00

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.

Cool....and not so cool.

2009-09-03T21:07:00.004-04:00

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!

Stuck, stuck....STUCK!

2009-08-07T14:05:00.005-04:00

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.

In transition....

2009-07-22T22:46:00.001-04:00

New posts shortly, as soon as I get my head above these boxes!!

I guess that's why they call it "The Blues."

2009-07-10T21:58:00.005-04:00

So here I sit...alone, in a very empty, lonely house. Mr. Whoo, CindyLou, and the Bean are moved out and already in our new home city, while I sit here on my air mattress, waiting for my sentence to end. As a part of the agreement I reached with my current employer, I am being forced to serve one more term as indentured servant while OtherDoc takes his annual 2 week vacation. It has been a very rough week. The day that the house was finally packed, and Mr. Whoo and the kids had left for new city, my old, fat, girl kitty died. I have half a mind to think that she realized that we were moving again, and was going to be damned certain that she didn't have to go through it again, but it doesn't make it any easier. I found her curled up in her bed, as though she were sleeping, but when I touched her back, she was cold and stiff. She was old, and fat, but I just wasn't prepared to lose her just yet. The fact that I found her dead the same day that the rest of my family had left me alone in the house did not help matters one little bit. Poor Kitty. Poor me.

True to form, I have been inordinately busy, so I haven't much time to contemplate staying in our house all alone. I can't help but wandering through the empty rooms when I finally do get home, remembering all of the times when the rooms were full of us, our stuff, and our memories. Now, all that remains are those memories and faint impressions of furniture upon the carpet. I am alone, with my sole surviving kitty, an air mattress, a laptop, and a new set of books (The Sookie Stackhouse series). I thank God for the interwebs, facebook, and hulu. I have been watching reruns of "Dead Like Me" on hulu. If you haven't seen the series, I highly recommend it. It is a very cute show (despite the fact that it is about Grim Reapers and Death and the like.) I miss my babies, and tear up every time I hear their sweet baby voices on the phone. I miss my family so much that it hurts, and I can't wait to start the next chapter.

I have some hair-raising work stories percolating at the moment, and will post them within the next few days. It appears as though I will be going out of this job with a bang rather than a whimper. I have but a week left in my current position, a new horizon looms ever more brightly in front of me. I can't wait to share my newest adventures with all of you.

More Advice you Never Wanted to Hear: Residency

2009-06-29T00:25:00.003-04:00

Holy shit, new residents are starting on Wednesday! Residency, for me, was such a far cry from medical school. When I started residency, it was back in the "dark ages" of medicine. Read: prior to the (oh so benevolent) 80 hour work week. That's right. I worked 120 hour weeks in my first 2 years. Uh huh. I'm the monsta. But seriously...I did have weeks when I was on call Monday, Wednesday, Friday, and Sunday. 36-48 hours on, 6-8 hours off. It was unbelievable. Surreal. I often fell asleep in my bed after a (much needed) shower with a Smirno.ff Ice or Be.er in my hand. I remember holding a retractor for a vag hyst, in an oncology case, at 9 pm, when I was post-call. I had tears streaming silently under my surgical mask. I thought I was going to die. But, guess what? I did not die. Not physically, anyway.

Residency isn't as hard as it used to be, but the principles remain the same. Work. Your. Ass. Off. I mean that. In order to be a good intern/resident, you'd better work (now turn it to the left). Pay attention in morning rounds. Make check boxes and lists. Make sure the labor and post-partum floors are taken care of when you are the OB resident. Be sure that all Gyn cases are covered, pre-opped, and post-opped when you are the Gyn resident. Be everywhere at every time. Seriously. I mean this.

A good resident knows his/her patients. Labs are checked often. Notes are written. Labor progress is always recorded. Gyn patients are rounded on 4 hours post op, AM, and PM. Know your patients better than the attendings know them. Be able to regurgitate labs, post-op blood loss, and diet orders. Help your fellow residents and interns. Don't throw people under the bus. Work as the team. If someone isn't sleeping, then *no one* is sleeping. Divide and conquer. Be nice to the nurses. Round on the floors and give universal "Wal-Mart orders" to the floors before you try to lay down (IE. if they can buy it at Wal-Mart ~heating pad, Tylenol, Tums, fan~ they can have it!)

Help your junior residents, and teach them how to run the board. There is no such thing as a "little" case. Scrub in on as many surgeries as humanly possible. I don't care if you have seen a million c-sections, scrub in on the next one....it may be a C-hyst. You need as much surgical exposure as humanly possible. Especially now in the restricted 80 hour work week.

If you have to do research for your residency graduation...do it NOW. Do not wait until your Senior year when you are trying to interview for jobs, study for written boards, and get licensed. Do the research early. Just suck it up and do it. Be good to your nurses, and they will be good to you. Don't whine. Don't ever let them see you cry. Stick up for yourself. Enjoy your time off. If you are considering a family, residency is a decent time to have a kiddo. Just be ready for the way your fellow residents will treat you. Especially if you are in a small program. No one wants to work more than they have to work, but you may never have so many people to cover your absence again. Don't delay your personal and family life for residency. Take care of yourself. Don't eat those fries with a grilled cheese at 2 am because you "deserve it." Exercise. Leave your job at work. Stay in touch with family and friends.

Learn as much as you can. When you go out into the "real world" you will wish that you did more surgery and paid more attention in clinic. Even when it sucks, you can do it. Even when you think you won't make it, you will. One day you will look back and 4 years of residency will be over...seemingly instantaneously. You can do it. One foot in front of the other. Life on the other side is good. Keep moving.

The Letter

2009-06-17T19:21:00.001-04:00

Yes. This.

Glenn Beck - Current Events & Politics - Glenn Beck: The Letter

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Ass-vice: The Med School Years

2009-06-12T21:11:00.007-04:00

Oh yes, so where were we? Medical School. Everyone finds their path to medical school a bit differently, but once you are there? It is a completely new "ball game." Once upon a time, you were the best of the best. You worked the hardest. You got the best grades. You were the smartest person that your friends knew. Guess what? Once you get to medical school...everyone is the same as you. You are all the smartest, the most rigorous, the most dedicated, and, no, you cannot all be the best in the class. Perhaps, for the first time in your young life, you will be an "average student." Please don't let that kill your self esteem. You know what they call the person to graduate last in his/her medical school class? That's right...Doctor.

For me, I felt like once I got to medical school I could actually *breathe.* I had, for all intents and purposes, made it to the "end game." I did not go into med school with a super clear idea of the field in which I wanted to specialize. (Aside: I thought Dermatology would be way cool with awesome hours/lifestyle, but, much to my dismay, I came home disgusted every day from Derm clinic (and also with a case of ringworm before the rotation was over).

However, first things first. The first two years of medical school? They suck. Hardcore suck. It is massive amounts of information, crammed into your brain in ways you never thought possible. You thought you studied hard in undergrad? Freaking forget it. I remember that I would sit....cross legged on my futon in my apartment, hunched over my books and notes for 8-10 hours (after going to class all day), pausing only for bathroom breaks and meals. I would do this, and then I would make a B or a C, because I was in the middle of the (incredibly intelligent) class. So. Frustrating. Studying in medical school surpassed anything that I ever dreamed of in undergrad, but so did the parties after the tests. Crayzee. I made my first D in medical school. I failed my first class (Endocrinology) in med school. I felt lower than I ever had felt....until 3rd year. Once we got into the wards, it all changed. I was taking care of patients. I liked it!!! All of the angst of the first 2 years felt redeemed.

For those of you going into medical school knowing that you want to specialize in Ob/Gyn...you have a leg up. I had no idea who I wanted to be when I "grew up." I blindly stumbled through the blocks until I found something that I really loved to do. For me, it was Women's Health. I loved reading about it. I enjoyed the clinics. I was intrigued with the GYN surgeries, and, of course, delivering babies was the biggest rush in the world. I remember vehemently wishing that I didn't love it. I looked at the lifestyle and was scared to death. But, I knew, just knew, that being an Ob/Gyn was what I was meant to do. I wished it was different, but I couldn't fight how I felt.

If you do know that you are passionate about Ob/Gyn in medical school, get involved early. Look for research (ugh) projects with residents. Bust your butt on your rotations, make yourself invaluable to your team, and impress your attendings. You will need good letters of recommendation from at least a couple attending physicians, so do as many rotations and electives as you can do. Be highly visible. Scrub every surgery that you can manage to do, get your hands in on as many deliveries as you can, and offer (often) to run scut for your interns. Learn the lifestyle before you take the final plunge.

The good news for you is that Ob/Gyn, because of the lifestyle, isn't super-competitive like Radiology or Dermatology. You don't need AOA to get into a good program. If you are a good student, with good references, you will likely go where you want to go. I graduated in the top 25% of my class, and I got my first pick from the Match. So, again with the bullet points:

~ If you know what you want to do, get involved early.
~ Don't despair, the first two years suck for everyone.
~ Go above and beyond on your Ob/Gyn (and, really, every) rotation. Make yourself invaluable to your team (without being a PITA).
~ Find research opportunities through the residents and interns. Everyone needs someone who can research charts and compile data.
~ Be thinking about your letters of recommendation early.
~ Work hard, and the rest will follow.
~ DO NOT be a know-it-all, or do anything listed here.

Up next, how to survive your residency...with your sanity somewhat intact! :)

"I give myself very good advice..."

2009-06-07T20:14:00.007-04:00

"...but I very seldom follow it." I've been getting a few requests in comments and emails about advice for people in various stages of pre-medical and medical life. I think I have spilled a few kernels of (snicker) wisdom here and there within the blog, but I'm feeling froggy enough to try to organize my thoughts for your collective benefit. Since there are a million ways from point A to point B, what I will do is to describe what worked for me, and, if you are in a hurry, will bullet point the highlights at the end of the paragraph.

Elementary School

Joking! Joking! Ok? You people are way too serious.

High School

I wish that I could say that I was consciously preparing for a medical career even in high school, but in truth, I really wasn't. I liked science, hated math, and loved to read and write. For a brief time, I thought I wanted to be a lawyer...that lasted until I took a class in Law. I did make good grades, participated in a lot of activities, and took as many Advance Placement courses as my high school offered, so the better not to have to take them in college. Let me clarify that my parents had already prepaid for a state school, so I had no lofty aspirations of Ivy League schools. My fascination with my Anatomy and Physiology class led me to choose to be a Biology major in college.

~Make good grades
~Take as many AP courses as you can handle
~Have FUN (it may be the last time you are able...Hahahaha. Just Kidding)
~Get involved (volunteer, sports, music, student council, doesn't matter what, just do something else besides study!)

College

So, once I went to college, and chose to be a Biology major. I had to seriously consider my options for a career. I could be a research scientist, go for the PhD track, maybe teaching, or I could pursue the medical field. Once I had an inkling that I wanted to declare myself for "pre-med," I began to actively seek opportunities to volunteer. I worked at a hospital rehab center a few evenings a week, shadowed an (family friend) anesthesiologist during the summer months during surgeries. I also sought out other "extracurricular" activities, many of which involved leadership positions in my junior and senior years. When I was applying for medical school (back in the dark ages, though I imagine it is much the same now), the main goal for many schools was to find the "well-rounded" student. (read, *not* the person buried up to their eyeballs in books day and night).

Don't get me wrong, I did *plenty* of studying. I studied harder than I ever had before, and was fortunate enough to make Phi Beta Kappa, Golden Key, and Mortar Board. These things look good on a CV. Bio majors' classes were always Monday, Wednesday, and Fridays (so no four-day weekends) and usually started at 8 am. Oh, how my college self suffered, only being able to go out 3 nights a week instead of 5. I still managed to make great memories and go to football games, even if I didn't get to go out on as many Thursday nights as I would have liked.

I also did not take a class for the MCAT prep, and I totally wished that I had. I did my own prep, and did just fine (obviously), but I hate to think of how much better I could have been. I didn't even automatically release my scores until I saw them, I thought they were that bad. Luckily, it all worked out.

One thing that I always loved was being able to take some "non-major" coursework in the subjects which interested me, like Astronomy and Philosophy. My Biology major afforded me the flexibility to take a few classes "just for fun." I know that you can still go to medical school without a science undergraduate major, but it is more difficult to do. I couldn't imagine trying to get in all the pre-requisites for a completely different college *and* fulfill medical school requirements. I know people who did it, but I was far too lazy for that!

~Choose a science major (unless you are not lazy).
~Volunteer and expose yourself (not like *that*) to the medical profession in any capacity possible.
~Again, get involved! Leadership positions are a plus, as well, and you are going to need good people skills. (Trust me on this one.)
~Don't be a martyr. Yes, you are working hard, and no, your final exam isn't going to be as easy as making a giant cardboard Apple poster (no shit), but you ain't seen nothing yet.
~Study harder than you did in high school.
~Take non-major classes that interest you. This is your last opportunity to learn about something "for fun."
~Take an MCAT prep course.
~Again....HAVE FUN! I had a great time in college, and it was because my studies and social life were fairly well balanced.

Ok, I think I will stop here for tonight. Up in the next installment....ass-vice, I mean, advice for Medical School, Residency, and beyond!

Run, run, run

2009-05-23T11:08:00.004-04:00

I'm coming off of another 18 day stretch of call, and has it been a wild ride. Most of the time, even with the unpredictable schedule I've come to expect, it isn't very often that I have a true, chaotic dash to the hospital to tend to an emergency. I know about most labors when they are early in the process, and can mentally prepare to leave for the hospital at the appropriate time. By the same token, most surgeries are planned well in advance. Of course, babies have a way of surprising even the most prepared, and they seem to have conspired against me in the past few weeks.

Emergency Dash #1 - Sunday afternoon, approximately 4 pm. I was out with CindyLou, Bean, and Mr. Whoo at the park, enjoying the weather. I answered an outside page from a husband, worrying that his term pregnant wife (OtherDoc's patient) had been in pain for 8 hours, and was now spotting. Of course, they were told to head straight to the hospital, and I pondered, loudly, why anyone would ever need wait 8 whole hours to make that call??? Just go, already!

As we rounded up the kids and were preparing to head out for ice cream, I received a "911" page from Labor and Delivery. Sure enough, the woman from the phone call had just arrived to triage...completely dilated. No time to change out of my sweaty workout clothes or to drop the family at home, we sped directly to the hospital. I dashed into the room, introducing myself, and promising that I was not some random person off the street in workout gear. Luckily, they believed me (or were so desperate that they just didn't care *who* caught the baby at this point), I made it just in time to catch the crowning baby boy, a mere 45 minutes after I had first received the page from the woman's husband. After all was finished, I joined my patient family in the parking lot, and we all went for some much deserved ice cream.

Emergency Dash #2 - Wednesday morning, 3 am. Awakened from a dead sleep, my groggy, sleepy brain was immediately doused with the equivalent of ice cold water as I saw the "911" page from labor and delivery. I dropped my glasses and the phone before being able to return the page. When I did get in touch with labor and delivery, I found that one of my patients had arrived in triage. She claimed that her water had been leaking since about noon the day before, but she came in because she was having pain. She was completely dilated, oh, and the baby was frank breech....and back down.

If ever there was an "Oh Shit!" moment, this was it. I think I got to the hospital in about 10 minutes flat (it usually takes 15), and the whole time I was on the phone with labor and delivery, checking fetal status, talking to the OR, and arranging for the patient to be in the operating room as soon as I arrived. The poor family medicine resident that had been up on L and D "just in case" she delivered before I got there (truly a nightmare, as a back down breech delivery in an inexperienced operator's hands would almost certainly lead to a head entrapment) offered to scrub with me. We did a true, stat cesarean section, complete with the nurses pushing the breech up from below. Luckily, the baby perked up nicely, despite a very bruised posterior. We got into the uterine arteries on both sides, due to the low position of the breech and extremely thin lower uterine segment, but were able to control the bleeding. Mother and baby boy ended up doing just fine, but I think I may have aged 5 years that night.

Emergency Dash #3 and #4 - I'm including these stories because they were eerily similar to one another. Both women were inductions, both in the same labor and delivery room, both on the same day, one week apart. Patient number #3 was an induction for post-dates. She had a very rough delivery with her last baby, and was leery of hospitals and interventions, but she had gone to 42 weeks, our agreed upon "exit point." She provided me and the hospital with her very simple birth plan, and everything progressed very nicely. She was 4 cm dilated at 11 am, and she decided on an epidural for pain control, as the narcotics she received at her first delivery made her have unpleasant hallucinations. I was at the office, seeing patients, when I got the call from labor and delivery. Her nurse had just come back from lunch, and as she went to check the patient. When she parted the labia, she saw the baby's head! Patient #3 was feeling *nothing!* She was fast asleep! I navigated lunch rush traffic as best I could, and, thanks to her excellent epidural, made it in time to deliver the baby boy at precisely 1:03 pm. She pushed exactly twice. Once for the head, once for the body. No tears, no pain, no long hours of contractions. She and her husband were thrilled, as was I.

Imagine the eerie sense of dejavu, when I had another induction, exactly one week later, in the same room. This time the induction was for IUGR, and the patient was a first time mom. Her induction progressed very smoothly, as well. At 11:30 am, I called to check in on her progress. Her labor nurse had just checked her, found her to be 4 cm, and medicated her with IV pain medication. Imagine my surprise, when a mere hour later, I got a call from the same nurse...she had just returned from lunch and was preparing the patient for an epidural. She checked the patient, as she was feeling pressure, and surprise! She was 9 cm and feeling very "push-y." It was yet another zig zagging race through town, at the lunch hour, where I seemed to catch every single light and get behind the *slowest* drivers on the planet. It is time like these that I wish I could have some kind of special "Ob/Gyn" flashing light to put up on my car to get people to move the heck out of the way!! I made it to the room, where she was trying with all her might not to push. I checked, found her to be completely dilated, and she proceeded to push. She delivered a healthy, if small, baby girl at precisely 1:03 pm. Weird, right?? Kind of cool, though.

Emergency Dash #5 - Yet another Sunday, about 6 pm. I had just arrived home after taking CindyLou over to the neighbor's for a playdate. We were just sitting down to the dinner that Mr. Whoo had prepared, when, you guessed it, I got the "911" page from L and D. This time, one of OtherDoc's patients, a G13P11 (that means 13 pregnancies, 11 babies) who had been wanting homebirth, arrived at the hospital. She stated her water had been broken for a week, she was 34 weeks pregnant, and "the baby just wasn't coming out." She was 9 cm when she arrived on labor and delivery. Fortunately, Sunday traffic isn't nearly as bad as lunch traffic, and I was there in time to help the resident deliver the little 34 weeker. The delivery was the easy part. The hard part came in the way of a retained placenta and post-partum hemorrhage (a risk in those grand multips). Thanks to cyto.tec and a banjo curette, we saved her a trip to the OR. Both mom and baby needed antibiotics post-delivery, probably due to her being ruptured for so long, but both went home a mere 4 days after delivery.

So, that's what I've been up to for the last few weeks. Freaking out, growing gray hair, and aging myself by leaps and bounds. Luckily though, all these moms and babies did well, so it was worth it. To say nothing of the other things swirling about, old job, new job, selling the house, looking for rentals, etc. I feel like I've been running a marathon, minus health benefits and sense of accomplishment. So, what have you been doing these days?

Dear OMFH

2009-05-16T15:57:00.004-04:00

I'm writing you this letter because I know I'll never get to say any of these things in real life. You are a major contributing factor to why I am leaving this practice. This, I am certain, is no surprise to you. You are the *worst* office manager I have ever had the good fortune to know. From the beginning, you have viewed me as a threat to your husband (and to you) and have treated me as such. Your sabotage is blatant. From telling patients that they were not *allowed* to transfer to me, to conveniently *not billing* for procedures that I have done, to blatantly attributing payments meant for me to your husband...trust me, I know what you have done.

You don't know shit about running an office. You couldn't manage personnel if your life depended on it, and you let the inmates run the asylum. You say it is "inconsiderate" of me to make patients reschedule an appointment when they arrive 30 minutes late (without calling), yet is perfectly considerate (in your opinion) to let patients wait 3 hours to see your husband's nurse, as he is off at the hospital for another delivery. Oh yes, and it is also very *considerate* of patients to tell them they need to transfer to another office if they want to see me as their physician. Totally ethical. It is abundantly clear that the *only* thing you care about is money (really, $6000 window treatments and a new Mer.cedes every 6 months??) It is no wonder that your husband works like he does: 1) he needs to support your inordinate spending, and 2) I am sure he'd prefer to steer as clear of you as possible. You think that you are my boss, and can tell me who I have to see, but let me assure you, you have no power over me. I'm sure it gives you great pleasure that you are the one that makes the call schedule, and you relish not putting out the new schedule until half of the month is already over.

You treat my nurse, who is the best freaking employee in that office, like she is dirt beneath your feet, all the while claiming to be a "good Christian." You kiss the ass of the employees that sleep on the desk, shop online during office hours, and shirk their responsibilities. Your hypocrisy sickens me. Your faux concern is laughable, and I cannot *wait* to be rid of your fake, bitch ass. Every physician that interviews here, I am telling to steer the eff clear of you and your "office management." If the hospital had any idea how much money you were costing them, perhaps it would motivate them to grow a pair and fire your ass.

So, yes, mission accomplished, you have run me out of town, but you won't have another physician in my place to screw over and to split your overhead. As for your humanitarian shortcomings, "Judgement is mine, sayeth the Lord." I'd be making atonement, if I were you. Here's hoping that you get *everything* that you deserve.

Most Sincerely,
Dr. Whoo

To Get to the Other Side

2009-04-23T23:30:00.000-04:00

There are times in life when everything seems to fall right in to place, and then, there are times like now. I can see the shimmering oasis of a new life, just on the horizon. A better call schedule, closer to family and friends, a chance to work in a collegial (not competitive) environment, more time with my precious kids and husband, and a chance to grow as a physician. Between the oasis and where I stand, however, is a treacherous, rock-filled, rapid river, swirling and threatening my ability to ever reach the opposite shore.

Obstacle #1 - Our house is on the market, and we have shown it at least a dozen times. Yet, despite positive overall feedback, not a single offer. I don't mean to boast, but our house is a beautiful house. I love it. I was ready to buy it the second I walked through the front door, and I can't believe that everyone else that sees it doesn't feel the same way. We never thought we would have to sell this house. Maybe we should have thought about selling it before we bought it. If we don't sell before we move, we'll have a hefty house payment, along with any rent payment we need to pay in Newville. This alone will be a financial strain.

Obstacle #2 - Mr. Whoo has yet to find a job, nor procure an interview in Newville. Granted, he has only starting looking in earnest recently. However, he is looking for work in the finance world, which isn't the best place to be seeking employment given the current state of our economy. We have been fortunate that he was able to quit his job last fall when our family really needed it, but now we worry that the employment gap may cause an impetus with new employers. Plus, without an additional income after the move, there will be more financial strain on our family. (See Obstacle #1)

Obstacle #3 - My current place of employment is not letting me go without a fight. There have been veiled and outright threats of lawsuits and damages and liabilities for me leaving earlier than my contract had mandated. There is also the matter of giving back a portion of student loans paid by the hospital. The fact that we would have to pay back was not unexpected, however, the amount that we calculated is about half of what the hospital estimates. We are procuring the services of a contract negotiator and a lawyer, who seem to believe we have a case for inducement, but I'm having angina just thinking of it. Not to mention the fact that, if the hospital's calculations are correct, they want us to pay up in less than 2 months. Add more financial liability to the swirly, cold, and fast water.

Obstacle #4 - Emotionally, I am wrung out. I am completely exhausted, and barely hanging on by my fingernails to make it to the date I indicated I was leaving. Being on call, continuously, with only 4 days off per month (plus vacation time), has left me completely burnt out. I find it hard to drag myself to work and muster compassion for my patients. They deserve better than the doctor I am right now. My health, mental and physical, is suffering. The remainder of my contract is a mere six months, and by finishing it out, I can alleviate much of the financial burden of the above obstacles...for the price of my very sanity. I want to cry just thinking of it.

So, I sit here on the bank, pining for the oasis, and unsure how to navigate the obstacles that lie before me. Oddly, I am reminded of the "old school" computer game, "The Oregon Trail." When faced with a river, you can try to ford the river, float the river, or hire someone else to help you across. Right now, I am pining desperately for someone to throw me a life line, or at the very least, a strategy for surviving these treacherous waters. The best advice I can relate to our readers is to know what you are getting in to before you sign a contract. There is no such thing as a perfect job, and if it seems too good to be true, it, in all likelihood, *is* too good to be true. Caveat emptor...and pass the caulk.

*cross posted at Mothers in Medicine

Revenge of the Pregnant Women

2009-04-19T17:55:00.003-04:00

Oooooweeeeeeooooo. Scary, huh? Well, to a poor, unsuspecting, newly-recovered from the flu Ob/Gyn, it is the scariest prospect around. You see, for the first time (and I do mean, the very first time) in 4 years, I was oh-so-fortunate to have an entire 3 weekends off...in a ROW! The audacity! The outrage! Ohhhhh, and the payback. You see, 2 of those weekends were included on my vacation, which was less vacation, and more "how much activity can you cram into 10 days?" This was spent in the southerly regions and in Newville, the site of our pending relocation. The third weekend was Easter weekend, by some stroke of luck, I was able to convince OMFH to grant me the holiday off, to visit with Mr. Whoo's family in the Great White North. Easter weekend marked the beginning of the the Whoo Family's dalliance with "The Flu." It started with Bean, quickly moved to me, and took out CindyLou later on in the week. Mr. Whoo is the only one left standing, and he's starting to get that characteristic hacking cough. Surely, I thought in my fever-fogged brain, out of all that glorious time off, some of my patients would deliver in my absence. Much to their delight (and my relative dismay), they did not. Other Doc, throughout the whole of my vacation and time off, did not deliver a single patient of mine.

Instead, they all waited for me. So this week, between popping Day.Quil, Ny.Quil, and Mot.rin, I have been exceedingly busy. The day that I returned from vacation, I had an induction for post-dates (41 weeks and 6 days). She had received cervical ripening overnight and actually was really contracting well. About 5 minutes after I hit the floor, she SROM'd the thickest meconium fluid I had ever seen, this was followed by a 10 minute trip to the 60s for the fetal heart rate. I checked for a cord, couldn't find one, tried everything possible to get the kiddo to recover, and eventually went down for an emergent cesarean. The baby was out in less than a minute, and needed a little transition time, but ended up doing very well. Not the best way to start the morning. After finishing up the paper work and talking to the family, I saw a familiar patient roll up to the nurse's station...in obvious distress. She was supposed to have a repeat C-section later that week, but, she was in labor today. Back we went to the OR, where I delivered a 9.5 pound baby boy. I finally made it to the office that day around 3 o'clock.

The rest of the week continued in a similar fashion. There was a severe IUGR baby, born to a couple that struggled with fertility for a very long time. She was only 37 weeks, but the baby was measuring 32 weeks. We had watched the growth for the last few weeks, and it had steadily plateaued. The patient received only cerv.idil, but quickly labored and delivered a healthy, 5 pound baby girl. The placenta was incredibly calcified and quite small, so I felt confident the correct decision to deliver had been made. Unfortunately, there were a few inductions, one for preeclampsia and one for post dates that ended in late night cesarean sections. Both moms and babies did well, but I hate to have failed inductions. It makes me feel as if I have failed those patients.

Oh, and then the "weekend" came. My first weekend back since vacation, and, let's face it, I was already dragging from a busy week and a lingering illness, and OtherDoc had a similarly bad week. There were a million patients to round on, and about half a million circs (my favorite! Not.) I got the first call a little after midnight about patient at term with SROM. I had a little hope, as she did not want an epidural (score 1) and was only 2 cm when she was admitted (score 2!) Between my sick kids and being paged every hour from patients and from labor and delivery, very little rest was had between her admission and the call telling me that she was 8 cm at 4:00am. I arrived at the hospital right as she was beginning to push. Blessedly, it was a very nice, smooth delivery. No tears and a healthy baby. I'm sure my patients didn't appreciate being rounded on at 5 am, but I certainly wasn't coming back later! I did my umpteen circs, rounds, discharges, and spent the rest of the day trying, unsuccessfully to catch up on rest.

In the late afternoon, another "rule out labor" came in to triage. She had not changed her cervix, but she was post dates, and I decided to keep her for observation. I communicated several times with the nursing staff before I went to bed, and was assured she was "doing nothing." I took a Ny.Quil and was in bed no later than 10:30. Imagine my surprise when I received a page at 3:30 am telling me she was completely dilated. It was an all-too-familiar dash to the hospital in the middle of the night. I arrived, broke the bag of water, and she pushed out a beautiful 8.5 pound boy over an intact perineum. Once again, it was circs at 4:30 am, and rounds at 5 am. I have spent the rest of the day trying to recover. I am just now starting to feel human again. I really can't keep up this pace. I hope that I have done sufficient penance for my time off, and that the pregnant ladies are merciful tonight!

Placeholder

2009-04-15T16:15:00.004-04:00

Whoa! I just blinked and a whole month was gone! Sorry to be MIA for so long. You have heard it all before. Get the house ready to sell, try (yes, I said try) to leave the old job, try to arrange things for the new job, take the family to the extremes of the North and South for back to back vacations, oh, and you know, work a full-time, 4 days off/month job. Makes it difficult to blog, ya know?

It isn't for lack of material, that is certain. I have a million ideas rattling around my skull, but no ability to focus in and write. Shall I write about how my current job in Whooville is giving me hell about trying to leave my contract early? Or shall I write about how difficult it is to tell my patients that I am leaving...especially the pregnant ones, due after I am supposed to leave? How about writing on how I managed to not eat pasta for the entire of season of Lent, and still managed not to lose a single pound? (Oink!) Or how we still haven't sold the house and I am freaking out? Maybe I should write about how big my kids are getting, almost 5 and almost 2, and how I feel like I've missed out on so much. It isn't anything you haven't heard me bitch/moan/whine or complain about before. I know I have to get back in the blogging "saddle" again, but I am unsure of how to start. What do *you* want to hear about?

Oh, and happy Tax day. Heh.

Cleanin' Out My Closet

2009-03-13T22:12:00.004-04:00

With all due respect to Em.in.em (who I strangely love), it is not as interesting as he makes it sound. We are T-minus 3.5 months and counting from the big move from Whooville to NewCity. Mr. Whoo has been a packing machine (watch him get down), and we are getting ready to pack the first of our P.O.D.S. in anticipation of the move. Unfortunately, the closet has been begging and pleading for our mutual attention. We have been fortunate enough to be blessed with a home with a large master closet. Well, I guess I mean blessed and cursed, because every damn thing that does not have a home ends up in our spacious closet. Oh, shit! Company coming? Shove it in the closet. Stacks of paper with no where to put it? The closet sounds like a good idea! No time to deal with it now? Put it in the closet. And so on, and so forth for 3+ years and counting. Except now? We need to show the house, awesome closet and all. Not to mention the fact that we need to pack, and, my lord! Do we really need all of this *stuff*?

So, for the last few days, we have been working on the closet. I have been forced to go through all of my clothing, hanging on hangers in the closet since 1991. I am not kidding. There were clothes in my closet that I wore in high school, and I have the yearbook pictures to prove it. To me, this begs the question...why in the *hell* am I holding on to these clothes? For one, there is no hope in hell of me fitting into my old high school clothes...ever. And, even if I managed to get back down to 110 pounds soaking wet, would I really be wearing a flowered shirt from The Limited? Really? (Does that store even exist anymore?) I took the plunge, made some hard (ahem) choices, and managed to purge more than half of my closet in favor of donations to Good.will. Going through the clothes was kind of therapeutic and fun, in a way. I finally parted with the cute gray skirt I would wear out on chilly nights in college with tights, and the sundry "dressy" skirts I would wear to my sorority chapter meetings. There were a lot of good memories in that closet, and, hopefully, the clothes that I donated will go on to a new owner (someone that can actually fit into them) and be a part of their memories. I feel a bit anthropomorphic, thinking of my clothes this way, but hey, I am the girl who cried about packing away stuffed animals because I thought they would miss me (damn you Veleveteen Rabbit book!)

I am finding that the more of the clutter that we pack away, the clearer my mind becomes. I have loved visiting the past by sorting through old clothes and sundry items stashed in the closet, but I have also felt comfortable leaving them behind and moving on to better things. I feel good about moving forward, and I am happy to be getting closer to a new life...one closet at a time. I hope you all are well...Happy Friday the 13th!

Why I Do This

2009-03-06T00:00:00.001-05:00

Lately, for me, all you have been hearing is bitch, bitch, bitch about how this or that sucks big hairy balls (can't wait to get the misguided google searches on that one). So why, you collectively ask me, either outright or in your minds, do you put up with all that you do? Why not quit and become a garbage collector or something? This list, my friends and frenemies, is why:

~ Bringing babies into the world is, quite simply, awe-inspiring. I love it. It is so special and intimate, that moment when a family is born (and re-born), and I feel privileged to be a part of it.

~ I love helping women. Women are way too busy taking care of every one else to worry about taking care of themselves. It is good to have 15-20 minutes to sit and listen to women, and make suggestions on how they can better care for their own needs.

~ I like to *fix* things. I am, at heart, a fixer. I want to change things for the better, and being an Ob/Gyn allows me to do this more often than not. I find this infinitely satisfying when I can make things better through surgery or medical treatment.

~ I enjoy the continuity of care that being an Ob/Gyn affords. I love being able to deliver multiple babies for the same patient, and then be able to take care of their Gyn needs once childbearing is over. I like the lasting relationships the field can foster.

~ I like to do Gyn surgery. General surgery, to me, was overwhelming, but Gyn surgery affords me the ability to do a variety of cases in a limited area of the anatomy. The perfectionist in me enjoys the focus on one organ system, but there is always good enough variety to keep it interesting.

~ Procedures are fun. Not just surgeries, but colposcopies, LEEPs, IUD insertions, polyp removals, and endometrial biopsies are all very enjoyable, and the results are often immediately evident. Highly satisfactory.

~ There is a limited amount of pharmacology. For me, it is pretty much antibiotics, hormone replacement or suppression, birth control, anti-inflammatory meds, the occasional hypertension or diabetes med, and some anti-depressants. I loathe polypharmacy, so I enjoy the clean and simple pharmaceutical profiles that Ob/Gyn provides.

~ The patients. That's right, for all that they do to drive me crazy, it's the patients that keep me coming back for more. Be it the infertile woman that I helped to conceive, or the anemic, miserable woman whose ills were cured by a simple procedure or surgery, or even the chronic pain patient who got the correct diagnosis, treatment, and subsequent improved quality of life. I do this for the patients, plain and simple.

~ At the end of an exhausting day, I feel that I am making a difference and an impact for good in people's lives. That fact makes the unbearable actually bearable.

So, look, I love my job. I love it. For all of my whining, I wouldn't do anything else. I hope this answers the questions out there. Thank you for listening.

**cross posted at Mothers In Medicine

"Blah"ging

2009-02-21T22:38:00.004-05:00

Wow, I just went fifteen days without even thinking about blogging! Maybe that is because I have delivered 12 babies in the last 2 weeks, including my second set of twins for the month. I am very happy to have attended 2 twin births this month, both vaginal deliveries, one without an epidural (go mom, woo!). February has been filled with post-dates patients and big babies (though none coming close to my recent 11 pounder!) It has also been filled with more C-sections than I would like to have, but I guess my good run of vaginal deliveries had to end somewhere.

The word is out that I am leaving the hospital. The feedback that I have gotten overall has been really positive. By that I mean, people seem sad to be seeing me go, but they aren't being jerky about it. Most people are very understanding of my family and call situation, as well as the reason why I am leaving. It's nice to know that I will be missed by the staff and the patients, for I will surely miss (most of) them. We have been showing the house sporadically. Let me tell you, getting the house "show ready" with two messy kids and (let's face it) two fairly messy adults is a serious challenge. After every showing I get this huge surge of hope that we will finally sell the house. And then? Nothing. I know it is a bum market right now, but the thought of carrying this house payment with us after we leave is daunting. So much hinges on whether or not we sell the house. Will we buy or rent in NewCity? Are we looking for temporary or more permanent? CindyLou will be starting Kindergarten (!!!) in the fall, so we are trying to find the area in which we want to settle in the "right" school district. So much uncertainty is fairly uncomfortable.

The licensing process is dragging on and on, but I think I have it all pulled together. Now I just have to get it all submitted. I don't know how anyone could fake being a physician and get a medical license. I can barely get all the bases covered, and I am totally legit! I just can't believe how much I am being nickeled and dimed to death on all of the various and sundry fees. I've decided that New State will be our final destination for the duration of my medical practice. I cannot fathom going through the licensure process yet again.

Mr. Whoo, CindyLou, and the Bean are all doing great. The Bean is 18 months old. (Can you believe it?) He is such a little sweetheart. His language has really taken off since he got his tubes put in last summer. He loves books, and will sit in your lap, snuggle, and read books for hours! He idolizes his big sister, and while he cannot say her name yet, he calls her "sissy" in the most adorable way. CindyLou is a stellar big sister, and, at times, is very much a little mommy to the Bean. She is so smart and curious. She drives crazy with her constant jabber sometimes, but I suppose this comes naturally. Both Mr. Whoo and I often got the admonishment of "Talks too much!" on our progress reports and report cards! Mr. Whoo continues to be the best husband on earth. I don't know where our family would be without him. I feel so lucky to have such a wonderful partner.

As for me? I'm getting through one day at a time. I am still 2 steps forward and 2 steps back (Paula Abdul reference completely unintended, sorry!) with respect to weight loss. I still find myself turning to food for comfort at the end of a long, hard day. I keep seeing everyone with whom I went to high school and college (via facebook, mostly) all looking so fit and well rested, I veritably seethe with envy at times. I look ten years older than I actually am, not to mention 50 lbs heavier than I should be. I know better times are on the horizon; I just need to quit making excuses. Any way, I just wanted to check in and let you know that I am still alive and kicking! Now I just have to figure out 2 snazzy posts for MIM before next Friday. Hmmm....

Is Mercury in Retrograde or Something?

2009-02-05T17:47:00.002-05:00

Hello all, what a crappy week it has been. Is anyone else having "issues" this week? My week actually started out on a pretty good note. One of my patients, pregnant with twins, began to develop preeclampsia. We made the decision to augment labor (she was already contracting and 3 cm), and late in the evening I got to do my first vaginal twin delivery since residency. I was nervous because I am used to doing twin deliveries in the OR as a "double set up," just in case there is a need to emergently deliver the second twin by C-section. In Whoo Hospital, there are no ORs on the L&D floor, so the deliveries are done in the room, and, should an emergency arise, you have to go down several stories to the OR. In a situation where minutes and seconds are precious, this is a daunting thing, especially as the night wore on and I realized that she would deliver in the dead middle of the night (aka skeleton crew time). Luckily, it was the smoothest twin delivery I'd had or seen in a long time. The first baby had no complications on delivery, the second baby stayed vertex, we broke the second bag of water, and baby number two was born about 5 contractions and 2 pushes later. Both babies and mom did wonderfully well. It was truly an amazing experience, and I was happy to be a part of that.

After that, though, it all went downhill fast. Of course, due to the middle of the night delivery, I got very little sleep. Therefore I overslept, and was later than I wanted to be getting to the hospital. Waiting for me there was a consult for the ever dreaded "pelvic pain." Before I get roasted about pelvic pain, let me emphasize that yes, it exists. Yes, there are gynecologic causes. Yes, it is not always supratentorial (all in the patient's head). But this patient definitely had supratentorial pelvic pain. She was already on a cocktail of narcotics and benzodiazepenes, and she spoke of severe excruciating pain in the calmest of voices, her pulse at 60, blood pressure at 90/60. Her exam was completely normal, as were her labs and imaging studies. She blithely asked me to "go ahead and do a hysterectomy while she was "here" (IE admitted to the hospital for pneumonia)." I blithely declined, set a follow up appointment in the office, offered medical suppression for her cycles (got denied), and asked her to sign a medical record release to obtain information from her prior ("out of state") physician.

Already in a *fantastic* mood by this point, I proceeded to the office. Where my right hand woman, SuperNurse, had slipped on the ice in the parking lot and (unknown at the time)broken her leg. For a while she tried to walk on it, but we all finally convinced her to go get xrays. So then, I was stuck with NotSoSuper medical assistant, who may well be the laziest person on the face of the earth. Any one who has worked in an office knows that the nurse who assists you can make or break the flow of your day. This day was definitely broken. The afternoon dragged on with the most draining kinds of patients around including such hits as "every organ system bothers me, can't you just wave a wand and fix it?" and, after a "routine" annual, a 20 minute nervous breakdown over the (unfounded) perception that her female anatomy was somehow horribly disfigured, and she wanted vaginal reconstructive surgery, not one but two Op.rah inspired "natural hormones" consults, and, last, but certainly not least, a patient with known cancer, sent to me by her radiation oncologist for a "skin tag" removal, that I am almost 100% certain is a vulvar carcinoma. Good times, good times.

Then, after a long, hard day already at 5pm, I log on to the internet to learn that one of my friends that I knew from middle school, high school, and college had taken their own life, and leaves behind a small child. I was shocked, then dismayed, and am still very sad over the whole thing. Just terrible news. Mr. Whoo had his community service club meeting, so I kid wrangled alone for bedtime and bath time. Exhausting. To top all of the rest of the day off, after being unnecessarily snarky when I had meant to be funny, I had a misunderstanding with one of my friends, feelings were hurt (I believe on both sides), and now I am getting the technologic freeze out which isn't very pleasant, either.

I am still struggling with the license application for obtaining my medical license in New State. So far I am out almost $1000 in various fees and I haven't even submitted the application proper (which will be $5000 +). We haven't sold our house yet, we haven't begun packing, I'm still over weight and not losing, despite my best efforts, and for extra fun, I have decided to cut all alcohol consumption for the month of February. Oh yes, and I am on call this week and all weekend long. So yeah, my week has pretty much sucked! How about you all? Am I the only one?

So, Anyway

2009-01-27T14:32:00.005-05:00

Where were we? Oh yes, my gigantor baby story. VM has been my patient since I started practicing here in Whooville. I delivered her first baby shortly before the Bean, so imagine my surprise (and hers) when she came to me last spring, pregnant with her second child. VM had gestational diabetes with her last pregnancy, but it was very well controlled with diet. This pregnancy was a different story. We tested early, and began the diabetic diet and teaching very quickly, but her sugars waged out of control for a good 2 weeks. There were some ups and downs with her insulin control, but we finally struck a good balance. She remained well controlled for the remainder of the pregnancy...on paper, any way. Long about 36 weeks, VM's fundal height began to measure larger than her dates by more than 2 cm. (2 cm above gestational age or 2 cm below are considered in the "normal range.") The ultrasound revealed a fetal weight extending into the 90th percentile.

Due to her early gestational age, we decided to observe the fetal growth and aim for induction of labor at 39 weeks (the week after Christmas). All progressed merrily, with an ultrasound at 38 weeks predicting an estimated fetal weight of 10 pounds 7 ounces. "Ha ha!" we laughed. How *funny* that would be if it were *true*? In the back of my mind visions of shoulder dystocias danced in my head, but I kept repeating the mantra that "Macrosomia is not an indication for induction." over and over until the voices were quashed. VM presented for induction of labor for insulin dependent gestational diabetes at 39 weeks and 2 days. She received ce.rvi.dil overnight, and pit.ocin was initiated in the morning. Her previous pregnancy had been a spontaneous labor at 38 weeks, and had lasted a little over 4 hours. By 10 AM, VM was comfortable, with a good epidural, and she was *frustrated* that the baby had not been born already! I reassured her that induced labors were different, and that this baby was probably just a wee bit bigger than her last (8 pound 3 oz) baby. Right about noon, she began to feel the telltale "pressure." Sure enough, she was complete and at +1 station. She had no discomfort at all, and not much urge to push, so we turned back the epidural and let her "labor down." Nearly 30 minutes later, VM was ready to push. I remember that she was laughing, because she couldn't feel what she was doing. What she was doing was pushing like a champ. She laughed/pushed for about 4 contractions.

Then, the head completely crowned....and I just about died. It was a very, very, large head. The delivery was very well controlled, but the head just kept coming and coming and coming. I made eye contact with the nurse, and, mirrored in her eyes, I saw my own concern. She maneuvered the patient into McRobert's and prepared for suprapubic pressure. We wouldn't need it. The anterior shoulder slid under the pubic bone with only the slightest pressure. I think I actually breathed again once I felt that shoulder deliver. I lifted the small toddler, erm, baby into the waiting arms of her mother, and she cried and the baby cried with her. There was a very small second degree laceration that was easily repaired. The head circumference as 16", and the weight was 10 pounds 15.7 ounces. VM asked if she could "get credit" for having an 11 pound baby. "Without a doubt!" I said. So that is my eleven pound baby story; the largest baby I have delivered vaginally. (The largest by C-section was 13 pounds, ack!)

SO, what is the moral of this story? Well, I think there are a few things. For one, sometimes, despite all of the talk of ultrasounds being incredibly inaccurate in the third trimester, your baby *is* as big as the ultrasound says it is. But second! Even if your baby is ginormous, and you have to undergo a god-forsaken medical induction, you can still have a smooth, successful delivery. And third, as a physician, it reinforces to me that it is always best to prepare for the absolute worst, while trusting the process, and hoping for the best.

Thank you all...

2009-01-18T19:07:00.004-05:00

...for your support. You guys make me want to cry! Don't worry, I'm not going to stop blogging, nor will I change the way that I blog. I value this space, and I certainly value all of you, whether you agree with me or not! So, thanks again for all of the kind words. I was beginning to feel a little persecuted! Coming up...Dr. Whoo gets her first day off in 18 days, relocation woes, and an 11 pound baby (!). Thanks for reading!

Commentary

2009-01-15T21:03:00.003-05:00

There were a couple of comments from sarai on my last post that were rather lengthy, so rather than leave them in the comment section, I am posting them both here, in their entirety, along with my response. Italics are sarai's words, and the regular text words are mine

It can be very hard for the patient however, after having the doctor be wrong numerous times over the years with drastic consequences to your life. I don't watch Oprah, and the articles you mentioned irritate me, but yes, I do look for reputable internet sites, and before the internet was available, I researched.

sarai, I realize that your postings are coming from a place where you have been burned by the medical profession, but I certainly do not believe that physicians are anything more than fallible human beings who will make mistakes. That was not the point of the post.

That doesn't mean that I approach the doctor like I know more, and like I expect them to act as my puppet. But if I go to an OB appointment and say my baby isn't moving as much, and I am concerned about placental insufficiency, for example, I DONT want to hear "you're baby is moving just as much, it just doesn't feel the same because he has less room". Excuse me, doctor, YOU are not the one that's actually pregnant here, DON'T tell me how much my baby is or is not moving. YOU are not the one that will have to live with a dead child if there is a stillbirth (which the medical world is completely unable to understand how to prevent) I and MY HUSBAND ARE.

I think you are misunderstanding me. I *do* appreciate an informed patient. As I stated before, I practice collaborative medicine, not paternalistic care. I take my appointment time with patient to educate them and talk about treatment options. I even have a list of reputable internet sites on which to research information. That is completely different than someone coming in (or better yet, just calling the nurse line) and telling me that they have already diagnosed themselves, and now would like me to prescribe this medicine or order this test for them.

Again, I know that you've been hurt, but I am not the doctor that didn't listen well enough to you when you knew something was wrong, so please don't cyber yell at me. Just because I may vent my spleen on anonymous blog about things that irritate me about patients does not mean that I quickly dismiss them or am rude to them, quite the opposite actually. I take my patient's complaints seriously and act quickly on alarming symptoms. The dismissive attitude you are attributing to me does not apply in real life. You only see the seedy underbelly of my brain here.

You doctors don't always know how many times in person's life a previous doctor missed something important and the patient paid a heavy price. The doctor may have done nothing wrong, they may have met the standard of care, but to the person living with the consequences, it just doesn't matter, and they will do anything they can (watch Oprah, read really stupid Reader's Digest, surf the net) to try to make sure they get more observant care next time around.

Yes, as I said, "we doctors" are not omniscient. I did already know the patient about whom I posted, and have been doing her GYN care for 3 years now ( and each time I did her pap, her small speculum was warmed and lubed). She is not new to me or my practice. My care of her has been as observant as can be. Doctors are human, we do our best, and sometimes, despite our best efforts, it just isn't good enough. It sucks, and we try hard so it won't happen, and it bothers us perhaps more than you will ever know.

As a nurse, I've seen term babies stillborn, (decreased fetal movement, doctor ignored, or minimized), diarrhea was actually Ecoli, which turned into HUS, by the time treated (after being sent home 3 times) kid had stroke and ended up needing kidney transplant, a "viral upper resp infection" was actually a bacterial pneumonia, doc wouldnt believe patient couldn't breathe well 'cause sat was OK, vomiting and increasingly decreased LOC was actually juvenile onset diabetes (also sent home a few time before ER doc figured it out -- kid almost died.) This may be why some people are reading articles and trying to advocated more vigorously for their own care. I know I am. Even as I feel sincere empathy for you as I see the look on your face when you see my internet sheets........

See above, and there are even term stillborn babies where there were *no* warning signs. No decreased movement, no pain, no bleeding, sometimes babies just die. We do everything we can to prevent it, but despite our best efforts, babies still die. Yes, there are physicians that dismiss patient concerns, or miss pertinent signs, but we are not all the same person. Advocating for your own care (what you are talking about) and telling the doctor what to do and how to do it (what my post was about) are two different things entirely.

And here's something that just kind of bothers me about your blog, which, BTW, I otherwise enjoy reading.........it's judgement both from you and commenters, about women's birth choices.

Well, I can't speak for my commenters, but part of my job is to regard "women's birth choices" with my own clinical judgement. That's my job. If women come to me for care, they are, in fact, asking me to use my clinical judgement in their care.

If I'm reading your blog right (and correct me if I'm not), the "ideal" expectant mother in your practice wants to go into labor naturally, not mind being past due date, and not object if you feel at the last minute she needs a crash c-section. Moms who want to be induced (God forbid a week or two early) prefer a c-section straight off, or "insist" on a "happy vaginal midwife birth" even if things don't go according to plan are subjected to the eye roll.... Kind of a tall order, Dr. Whoo.....

I don't know if there is a "right" way to read my blog, so who am I to say who is "reading it right" or "reading it wrong?" I do think that you may perceive my words in a more malicious way than they are intended, and this is probably only highlighted by your bad experiences. I vent on this blog when things get tough to take, a safety valve, if you will, so that I do not blow up in the presence of an actual patient. There is no actual eye rolling going on in the presence of my patients. No matter their circumstances, personality quirks, or clinical needs, they are treated fairly and equally.

Loosely speaking, my "ideal" patient (as you put it) doesn't exist. My guidelines for delivery, elective or otherwise, are dictated both by the standard of obstetrical care, my clinical judgement, and the individual aspects of each patient. What I expect of my patient is a relationship of mutual respect and trust. Those are things that must be earned...by both parties. There is no "laying down the law." There is a give and take that is natural in these kinds of professional relationships, and quite honestly it doesn't merit many blogging entries because it is so routine. I don't think that you understand, you only see so much of me here.

One thing I did NOT NOT want with my first child was a crash c section. Either a vaginal birth, or a planned section, didn't care which. Of course, doc wouldn't do a c-section just because I wanted one, so we had a crash vag delivery with vacuum, (baby crashed too late to get c-section) where I got to experience watching my firstborn be revived, separated for her for hours after birth while she stabilized, and was so sore and torn up that I didn't want to have sex for months and months, and still deal with stress incontinence since that delivery well over a decade ago.....but because I didn't go to med school I didn't get to decide what would be better for me. I would like to argue, both as a nurse and as a mom which was physically better for me -- ugly vag birth or planned c-section. Yep, I'd choose c-section. Sorry.

I'm sorry that you had such a traumatic experience, and that it still haunts you. There is no way to predict when something like that is going to happen. Crash deliveries of any kind are heart stopping, but it *is* the physician's decision, in that moment, what will lead to the best outcome for mother *and* baby. If there is a terminal deceleration, and the baby is on the perineum, it is much more likely you will get a better fetal (and maternal) outcome with an assisted vaginal delivery.

I'm sorry that your bottom got torn up, and you had to undergo the trauma of seeing your daughter (successfully?) resuscitated. But, if I'm reading correctly, your baby survived. If your physician did what you wanted them to do, what you *perceived* to be "physically" better for you, and did a c-section, your baby's brain could have been deprived of several additional minutes of oxygen, with possible disastrous consequences. Whose fault would it be then? Yours? No, it wouldn't, it would be the physician's fault, who let the clouded judgement of an overly involved party (read, you) make the call. Instead of a torn up bottom, you could have hemorrhaged and required an emergent hysterectomy, precluding any future deliveries. Would you take the responsibility of zero future fertility, just because you *wanted* a surgery? Or is that the physician's responsibility? So yes, when you put your medical care into the hands of your physician...in that critical moment...you may not get to make that final call on what you *think* may be best for you. That is what a physician is there to do.

The recovery from next delivery was even worse, crash section, nobody's fault, but if I had it to do over again, possibility of crash section or planned section, well, I'd choose planned every single time. The crash carries psychological scars --- many of them. If you are lucky, you get to go to sleep and miss your baby being born. If you are unlucky, you have to stay awake, with no one talking to you, while your baby gets CPR. and your husband is God knows where. Physically, its a lot harder, too, and wound healing is not nearly as good than it is when the surgeon has time to take his time.

Agreed, but the point is the same, you cannot always predict these things. You said yourself, nobody's fault. Precisely. Planned surgeries are often more controlled than emergent surgeries...but not always. There are exceptions to every single "rule." Again, I sympathize that you have had such traumatic experiences, but the neither medical profession at large (in general) nor I (in particular) are to blame for this. I didn't have the perfect, ideal, rainbows and orgasms births that I would have loved to have, either, but I was fortunate and had 2 viable, healthy babies. I wouldn't trade that for any "experience."

The reason that patients want to run the show is because THEY have to live with the outcome!!!!!!! Tell yourself over and over and over again, its not about me, its not about me, its not about me!!!! especially in your profession where the stakes are so so high.......

But in order to be safe, objective, and effective the patients cannot feasibly run the show! They can (and should) be involved in the decision making process and development of a treatment plan, and they can consent or not consent, but they *cannot* "run the show." That is what a physician is supposed to do. Run the health care show.

This blog *is* about me! How I feel about the things that I do and that I see. Here, in this little corner of the internet, it *is* all about me. That doesn't mean that I disregard what my patients want. It also doesn't mean that I haven't had to make a decision that a patient was not capable of making on their own.

Maybe they really want to be induced when they know YOU, whom I'm sure they all really like, will be there. Maybe they are tired. Maybe afraid of late 3rd trimester stillbirth. Maybe they are struggling financially and need tax break. Maybe already not able to work anymore and trying to maximize maternity leave. Wanting to be induced at 38 1/2 weeks is not a sin.

Perhaps it isn't a "sin," per se, but it isn't valid medically. There is a lot of research to read about elective inductions, especially prior to 39 weeks. Often the outcomes are less than stellar, both maternal and fetal. Wanting your own physician, or "being tired," or "being afraid," or "needing a *tax* break (!)" are not viable indications for medical procedures that can have lasting impact on fetal and maternal health and well being. Elective induction of labor is associated with higher rates of cesarean deliveries, fetal distress (and dreaded "crash deliveries"), and fetal hospitalization for various immaturity issues.

Take a page from your midwives book. Listen to your patient. Ask questions. Try to figure out what the patient is afraid of. What she values. Try "why is this so important to you?" instead thinking "I can't believe she wants to have her baby by Christmas!" Find out what other experiences she has had with other health care providers. Maybe the last doc that did a pelvic jammed a large cold speculum where the sun does not shine, and she thinks you respect Oprah more than her. And remember, if she wanted a midwife, she'd probably be seeing one, so try to tactfully ask what she wants from your expertise, if you feel like she is treating you like her puppet.

Not to beat a dead horse, because I'm already feeling nuts for defending myself for talking about the way I feel on my own freaking blog, but how do you know that I *don't* listen? You don't know. You don't know me. You don't know how I treat my patients. The last doc that patient had for a pelvic exam was *me*, and I did not jam a cold, extra large speculum into her.

I've found that being a patient and having really horrible medical experiences makes me a lot less offended by my patients. Because if a patient asks me "will the doctor use a small, warmed speculum like it says to in Oprah's magizine?" my first thought is not to roll my eyes, it is to ask, "what has your past experiences with pelvic exams been like...."

Unfortunately, having really horrible medical experiences makes you a lot *more* offended by the things that I say, anonymously, on this blog, and causes you to extrapolate and frame my commentary in a less than favorable light. I hope my response has given you some insight. And truly, for all the snarking on the blog, I never forget that my patients are just people, just like me, with a different frame of reference. Even if it doesn't translate in text, I'm certain it translates well in person. I wish you healing as you attempt to move forward from your painful past experiences.

Really?

2009-01-10T12:23:00.004-05:00

It's a new year, it's raining outside, I'm cranky from dieting, and OtherDoc has been out of town for a week. Do I need to provide anymore preface than that? That's right, time to vent!

It's weeks like this that I truly wonder why any sane person would ever consider being in the medical field. Money? Small potatoes compared to other professions. Autonomy? Hardly. Respect? A resounding "Ha! I don't freaking think so!!" I don't know about anyone else, but I am getting sick of hearing about what Op.rah thinks about my profession. This week a patient advised me (and I quote), "Well, Op.rah said to be sure you use the very smallest, um, sepulchre things, and warm it up, too!" Um, did you *really* just say that to me? Really?? Gee, I would have never thought of that without Op.rah's help. Thank you so much for enlightening me, O great one, in how to better practice medicine for my patients. News flash, I know, but I *already* use small *speculums* and I always warm them, too thankyouverymuch. I am already cringing about next week when all the people that watched her s.ex show on Friday call in for urgent, stat libido check appointments. Thanks a heap, O.

It's not just her jumping on the bash physicians bandwagon, though. I see magazine articles and news stories every day instructing people how to "Find out if you have a *good* doctor," or "Things your doctor isn't telling you," or "Medical horror stories, part 374." It makes me physically ill. Like we don't have enough on our proverbial plates, now we have to dispel the media panic surrounding our profession, as well. Why is it that you never see articles about "Accountants gone bad!" or "What your plumber isn't telling you (but should)"? It certainly doesn't help me out when patients come in with printed sheaves of website information instructing me on how to treat their perceived ailment, before I have a chance to take a history, do an exam, or any baseline lab work. It seems that physicians are being reduced to being the "gatekeeper" of health care, instead of the director. "Just shut up and give me what ever test, drug, diagnosis, etc. that I want." What is worse is that we get this from both patients and insurance companies, further restricting our ability to practice our profession the way we are meant to practice. Don't get me wrong, I'm certainly not of the mindset that physicians are omniscient. I practice collaborative medicine, not paternalistic care, but I see the shift even away from collaboration to patient demanded care, and it just isn't right.

This attitude is reflected in the patients each time they call to demand a Di.flucan prescription without coming in for an appointment, over the phone, even if they haven't been seen in the office for 2 years. Or women who delight in paging the physician at 2 in the morning to ask for the list of cold medicines to take in pregnancy because they "lost" the sheet given them in the office, because that's my *job*, you know? It is also rampant in the lay and medical blogospheres. The fear and mistrust of the medical profession is almost painful to read. Sometimes I have to sit on my hands to keep from commenting, lest I perpetuate the "doctors are assholes" perception. Especially in the birthing blogs, where the common thought is that Ob/Gyns are out to fillet every pregnant woman that comes through the door, just because they are evil, scum sucking doctors and not loving, caring midwives. Practicing medicine isn't what it used to be, and I find myself disheartened at the direction our role in medical care is taking. I see my colleagues (and myself) yearning for a job where we can turn off our brains after plugging in our allotted hours of time, instead of taking our work home with us and worrying about people who only see us as drug dispensing/test ordering automatons.

I still have the flashes of what medicine is supposed to be. I'll have a really great pregnancy/delivery with a patient, or I'll do a surgery that improves some one's quality of life, or I'll make a diagnosis that has the potential to alleviate suffering or even save some one's life. It is those few moments that keep me moving forward, doing what I've spent 12 years of my life training to do. Medicine used to be about helping people, but if the changes I see now continue on, medicine will soon be just another "punching the clock" kind of job. If that happens, my friends, then we all lose. Every single one of us.

Holiday Haze

2008-12-21T11:47:00.005-05:00

It's almost Christmas, a season that can turn the most placid of households upside down; so it follows that the chaos that exists on a daily basis in our house is multiplied three-fold during this time of the year. Shopping, cards, wrapping (or not wrapping as is our case), prepping the house, and controlling the building Christmas fervor from young CindyLou and keeping the Bean from upending the tree makes day to day life that much more, um, full. Ha.

Labor and Delivery is not immune to Christmas Chaos, either. Every induction slot is filled with patients hoping to check "have a baby" off of their pre-Christmas to-do list, much like the shopping for and wrapping of gifts. To be honest, I'm not really certain how I feel about that. Let's face it, no one, doctor or patient, wants to be in the hospital on Christmas Eve or Christmas Day. Doctors hope to spend those rare days away from the office with the people that they love, not in the nurse's station on L&D. Pregnant women with children want to be certain to secure the holiday for their children that have already been born. There are enormous familial pressures for these women to have their babies "home for Christmas." It makes for a lot of soft, elective induction calls, and sometimes, when a patient truly needs to have a baby for medical reasons, it throws everyone's nice, neat plans into a tailspin. I've seen a few of these holiday plans get ruined by a true medical emergency, and while it is unfortunate, sometimes I wonder if it doesn't serve us right for trying to control as much about labor as we do.

Personally, I have 2 patients due right around Christmas Day, one of whom has a potentially macrosomic baby, and, since they are both healthy and doing well in all other aspects of their pregnancies, we are not scheduling them for induction this week. I hope they will go into labor without medical assistance. It makes it difficult to make definitive holiday plans, given the unpredictability of my profession. OtherDoc and I try to split up Christmas Eve/Day, and New Year's Eve/Day, in order to get some of that time off with our families. I approached him about doing that this week, and he has not decided which days he wants to take call. I already worked the long Thanksgiving holiday, and I hope he takes that into consideration. I am almost giddy that I won't have to deal with this BS next year, and if I do work Christmas, I certainly won't be working Thanksgiving or New Year's. I. Can't. Wait.

So, I will end this rambling, no point post here. What ever your holiday plans may be, I wish you and yours a peaceful season. I enjoy sharing glimpses of life with you, and hope that you will continue to read here in 2009. Merry Christmas from all the Whoos down in Whoo-ville! :)

Done, done, on to the next one...

2008-12-11T21:28:00.004-05:00

Oh, my poor little neglected blog, how I have missed you. I am finally done with the oral boards...at least for this year. All I can think about is of what I should have said that I didn't (and what I did say that I shouldn't!) The exam was over quickly, mercifully, but the more I think, the more morose I become. No matter now, if I fail or if I pass, I shall not speak of it again on the blog. Suffice it to say that I am done and trying to get over it, and now must focus my attention to the holiday that is a mere 14 days (FOURTEEN DAYS!!!) away. I have cards, cookies, and call on tap for the weekend, along with a Christmas and a birthday party. Oh, and online shopping, the working woman's savior.

Our house is properly Christmas-ed, thanks to Mr. Whoo. We have made the the obligatory mall Santa visit, complete with non-screaming children in the picture, a coup! CindyLou is *beside* herself with excitement. It is so wonderful. To see her joy and wonder about Santa and the season does my poor, 3-sizes-too-small, grinchy heart so much good. Bean is fascinated by the tree and the lights, and while he doesn't quite "get" it all, he is loving the experience. Of course, my favorite moment of the season thus far comes from Mr. Whoo, explaining our nativity to CindyLou.

Mr. Whoo: "...and this is Mary."
CindyLou: "Oh! Like 'Mary Had a Little Lamb'?"
Mr. Whoo: "No, more like Mary had a little Jesus."

It was priceless...maybe you had to be there. Anyway, I'm back, and, if the pregnant ladies cooperate (ha), I will try to get back to more reliable posting. Promises, promises. :)

Don't You Forget About Me

2008-11-15T18:59:00.002-05:00

Although, I wouldn't blame you if you did. I know it has been over a month. I have a lot of great excuses that you probably don't want to hear right now. The long and the short of it is that I've been studying for oral boards, a lot, and working, a lot. When I'm not doing either of those things, I am lying upon my couch like a slug, it is my only defense (name that classic movie). In the meantime, I will post a link to my most recent post at Mothers in Medicine, and promise to be more present in the blogosphere in the coming weeks. Hope everyone is having a wonderful fall weekend!

In the Middle of the Night

2008-10-10T15:33:00.005-04:00

It's time for my husband's annual "man weekend" with his high school buddies. For almost a decade, he and his friends find a cabin in the woods somewhere and behave (I am assuming from the pictures) as 10 year olds...that drink. Junk food, video games, and staying up way too late are part and parcel of the festivities. They look forward to it every year, and I'm happy to have him go. (The wives have a "girl weekend" in the spring, just to be fair.) So when I found out that he would be out of town for a weeknight (when I am on call for my patients), I thought to my naive little self, what's the worst that could happen? Ha. Ha. HA!

So I went about my regular single parenting duties in the evening relatively unscathed. Picked up the kids, got dinner on the table while Bean protested loudly that it wasn't fast enough for him, wrestled two squirmy kids through bathtime, and got everyone tucked in by a reasonable time. Then I prayed really hard that I could make it through the next 12 hours without having to leave the house. The peace lasted roughly 3 hours. The first warning bell came as a page from triage. A 38 weeker, possible early labor, contractions 20 minutes apart. The triage nurse said she was pretty sure the patient was "not doing anything" but we decided to observe her and let her walk for an hour. My second warning came at 1 am. The patient had indeed changed her cervix from 1 to 3 cm. A definite keeper. "Ok," I pleaded with the nurse, "PLEASE keep her comfy and pregnant for the next 5 hours so I don't have to pack my kids up in the middle of the night to come to the hospital." The nurse was fairly confident that the patient was not contracting regularly, and could probably coast until morning. I settled into an uneasy rest...until 2:30 am. I returned the page, thinking that I was going to have to drag in to cover for the patient's epidural. Imagine my surprise and dismay when the nurse answered the phone with "She's 9!"

Shit. Shit. Shit. It was off to the races...throwing on scrubs, rousting the kids up in their PJs, and flying down the highway in the middle of the night. "At least it will be fast," I chanted to myself as I sped to the hospital. I deposited the kids with one of the nurses and stepped into the delivery room just before 3 am. The patient was completely dilated and ready to push. She hadn't even had a chance to get *any* pain medicine, epidural or otherwise, due to how quickly she had progressed. So, the patient started to push, and *then* all hell broke loose. The first push sent the fetal heart tones down to the 30s. Ummm, surely that wasn't right! I placed a scalp lead to get an accurate tracing...still in the 40s-50s. Scalp stim...up to the 60s. Oxygen, reposition, knee chest. Nothing would bring the rate back up. The baby was at zero station. Too far up for vacuum or forceps. We tried a few pushes, but the head wasn't descending fast enough and the heart beat was a slow tick, tick, tick of a baby running out of time. After a quick verbal consent, we called the OR to let them know we were coming down for a crash section. "We aren't ready!" they said. They had another case going and needed to call in a team. "No time for that," I said, "This baby needs to come out now."

We ran the patient to the OR. The staff assembled a rag-tag team of recovery room nurses, opened the crash section cart, and haphazardly prepped. There was no time for a foley or to count instruments. Every second felt like an hour, though only 5 minutes had passed from calling the section to draping the patient. The patient went to sleep, and we got the baby out in less than a minute from the skin incision. She looked like a *million bucks*! She squalled as soon as she left the womb. She was pink! and happy! and had Apgars of 8 and 9! and didn't look at all like her strip suggested. I had truly feared the worst, the last terminal decel that I had seen like that, the baby had anoxic seizures after delivery. Luckily, this baby was great. The collective sigh of relief was audible in the room as I placed her on the warmer. The rest of the surgery proceeded smoothly, and I was happy to let the family know how well she had done.

As for the kids? I ran back up to labor and delivery to find them happily snacking on graham crackers and juice. CindyLou was entertaining the whole floor, and she kept saying how she wanted to be a doctor "just like mommy." (Oy.) We got them gathered together, I thanked the nurses profusely, and drove back home. "I like to go to your work, Mommy" Cindy Lou chirped, "It's still *night time*!" Once at home, the kids went back to bed without a fuss, and I crashed into the best 2 hours of sleep of my life.

The moral of the story? I survived! It could have been the worst case scenario, but we all made it. The kids did fine, the patient did fine, the baby did fine. It could have been a disaster, but it wasn't. I am ever so grateful for that, and never have I been so convinced that I *never* want that to happen again! Scary things do happen in the middle of the night, and sometimes the outcomes are not as good. I'm thankful for the nurses and OR staff that did what they could to make the surgery happen quickly enough. I'm grateful for the compassion the nurses showed to me and my children by caring for them when I had to care for someone else. Most of all, I am so thankful that my kids were able to take it all in stride and go with the flow. They are pretty amazing. I hope you all have a wonderful weekend, and are not bothered by scary things in the middle of the night.

Running on Ice

2008-09-19T14:00:00.005-04:00

Where does the time go
Spinning my wheels
Standing still
It's like running on ice
I only gain a little distance when I fall

How did I become a molecule
In the concrete of this city
Indifferent to my endless motion
In a space too small to see
Nonetheless expected to be
I only get a little attention when I fall

Chorus:
And I'm falling
Falling down
Falling
Falling down

Cursed with reason
In a world so defiant
Without conclusion
This is the story
The story we live out
And it is the moral too
Look at me I'm falling for you

Shaking, crying
Hating lying to myself
I'm tired of telling myself it's OK
To be this tired
This sick and tired of the turns the world takes
And the people that it makes us be

And lately it appears to me that I'm falling down... --"Falling Down" Vertical Horizon

I searched the internet for a complete sound bite/you.tube of this song, because the lyrics, while fabulously apropos to my situation in life, are nothing without the frame of the song. Alas, this song is so old/obscure, it hasn't even an entry! Anyway, 'tis a great song, and it sums up very nicely how I've been feeling these last few weeks. A whole lot of running without a lot to show for it. We have received contracts, had them reviewed, and have all but signed one on the dotted line. Yes, I believe I have found a new job and the start of a whole new chapter in the life of the Whoo family. Hopefully for the better! We have also begun readying the house to put on the market, and begun research on daycares and houses in NewCity. I feel like I can't totally relax until the ink is dry on the paper, yet I am anxious to move forward. It is an unsettling place to be.

My grandfather passed away in the middle of all of it, and I think I am still coming to terms with the loss. Trying to explain death and dying to a four year old, while trying to keep yourself together is quite a task. CindyLou cut straight to the heart with several of her questions. (Why did he have to die? I liked it when he was alive. Are *you* old/sick? Why do people die?) We tried to be as direct as possible with her, but damn, that was hard. I'm also sad for my grandmother, who has lost her partner of nearly 60 years. It breaks my heart to see her try to pick up the pieces and move on. This loss has also solidified in my mind how important it is to seize this day/this moment, for we may not have a tomorrow.

As for day to day life, we seem to have found a nice groove lately. My schedule has been miraculously corrected (and it only took a couple of years of whining, begging, and groveling), leaving me a little more breathing room at the office. As a result, I've been getting out of the office on time, getting more home time with the kids, and am having, in general, more satisfaction in life. It's funny that everything started improving once I had made the final decision to move on...like an abusive relationship or something. It makes you a little wistful for "what could have been," but it doesn't change the malignancy lurking just beneath the surface. I know the best decision for our family is to move upward and onward from here, but we will have fond memories of this place.

Also, fall is here, my very favorite season, and along with it, college football! Yay for cooler weather, changing leaves, and sweaty men fighting over the pigskin! I'm also really enjoying my most recent crop of patients. I have several this month committed to laboring on their own, and not pestering me for induction starting at 36 weeks. Also in the coming month, I will (hopefully) get to deliver the 3rd baby of one of my favorite patients (I got to deliver 1 and 2!) I feel so privileged to play a part in helping their family grow. So, for now, I am happy. Moving forward in life, enjoying my family, and looking forward to better days ahead. Life is good.

Response

2008-09-03T18:03:00.006-04:00

This is a response to the scathing comment below from a very "brave" (ha) anonymous poster, 9/3/08, 5:06 pm. Actually, I *am* quite fed up and burned out. It comes with the territory of being taken for granted and treated as less than human. Chances are, your physician(s) are too, whether you get to see it or not. I'm all about patient education, in the office, during normal work hours. Not at 2 am in the morning. Sorry, and I don't think you'll find another professional around who would be happy to "educate" their clients about trivial things in the middle of the night. (Just try calling your plumber to ask them which drain cleaner is best at 2 am, see how far you get.) Again, it's people like you, who seem to think that doctors should be superhuman, that are driving physicians out of the practice of medicine...in droves. Also, anon nasty poster (9/9)that I chose not to publish. I'm glad you aren't coming back, and it is *my* blog, so *of course* it is self centered! Geez. Apparently *some* people don't get the concept of venting!

Annoying Things

2008-08-29T18:12:00.007-04:00

I think I've been more than a tad touchy these last few weeks, as I contemplate major upheaval in my career and family life, so maybe I am noticing things that bother me more often. Never the less, I am going to post annoying things that people say and do that really piss me off, since it wouldn't be *professional* to say it to their collective faces.

~ Any referring physician (ER, family medicine, pediatrician, all are offenders) that tells their patient with unexplained lower abdominal or pelvic discomfort and a normal exam and ultrasound that 1) "You must have had a cyst that ruptured." or 2) "You probably have endometriosis."

First of all, sometimes, you can just have pain in a certain area with no pathologic explanation. Some people have pain when they ovulate, or right before their period, or when they move the wrong way, or have sex 3 times a day, every day (yes, one patient referred to me for vaginal irritation and pain admitted to this...hmm, wonder why you are so sore???) Second of all, there are a whole bunch of different things that reside in the lower pelvis, including bowel and bladder, both of which can be causes for significant pain in their own right. Why every woman with low abdominal pain must have a "female issue" is totally beyond me.

It isn't that women with pelvic pain shouldn't be referred, they absolutely should be seen and worked up by a specialist. However, I have found that these two phrases mentioned above are physician code for "I have no idea what is causing your pain, but instead of saying that, I'll scare you into thinking you have ovarian cancer or a chronic disease." Because that, my friends, is what the patient hears, and is scared to death until they come see the GYN, so much the better for all involved.

~GYN consultation in the hospital "for pelvic exam." I kid you not. Apparently I have been doing it all wrong, doing my own cardiac exams and lung exams on my patients when I should have been consulting cardiology and pulmonology. How silly of me! What, the patient hasn't had a pap in 4 years, has a broken femur, can't move her hip, and is on her period? Why *don't* we "just do it while she is in the hospital?" Freaking fabulous idea. Thanks, alot.

~"Annual Exams" that really aren't annual exams. By that I mean, I made an appointment for a routine health screen, but what I really meant was that I just had my pap and breast exam at the health department last month, *however* I think my boyfriend is cheating on me, and I need tested for all STDs, and it has made me really depressed (I think it is my hormones), and by the way, I have no libido....can you please fix me in 15 minutes??

~Referrals for a "dropped bladder" (gotta love that technical term) on patients that weigh 350+. There isn't a surgical procedure in the world that can combat the overall gravitational forces working on those bladders. Never mind that most of these patients also have multiple medical problems, making surgery a veritable nightmare to begin with, and if you mention losing weight to help with their incontinence they wonder aloud why you "can't just fix it?" Oy.

~When men come into the exam room with their wives/girlfriends, etc., proceed to speak for them the entire visit, ask to "look in there" when you are doing the pelvic, and then finally, when you have your hand on the door, reveal that the "real" reason they came was because he thought there was something "wrong with her" because she doesn't want sex as much as (the guy) does. Gee, I just can't imagine why she isn't all over you, buddy. Nice.

~People who tell patients (pardon the poor grammar, but this is verbatim) "Just call your doctor if you have a question, that's what they are there for." (or the variation, "that's what you are paying them for."). Actually, your physician is "there" to provide health care and ensure that you (and, if pregnant, your baby) are well.

They are not "there" so you can page them at 1:40 in the morning (this is an actual call here) when you notice that your right breast is just slightly larger than your left, and you wanted to be certain that was "normal." Also, "you" are very often *not* paying your physician to answer after hours phone calls, and neither is your insurance company. They are answering your questions *for free* on their own, scarce, precious home and family time. (Oh, what, you think that answering ridiculous phone calls are just "part of the job?" Then why do lawyers get to bill by the hour, phone call, and email? Why is a physician's time and expertise any less important?)

So quit thinking that doctors are automatons with no lives, that never sleep, who "deserve" to work for free, and live only for the next breathtakingly inane page about your deep ruminations about your inner workings, You're wrong. And amazingly inconsiderate. If you aren't bleeding, losing appendages, or dying, save your calls for office hours, please.

~Finally, the most annoying thing of all...being on call for the whole. long. holiday weekend. There's nothing quite like having someone wish you a great "weekend off" when you know you'll be living at the hospital and fielding midnight phone calls while every other American in the free world is getting their drink on, living it up with parties, picnics, festivals, and sleeping in. Bitter, bitter, bitter am I.

Luckily for me, (and you, I imagine) a change will soon be coming. And not a moment too soon. Thanks for letting me get it off my chest...oh, and have a great Labor Day weekend. Heh. :)

The Evolution of a Pregnancy (a conglomerate of myths and multiple patients, seen through the years)

2008-08-16T12:23:00.010-04:00

Pregnancy is supposed to be a sort of "golden time" in a woman's life. The media tells us this in softly muted images of unblemished bellies and serene smiles. Our own family members knowingly wink and talk about how grand their pregnancies were and how "you don't remember the pain" of labor once you are holding your little (angelic and sleeping) bundle of joy in your arms. Before you become pregnant, the state of gestating a life seems almost mystical, magical, and other-worldly. It seems like somewhere you really really want to be.

Then, you take the plunge, and if you are lucky, you become pregnant. It is then and only then that you realize you've been duped! All the blissful, sighing moments you imagine in your pre-pregnant state are replaced with the bitter reality of puking your toenails up morning, noon, and night, or breasts so sore that it hurts when someone dares to *look* at them. The heartburn burns a path from stomach to esophagus so fiery, you are certain that the 9th circle of hell is cooler, and the mind numbing fatigue turns you into a zombie.

Then, your family and friends, so encouraging prior to your pregnancy, suddenly morph into this raging band of harpies...right before your very eyes! Then, the "advice" and the subtle "judgement" from all sides. Oh, I *never* got sick with *my* pregnancy. Not one time! Are you sure everything is ok? Wow, are you sure you are pregnant? You just look chubby! You don't look like you are gaining enough weight. Oh, no, no, no! You are gaining *way too much* weight! You should always... You should never... You are going to eat *that?* My husband's sister's cousin's best friend's aunt had a miscarriage because she ate too many hot dogs, you know. What was the heartrate? Oh, then it is definitely a boy/girl/fire monster. Face it, people are mean to pregnant women.

Dutifully, you make lists, and bring them to your obstetrician, who spends a good 10 minutes each session systematically de-bunking the myths and reassuring you that the soft serve ice cream that you had last week will not, indeed, turn your child into a four-headed fire monster. As for the heartbeat, naturally it is faster when the baby is smaller, and slower as the baby grows. NO, you cannot tell by the rate whether it is a boy or a girl. Truly, you cannot. You go away feeling somewhat assured, but uneasy. After all, every one you know has an opinion about your pregnancy.

Then, you reach in the second trimester, and you must endure unwanted belly rubs from strangers in the grocery line, accompanied by clucking "you are *how* far along, dear? Oh my, you are (way too big, way to small, carrying *high,* not carrying high *enough*, OMG are you sure you aren't having twins???) Then, these expert eyewitnesses will attempt to divine the sex of your child, simply by looking at the curve of your belly or the, er, thickness, of your derriere. It doesn't matter what the ultrasound says, honey, look at how big your ass is getting! That is a sure sign of a girl/boy (take your pick)! Fifty percent of the time, it works, every time, you know?

Rolling on to the third trimester, you start to fear how you will ever, ever get this growing baby out of your uterus, and your friends and family are now ready to regale you with the *horror* stories they've been keeping secret from you until you have reached the point of no return. Your already sleepless nights, filled with multiple bathroom visits as your precious bundle plays trampoline on your bladder, are now punctuated with fitful imaginings of epidurals that don't work, babies that get "stuck," episiotomies gone bad, and emergency cesarean sections. You turn to the internet for comfort, but instead only find more horror stories about Ob/Gyns that are only out to cut every woman that they have ever met, the evils of hospital births, and about how you should have had a midwife and a doula all along.

Alarmed, you present to your next visit, and try to determine whether or not your OB is one that will cut your belly in favor of getting home in time for dinner that night. Surprisingly, your OB seems reasonable about birthing plans and open to questions about cesarean rates and episiotomies, but you never know, the internets say to beware of medical professionals. Ultimately, you get to the final four weeks of your pregnancy, and you realize that perhaps you really don't care how the baby gets out as long as it does it soon. Your sister suggests that you should just "tell the doctor" to induce you, so you can have a Leo baby instead of a Virgo. You entertain the fantasy of asking the doctor to just "go ahead and cut it out, already," previous worries of cesarean section be damned. Your physician isn't swayed by your pleas for induction at 37 weeks. Heartless bitch.

The final week before your due date drags on. Your feet are swollen. You move like a 89 year old arthritic woman. You have the occasional contraction that makes you excited that the end of the pregnancy may be near, but nothing ever gets close enough. You visit triage once or twice, just to make sure you aren't in labor, and you get turned away, ashamed. You are tired of the "sure fire" ways to induce your labor. You've eaten enough Mexican, Chinese, and Eggplant Parmesan to induce 10 labors, but all it did for you was give you more heartburn (this kid better have some freaking hair!) You've walked the malls, rubbed your nipples raw, and had the most uncomfortable sex of your life, but there are no contractions to show for it. The due date comes and goes, and your OB tries to explain that the due date is more like a "4 week window" of when the baby is likely to come out, and not the day that you magically burst into spontaneous labor as you had been hoping. You are certain that you will be pregnant forever.

Then, one fateful night, you start to have regular, and (oh my lord) painful contractions. You begin to realize that all of the time you thought you were contracting, your uterus was just doing some minor stretching. These contractions? Hurt like hell. You arrive on Labor and Delivery with the bag you packed 5 weeks ago when you were hopeful that you were going to go early (because Aunt Melanie said she "just knew" you weren't going to make it to your due date). You are certain that you are already 8 cm dilated, because, holy hell, these contractions hurt. You are both dismayed to find that you are "only 4 cm," and relieved because you know you have reached the magical cervical dilation for admission. Your determination for a medication-free delivery wavers with each body-wracking contraction that you have. Finally, you just can't take it any more, and you "break down" and ask for the evil epidural. Only, it's too late. You are fully dilated and there is no time to do anything but push. Nothing ever felt so great and so horrible all at once. It is truly like your instincts just take over and your body works with you to finally push your baby out into the world. There's burning, stretching, tearing, grunting, and screaming, and then, relief...followed by a small cry and a warm, slippery body being laid upon your belly.

As you look down at your baby, and they look up at you, white with vernix, covered in goo, certainly not quiet or sleeping or serene, and hairless (heartburn be damned!) you know (despite what everyone else told you) with every ounce of your being that you will never, ever forget the *pain* that it took to get them here. You also know that it was worth it....all of it.

Apathy

2008-08-10T19:55:00.005-04:00

It's what's for dinner! (Quite seriously, we've ordered every form of takeout you can imagine this week!) It is the theme of the week. I just can't get excited or motivated about a darn thing. I assume that this is a typical problem, adjusting back to the daily grind after some much needed time off; I just can't seem to get back into the groove. At the heart of the matter, I'm aware, is the cold hard fact that I am tired of being tired. I find myself mentally withdrawing from my current place of employment. It isn't hard when you are welcomed back to the office with 8 patients scheduled in your first hour of the day. I'm over getting fired up about it. I've drawn out templates, been nice about it, stomped my feet about it, and taken it to the office manager that hates me, and nothing has changed. I know very much where I stand in this office. The writing is on the wall.

I know that staying in this position is no longer a viable solution, and while I know this will open up the chance for a much better life for me and my family, I am very sad about my patients. I am going to *miss* (most of) them a lot! Of course, I haven't told anyone that I am even looking for another position, and hope not to be forced to do so until I have a reliable back up option in place. You know, just in case they tell me to go ahead and get lost when I do reveal that I am seeking another opportunity. I find myself seeing my annual exams, and writing for a 12 month follow up visit, knowing full well that I'll likely already be gone. I feel so *deceptive*. I want to tell them to start looking now for a new physician. I'm so torn between my desire to get the heck out of dodge and make my life better, and the guilt I feel about leaving my patients. I've already gotten an attractive offer, but the catch is that they would like me to start in the early part of 2009. Ack! I'm not ready! I'll still have pregnant patients due then! How can I leave them mid-pregnancy? Don't get me wrong, I suffer no delusions that I am so awesome that all of my patients will be just crushed when I leave. I am *just* the doctor to the vast majority, I am certain, but I do know a few that will be crushed. The worst thing is that I let this guilt come to be on par with my family's need for a better lifestyle. My husband tries to reason that it is "just a job," but, to someone in medicine, it really is so much more.

On so many levels, I'm past ready to move on. I know that the decision I am making will be the best one for my family. I think the apathy that I am feeling is a resistance to the change that is coming. If I don't get things ready for leaving, like putting the house on the market or making the proper preparations to leave one practice for another, then it isn't truly real. It *is* real, and I need to embrace it. There is much to do...so I think I'll sit here and play on the Internet for a little while longer. Queen of procrastination, am I. If anyone out there has been in a similar situation, I'd love some advice on how you handled transitioning out of a busy practice. This is brand new territory for me, since leaving residency was inevitable, so I never worried about the aftermath of leaving. Sorry for such a downer of a post! I use the blog to get things organized in my mind, and this has been weighing heavily all week long. More fun filled L&D hi jinks soon, promise!

I'm Baaaaack

2008-08-04T19:26:00.006-04:00

Ack! Long time, no blog, I know. I'm sorry. I suck. I missed you guys, too. A few bullet points to catch up, and a longer post later this week if the L&D gods are kind to me.

~ First and most important, my baby Bean turned 1 year old on July 19th. My *baby*! *sniff*

~ We celebrated with a cookout and cake. Bean ate and smashed his cake to pieces, had a bath, and then slept for 14 hours straight (sugar coma).

~ I had my second blogiversary. Whoa. (How do you spell that? It is a made-up word... makes it difficult!)

~ I delivered 20 babies in the first 23 days of July.

~ I then lapsed into a deep coma, er, "went on vacation."

~ My lovely office staff booked 22 patients (in 3 hours) for my "half day" prior to leaving for vacation.

~ This made me so happy that I started my trip with a "to go" cup of vod.ka and Sprite, just to get the party started right.

~ Driving for 8 hours in the car with a 4 year old and 1 year old (who is not yet big enough to sit facing forward) is a bitch. Even with the aid of vod.ka and Sprite.

~ Even so, my kids are awesome, and were quite well behaved 95% of the time.

~ I visited with my husband's family for 10, boring, I mean, fun filled days in which I subsisted primarily on hot dogs, turkey sandwiches, chips, and spaghetti. Oh, and vodka. So much for low carb.

~ I am fat. I love food. I am screwed.

~ I finished my oral board case list. Woot! Let the angsting over that on which they are going to grill me on commence.

~ I scheduled 4 more interviews. (I know, I said I was done...I wasn't, apparently.)

~ I went to not one, but two of my husband's family reunions. I deserve a medal for that.

~ I also deserve an honorable mention for spending 10 days without any form of air conditioning.

~ I wrote a post for Mothers in Medicine for the "birth story" topic day. Check it out if you want a long-winded account of CindyLou's delivery.

~ My grandfather had a heart attack, a couple of heart caths, and fortunately has made it back home ok. I worry about how much longer he will be with us.

~ Last but not least! Thanks to anonymous for the tip...I got linked in an article by Melissa Healy in the LA Times, y'all! (The LA. Freaking. Times.) I was linked along with some real giants of the blogging world like Kevin, MD, GruntDoc, and Dr. RW. Of course, the rant that was selected to quote I sounded the most unintelligent and angry out of all of them. In fact, I was called "ribald" which means of lowly status or base {boo} or lewdly funny {that's more like it}. I own that, and hey, it's the LA times.

So, I'm certain that lots and lots more than this happened, but these are some of the highlights. Now I have to go clean the house and do laundry so the cleaning lady can find the floors and counter tops tomorrow! It's good to be back!

P.S. Holy crap, it's August. Where did July go?

It's the Most Exhausting Time of the Year

2008-07-13T07:24:00.002-04:00

Ah, yes, OtherDoc's vacation is once again upon us. My days are spent running frenetically back and forth between labor and delivery and the office (seeing mostly his 4 billion prenatal patients), trying to figure out what the hell is going on with any problem patients (he doesn't chart a freaking thing), and deflecting pain medicine requests and ridiculous after hours calls (such as last night 11:40pm "*giggle* I don't know if this is an emergency, but I have a rash and it is getting itchy! Can you tell me what it is? I know I'm not due for two weeks, but can't I just be induced tonight?") My nights are peppered with pages from triage, roughly every 2-3 hours, with patients in labor, hoping to be in labor, who have a hangnail, or nothing better to do at 3 am, and if I'm really lucky, a dash to the hospital for a c-section or a delivery. I've delivered 9 babies since Monday, and there is one in early labor right now. I think I have had at least one delivery every single day except for Friday.

Also, dumbass that I am, I have decided to chose this same 2 week period to attempt a no carb diet, as a "jump start" to losing weight. I'm not very sure if I have made it clear in the past, but I freaking adore carbs. Were it up to me, I would never eat meat again. I would eat spaghetti every single night if it were socially acceptable and Mr. Whoo would let me. I'm going through withdrwal like a proper junkie, headaches, shaking, terrible cravings, etc. , and even though I have lost 6 pounds (and holding at this point) I am in such need of food comfort that it is a struggle to stay on the wagon. I would also like to drink a couple of gallons of wine, but, since I'm running to the hospital all hours of the night, definitely not a good plan, plus, not low carb, either.

I am also in the process of weaning. Bean has become less and less interested in nursing of late. I can only get him to really focus early in the mornings, and even that is inconsistent. I cut my AM pumping session first, followed by my pre-bed pumping session last week, and I am down to only pumping at work during lunchtime. I'll probably drop that session this week. I've survived so far with only a mild case of mastitis. Part of me is sad to let it go, but Bean seems really ready, and I don't mourn the loss of pumping sessions for certain. I always had a goal to make it for a year, and Bean's birthday is on Saturday (can you believe it??)

The job hunt is still on (especially after putting up with all of the BS this week). We are actually considering moving closer to family and friends, to a place we would never have considered in the past, but now it seems to be all that we are thinking about. I've had a few promising leads and conversations, but any interviewing will have to wait until this crazy month is over.

Last but not least, I'm spending any spare time completing my case list for Oral Boards. I have all of my OB and GYN cases entered, but am struggling to get the office cases picked out and entered (too indecisive). I have my case list construction seminar this week, and it will be a welcomed break from all the insanity. I hope that they don't expect the entire list to be finished! I'm a little worried about the breadth of my case list (92 GYN cases, 110 OB cases) because I had a 7-8 week maternity leave in this last year, and I had also cut my patient load before delivery, so I was only getting back to full speed on OB for the second half of the year. The list is due on August 1, so I want it to be done quickly after I return from the seminar.

Well, enough whining for one post! Mr. Bean just crawled into my lap to snuggle. Aw. Hope you are having a wonderful Sunday!

Is there life out there?

2008-07-05T08:20:00.004-04:00

Wow, has it really been a month already? June was a veritable whirlwind. I finished out that last call and then embarked on a 3 week "tour of duty," visiting friends that we hadn't the opportunity to see for 2 years (eek) and also doing some interviewing. I wish that I could say that I've found the perfect job and everything is going to be happily ever after, but so far that hasn't happened. All of the interviews that I have had have gone wonderfully well, but it seems that I just can't find the dream combination. For example, I interviewed at a rather prestigious "big city hospital" and loved all of the aspects of the job. The facility, the physicians, the work schedule and call schedule were all great. The compensation was good, and, as cities go, the city was really nice. But....it is still a city. The housing prices, property taxes, and available homes are a little less than desirable, and while there are good schools there, I worry about raising my children in a larger city. At least there, I would have better chance of participating in their lives. I am moving forward with the next steps to see if this position is the right fit for us.

I also interviewed at another practice, in an area of the country where Mr. Whoo and I have always wanted to live. The practice was nice, hospital was beautiful, and, of course, the area was everything we wanted, but I sensed an underlying air of malignancy amongst the physicians working there. I could sense that they really were not friendly outside of work, there were several family member with controlling shares of the practice, and there were a few warning flags raised when discussing the financial aspects of the practice. So, while the area was perfect, the job was not. If anything, the visit cemented in our minds our desire to one day live in this area. We are continuing to look for other practices there, but so far, nothing has panned out.

I do know, as I've gone through this process, that there *is* life out there. Every day that I spend in this particular position, I am missing out on a better lifestyle. It gives me a lot of hope to see that I can still do the job that I love while simultaneously enjoying my life and family. It is just a matter now of finding the best fit.

In other news, it is crunch time for finishing my case list (due August 1!), and I find myself once again in the midst of 18 days straight of call (boo). My little baby Bean will be one year old on the 19th of this month (impossible). I am also very honored join a new blogging group of physician-mothers, Mothers in Medicine. This is an amazing group of women (regular posters and guest posters alike), and what they write hits home with me so much, I find it difficult not to comment on every post..."Me too!" "Oh, that's exactly how I feel!" etc. Check them out! I hope everyone is having a great weekend, and for my readers here in the US, I hope you are having a great time celebrating our country's birthday!

Seriously, people

2008-06-06T22:06:00.003-04:00

Do not page your doctor on a Friday night because you are pregnant and notice a mucous-y, creamy discharge (not bleeding or pain) after sex. It is semen, you rocket scientist, and we really, really did not need to know that. Also, it is not an emergency, like the message says when it provides the number to have the doctor paged...at their home...taking care of their family...who has to take time away from that family to hear about the effluent from your nether regions after your feelgood Friday night. Seriously, think before you page, and have a heart. Doctors are *people*, not 24 hour information hot lines. Dr. Google is open 24 hours a day for "emergencies" such as this. Thanks so much. Heart, your overworked, cranky doctor.

L & D Concierge

2008-05-31T08:57:00.006-04:00

I know I have said it before, but, it takes an amazing person to be a nurse in general, and an L&D nurse in particular. This week, as I sat at the computer behind the nurse's station, back to the counter, signing off charts and awaiting an epidural to be placed in one of my labor patients, I got a small glimpse into what ridiculous requests the nurses (trained and skilled professional people) had to stop their work and fulfill with a smile.

This day was fairly busy, 3/4 of the rooms on the floor were full (LDRP and post surg beds). There were 3 in labor, several postpartum ladies with babies, and a few post-op patients, triage was steady in and out, oh, and there were only 4 RNs. The deluge started with about 4 family members standing shoulder to shoulder at the front counter, not saying a word, but not moving, either. After about a minute of silent staring at the back of my head, I turned and asked if I could help them. They replied that they needed a nurse in room 10 (laboring patient). I checked the board, found the nurse hanging medications in another room, and let her know that the patient needed something. I went back to signing charts. Moments later, room 10's nurse came back out of the room, obviously flustered. When I asked what had happened, she sighed and said the patient was fine, but room 10's family needed some cokes. She handled it far more gracefully than I would have, because I would have been inclined to tell them where to stick their drink order. From there it just got better. As I sat/observed for that hour or so I heard requests of the nurses for:

~ socks for a postpartum patient (who had a scheduled induction and should have packed her own fragging socks)
~ cups of ice for kids to *play* with
~ pieces of paper and pens
~ putty to hang up a sign (um, WTF?)
~ a request from a visitor to a different floor for a *free* binky, since they forgot to bring their own for their child
~ extra diapers and a *case* of formula *to take home*
~ for the nurse to launder some one's own personal baby blanket that got a teeny bit of spit up on it
~ directions to the hospital from another state
~ a phone book
~ 7 cokes and 4 cups of coffee
~ a toothbrush
~ for the nurse to "re-do" a baby girl's hair because mom didn't like the *bow* color
~ for a nurse to take out a patient's garbage
~ and (the kicker) the snide comment to a nurse sitting to feed a "boarder baby" whose parents were sleeping, "Oh, I'd love to do what you do! Sit and hold babies all day!" GAH!

Not to mention beeping IVs, meds, labor checks, and other, more legit responsibilities. It was like I was observing a full service concierge desk at the Hilton instead of a hospital. As if being a responsible medical professional was not enough, they must be the waitress, janitor, Wal.Mart, Goog.le maps, Off.ice Depot, hairdresser, and babysitter. The worst thing, though, was that I don't think that I heard, in any of the above requests, a "please" or a "thank you." Unbelievable. So, remember to thank your nurses, people, and maybe, just maybe, go get your own damn coke.

Musical Musings

2008-05-24T23:00:00.004-04:00

Hello again! No, I've not fallen from the face of the planet. Just running like crazy. You see, once you take time off you *must be punished* for your time away! I think I blinked and missed the whole month of May. We had a fabulous time at the wedding. Everything was beautiful, and it was so fun to see everyone. The meeting of the other woman was completely bland and uneventful (as we had planned, there's been enough drama). I was cordial, but did not engage either she nor Cheater any more than I had to in polite conversation. It went as well as could be expected. This person is no dummy, so I am certain she could feel the chill from Mr. Whoo's and my shoulders, but no awkwardness was made...I think. At any rate it is over, so that makes me happy.

Bean and CindyLou were superstars on the car trip. Such amazing kids! We are truly blessed. As is often the case on road trips, Mr. Whoo and I resorted to music to keep our trip interesting and fun. This time, we busted out an artist we haven't listened to in a little while, John Mayer. Don't get me wrong, I know he is so 2001, and has gotten uber weird and into himself, and dates flaky arm candy that doesn't mesh with his "I am an artiste!" persona, and he does weird things with his mouth when he plays guitar, but he can turn a hell of a lyric! Anyway, I got to revisit some of my favorite lines, and am posting them here, as well. Have a great holiday weekend, all!

When Autumn comes, it doesn't ask,
it just walks in, where it left you last.
You never know when it starts,
until there's fog inside the glass around your summer heart. - Something's Missing

You asked to kiss me once goodbye, but you already did,
on somebody else's lips. - Why Did You Mess with Forever? (No videos, bummer...great song.)

Today I finally overcame trying to fit the world inside a picture frame. - 3x5

And I will go to my grave with the life that I gave
Not just some melody line on a radio wave
It dissipates, and soon evaporates, but a home life doesn't change. - Home Life (weird little video, but the song is unmarred)

Oh, another social casualty. Score one more for me.
How could I forget? Mama said "think before speaking."
No filter in my head. Oh, what's a boy to do?
I guess he better find one soon. - My Stupid Mouth

Numb is the new deep. Done with the old me.
I'm over the analyzing, tonight. - New Deep

I can't wait to figure out what's wrong with me,
so I can say this is the way that I used to be.
There's no substitute for time. - Split Screen Sadness

So what, so I've got a smile on. It's hiding the quiet superstitions in my head.
Don't believe me when I say I've got it down. - Why Georgia

Check your pulse, it's proof that you're not listening to the call your life's been issuing you.
The rhythm of a line of idle days.
Scared of a world outside you should go explore,
pull all the shades and wander the great indoors. - The Great Indoors

Oh, if only my life was more like1983.
All these things would be more like they were at the start of me . - 83

Happy Mother's Day

2008-05-11T17:31:00.003-04:00

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)

2008-04-24T19:54:00.006-04:00

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

2008-04-20T00:02:00.004-04:00

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...

2008-04-12T13:17:00.002-04:00

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

2008-03-20T10:13:00.007-04:00

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...

2008-03-15T19:19:00.004-04:00

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...

2008-03-07T23:58:00.002-05:00

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

2008-02-23T14:31:00.003-05:00

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

2008-02-16T12:59:00.002-05:00

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.

2008-02-11T11:47:00.000-05:00

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

2008-01-19T13:02:00.000-05:00

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...

2008-01-06T15:24:00.000-05:00

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...

2007-12-29T14:42:00.000-05:00

...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

2007-12-25T22:20:00.000-05:00

....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

2007-12-15T07:56:00.000-05:00

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

2007-12-01T08:34:00.000-05:00

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

2007-11-17T15:45:00.001-05:00

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

2007-11-11T13:38:00.000-05:00

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

2007-11-03T09:54:00.000-04:00

...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

2007-10-22T09:14:00.000-04:00

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.....

Caution! Full Force Whining Ahead

2007-10-21T09:38:00.000-04:00

This weekend has been less than ideal. I'm on call (which always puts a damper on the weekend), I'm nursing a second bout of mastitis due, I think, to Bean weaning some night feedings, even when I'm not getting called every couple of hours, I'm not sleeping well. My best sleep seems to be right around 6 am, which is unfortunate because that is when CindyLou has decided to wake up for the last 3 mornings and demand to be fed. The house is a wreck, I don't feel like cleaning, something in the fridge smells bad, I don't want to search it out, the bottles need labeling for the week, and I don't want to do it. I feel fat, but all I want to do is eat bad food like pizza, pasta, and Chinese. I need to organize baby photo albums, not just for Bean, but for CindyLou, too. I need to go shopping, but I don't want to leave the house. Florida State lost (again) to a team they should have beaten. I got a new consult this morning on a patient with an adnexal mass that looks like cancer. Oh, and Mr. Whoo is sleeping in today. (Now, this is partially my fault, since I told him to go ahead and keep sleeping when I took the kids downstairs at 6:30 this morning, but he is taking full advantage, let me tell you!) Bitch, bitch, bitch...ad nauseam.

I feel really short tempered and snappish, but I think it all stems from being bone tired. Yesterday I had to transfer a patient with PROM to the tertiary care center, and I got treated like some kind of second class resident by the accepting physician. Usually I can let these things roll off my back, but they really ticked me off. I got the business about whether or not I had personally examined the patient (I had), whether or not the appropriate antibiotics had been started (they had), and whether or not the patient was in active labor (she wasn't). I realize that I am a community physician, but I'm not stupid. I trained in a residency that was 90% management of high risk patients. I know that tertiary care centers get a lot of "dumps" on the weekends, but I have never shipped a patient that didn't warrant transfer. I don't know why I let that physician get to me that way, but I'm still silently fuming about it.

I also heard about a terrible call that the L&D nurses and pediatrician had to attend. Apparently a woman was being attended in a home birth by a lay doula, (no midwife, no back up physician, just a doula with no medical training) the baby was footling breech and had a cord prolapse...instead of immediately going to the hospital, she continued to labor the mother at home. The baby was dead when it was delivered. A beautiful, perfect term baby that didn't have to die. When the medical team arrived the doula was chanting and lighting incense around the house and the mother was hemorrhaging in the tub. It just makes me physically ill to think of it. Don't get me wrong, I respect the art of midwifery, and I think that having a doula can greatly enhance a mother's birth experience. In this case, the doula overstepped her bounds of expertise with deadly consequences. I wonder if she will be subject to the kind of lawsuits that obstetricians face daily. Sometimes, even in normal births, things go terribly wrong, and ignorance of when to forgo the desired birth "experience" and get to the hospital to save a baby or a mother is catastrophic. So sad for that family.

I'm dreading heading back into the hospital. The only patients in house are OtherDoc's patients, and it is always difficult to manage his patients because our styles are so very different. I tend to be overly cautious, and I write a lot in my progress notes. He tends to be a bit more relaxed, and often will not write notes at all. It can be really frustrating. Oh well, at least I have next weekend for which to look forward. Two whole blissful days off, just 5 short days away. I think I can hold out until then. Hope your collective weekends are going far better than mine! :)

Whoop, dere it is

2007-10-13T12:05:00.000-04:00

Do you ever get inappropriate song lyrics stuck in your head on constant repeat? (Whoop! Shakalaka-shaklaka-shakalaka, whoop!) Just me? Damn. The inspiration for my chosen song of the weekend is not so funny, unfortunately. It seems that Bean may be in the early stages of whooping cough or pertussis. A child in the daycare was just diagnosed this week, and yesterday he started with the characteristic cough. Since he is such a little man, and has not completed his vaccinations yet, he is now on antibiotics to (hopefully) keep him from developing the paroxysmal coughing spells that are pathognomonic for the illness. Poor guy. He actually otherwise seems very happy. He is eating and sleeping well, so that is all that I can ask in this situation. Hopefully we have caught the illness in the mild stage in time for him not to develop the severe symptoms. Fingers are crossed.

Did I mention that I am playing single parent this weekend? Well, I am, and boy, is it rough. Mr. Whoo is off in the woods with his (boy)friends, acting like 13 year olds (video games, junk food, staying up late, oh and also with beer, lots of beer). They do this trip once a year, and I think it is great for their friendship, but man, it is difficult at home. When CindyLou was a baby, she decided to get her very first stomach bug when Mr. Whoo was off on his "guy" weekend. Bean just had to do her one better, I guess. You may remember at the onset of this blog that the wives started their own little get-away weekend. We didn't do it this year (logistics were tricky with pregnancies and whatnot), but are in the early stages of planning next year's trip. (A whole lot less video games, same amount of alcohol, and more spa time.) CindyLou and the Bean have actually been angelic, though, so I have been really lucky. She is off on a playdate right now, and he is sleeping somewhat peacefully in his swing. Hence, blog time! Woot!

I am taking a little longer to adjust back into a full work schedule than I anticipated. I am booked for new patients out into April, with women approaching me personally in the hospital and elsewhere (!) requesting to be seen sooner. I also am trying to decrease my patient load for less deliveries per month in hopes of eking out some sort of better lifestyle. I am going into the 3rd year of a 4 year contract, and I have a lot to consider. Now, with two children, I am finding that lifestyle is becoming increasingly important. I came in to this opportunity with the attitude that I could do anything for 4 years (just like residency). When I come out of this contract $200,000 of my student loans will have been repaid. (You read that figure correctly.) This is huuugge. I will not be "debt free" but the amount left over to pay after that is entirely manageable. I love the location and the patients. I do not love the call schedule...at all. I am still only getting 4 days off per month (every other weekend). I am on call 24/7 all week long and 2 weekends a month. This is too much. I was led to believe that call would be 1 in 3 when I arrived here. This never materialized, and I am somewhat bitter. My employer is looking to expand, and I am hopeful that adding one or two more OB physicians is in their sights in the coming years. If I could have a true 1 in 3 (or 4) call with 1 in 3 (or 4 )weekends, I think I could be a very happy camper. If this does not happen, I'm afraid I may have to start the process to look elsewhere. Bleah. I hate moving. I am trying to be patient.

I am glad to be back with my patients. It is awesome to get back into the OR, and catch some babies. One of my favorite patients is due this month, and I can't wait to deliver her second baby (I delivered her first about a year and a half ago). That is the part that I love about OB, the continuity of care and the relationship with the patient. It is such a privilege to be a part of such an intimate occasion as childbirth. I wish sometimes that I didn't love my job as much as I do. I wish it would be an easier decision to scrap years of training and debt and say "I'm staying with my babies." I just can't. I love my children immeasurably, but I know that the work that I am doing is more than a job, it is a calling; just as much as motherhood is a calling, and so I do my best to serve both of my passions in an equitable way. It isn't easy, and I will state now that I am choosing not to engage the work vs. stay home debate mongers here. A few of the comments I have received and chosen not to publish are hurtful, not only to me, but to women in general, and I will not allow this misogynistic rhetoric on my blog. If you are looking for a fight, please look elsewhere. We women are doing the best we can, and we don't need members of our own sex seeking to tear us down for the choices we make in life. With that, it is time to nurse the little man. Happy weekend, one and all...thank you for reading my stream of consciousness. :)

Been Away

2007-10-05T14:22:00.000-04:00

....haven't seen you in a while. Thanks for continuing to check in on me. I really have missed blogging and checking in with all of you. It is like a missing part of who I am, but who has the time? If I thought life was crazy before, it was nothing compared to working full time with a toddler and a newborn. As much as I hate to do it, I am being forced to become more organized, lest I pay the very hefty price when I neglect organization. I now try to shower, prep bottles for daycare, and, if I'm really good, lay out clothes for myself and the kids in the evening. If these three things are done consistently, mornings tend to be hectic, but smooth. If not? Unmitigated chaos.

Our daycare likes to complicate matters more by these ridiculous restrictions on the bottles that we bring in for Bean. For example, all bottles must be labeled with the baby's name (naturally), ounces in the bottle (mmm, okay, but can't you see the marker yourself?), and, here's the kicker, the date can only be the day prior or the date that the bottle is being used (seriously?? Don't they know that breast milk keeps longer than 24 hours in the fridge??) In addition, all bottles must have nipples on them, as they cannot rinse and re-use a once used nipple (ridiculous). This is a pain in the ass because half of the bottles we have are breast milk storage bottles, so nipples must be washed twice as frequently during the week. I have offered to provide a "doctor's note" that it is perfectly acceptable to re-use nipples and to use breast milk that is older than 24 hours, but no one seems to take that offer seriously.

So, every night we have to re-date bottles (because let's be serious, I'm not washing perfectly good breast milk down the drain, the stuff is liquid gold), wash and re-place nipples, and keep track of how many bottles are needed for the next day. It seems a small feat, but add that to feeding, entertaining, and bathing a toddler, feeding, bathing, and entertaining the newborn, and feeding (and in my case, bathing) ourselves, and things get a little more hairy. Then there are mornings like yesterday morning when we all woke up late, and Bean decided to give himself (and his mother) a different kind of shower. Now when changing a boy's diaper, unexpected sprinkles are not uncommon, but this one occurred in between the removal of the requisite "shield wipe" and the fastening of the diaper. The result was pee on his head and chest, my hair, my clothes, and all over the bed (he even peed over the chux that he was being changed on!) This earned him a quick wash down from head to toe with my closest available "washcloth" (a clean sock) and baby shampoo, and it earned me a whole new shower. Which,in turn, made me unable to go in for rounds and just barely on time for the office. Ah yes, life is different indeed.

On the work front, I am working with my staff to whittle my schedule back to a reasonable pace. For now I am restricting OB patients to 15 total deliveries per month, with the availability to go to 20 per month if my schedule allows. I have blocked time to pump throughout the day. I also have stopped having routine scheduled patients after 4 pm, leaving the hour between 4pm and 5pm for work-in patients and emergency room follow-ups. If there are no work-ins, then I have that time to do the office charts for the day, sign off on labs, and dictate. So far it is working well. Time will tell if I can keep that pace and still be profitable for the hospital. The call schedule is still less than desirable, only 4 days off per month is not going to hack it in the long term. I am holding out hope that the hospital will hire one (or two) more physician(s) sooner than later. If no help comes for the call schedule, no matter how much we like everything else, here, we will likely go looking for a better quality of life. My patients are happy that I am back, and that makes coming back a whole lot easier. I did miss the patients and the relationship I have with them. I love what I do, I just need to find a way to make my job fit more into my life rather than working my whole life around my job.

Eh, this entry is boring, but it is what is on my mind. I am glad to have this time to write, and will make an effort to make more frequent forays into blogland. As for topics, if you have any requests I'll be happy to try to work them in between the whiny me, me, me posts! :) Happy (OMG it is freaking) October!

Letter to Bean and Ramblings

2007-08-17T14:54:00.000-04:00

Oh little Bean, you are already 4 weeks old. There are many days when I debate adding an "o" to the end of your pseudonym. Why? Because of the surprising, staccato bursts of sound which issue from both ends of your maturing digestive tract. Your other affectionate nickname is Vladimir, as in Vladimir "Pootin'". Yes, your parents are corny, may as well accept that now! Seriously, though you have got to be the gassiest baby I have ever the great fortune to know. And the sheer volume of solid waste that you manufacture on a daily basis? Impressive, my friend, especially for a breast fed baby. There is never any doubt of when you need to be changed, because we can hear you fill your diaper from across the room! I can't believe that I used to fret about your sisters weekly movements, only now to fret that there is nary a diaper change that you aren't at least a little dirty. You are the sweetest little man, though, so laid back. Every time you fuss, there is a solution. You can even fall asleep all on your own! This amazes me. You are also so serious, it takes a lot to get you to crack a smile; however, you are very chatty, cooing and squeaking all day long. I am treasuring this ever dwindling time with you, cuddling you when you sleep on my chest. Too soon you'll be "all grown-up," just like your big sister.

It's been a trying week in Whoo-ville. Last Friday I was practically in tears I felt so horrible, but I had no idea why...until I spiked a temp. Then the vague aching in my left breast took on a more significant role than an after-effect of overaggressive pumping. I had the fantastic luck of getting a rip-roaring case of mastitis. Fortunately for me, I could call in my own antibiotics. Unfortunately, I got really sick really fast. At one point my temp was up to 104.7, and Mr. Whoo was on the brink of forcibly carting me to the ER (I'd really have to be dying to go to the ER!) I knew I was on the correct meds, but when I was on my 24th hour of spiking temps, I must admit I had visions of MRSA dancing in my head. I defervesced sometime between Saturday and Sunday, and I'm still taking antibiotics. The illness took a lot out of me, and I was feeling pretty wiped out until yesterday, when the next great thing happened, we lost power.

Big deal, right? The loss of power in our particular section of the neighborhood occurs approximately every 15 days, and is out for 8-10 hours at a time. The frustrating part is that it is only our street. The other houses in our neighborhood, including the street over never lose power, so this puts us low on the priority list to have power restored. The first winter snowstorm that we had when we moved in resulted in power loss for 3-4 *days*, forcing us to move ourselves and (our then 18 month old) CindyLou into a hotel. When your power is out this long, you are forced to throw hundreds of dollars of food away, and spend your nights either sweltering or freezing cold, oh, and no cooking because the stove is electric as well. Throw in a 3 year old and a newborn and 10 hours of power loss in the middle of the night is just not ideal. We sweat our way through the night, CindyLou came into our bed because her nightlight was out, and Bean wouldn't nurse in the total dark, so we had a flashlight sitting upright on the bedside table, which woke up CindyLou, Bean was too hot to sleep on me, but wouldn't sleep in his bed, either. Mr. Whoo and CindyLou eventually moved to her room and Bean and I stripped the covers from the bed and rested, albeit fitfully, throughout the night. The following morning, poor Mr. Whoo had to go to work. I kept CindyLou home with me, which may have been insane, now that I look back...no sleep and keeping and active toddler entertained all day? Not the wisest of moves.

My hat is off to all of you stay at home mothers out there, especially those with multiple children. It was exhausting trying to keep up with all of the demands of both children. At one point, CindyLou decided that she wanted corn for lunch. Once I was able to detach Bean from the breast long enough to fix her lunch, I complied (I thought) with her request, and opened a can of corn. Oh no, it was meltdown time! You see, she wanted corn in a *line* (ie. corn on the cob) not a bowl! By the time I had her calmed down and eating the much maligned bowl of corn, the Bean had audibly filled his diaper, then CindyLou needed to go to the potty, then Bean needed to eat...so on and so forth. Mr. Whoo came home to CindyLou planted firmly in front of her portable DVD player with a movie, the house in utter disarray, and me catatonic on the couch with Bean sleeping on my lap. Mother of the year, I am not. That day did cement in my mind that I do not have what it takes (patience, aplomb, creativity, a will of iron, etc.) to stay home with kids. I think they would be miserable and I would be certifiable. This is a small thing to hold onto as my re-entry into the work fray draws ever closer. *sigh* I have more to post on that at a later date.

I believe that I have rambled long enough for now, my poor sleep deprived brain doesn't know when to stop the literary diarrhea. Maybe it is related to lack of adult interactions during the day? I'll spare you more painful minutiae for today. Thanks for all of your comments, I am reading and posting them when I can, and I appreciate everyone's advice!

3 Weeks Old and Searching for a Routine

2007-08-09T12:18:00.000-04:00

Oh, who am I kidding? We definitely have a routine, it just isn't the most productive routine. My life is incredibly boring right now, a far cry from my usual life, so if you snooze easily you may want to skip this post. My days since all the company left have shaken out something like this:

7am - 8am CindyLou barges into the room, wakes me if I'm sleeping, ignores me if I'm not, and searches immediately for Mr. Whoo. Mr. Whoo and CindyLou get ready for work and school as per as normal routine as they can manage. (Yes, she is still in school, especially this week while I am adjusting to being alone with the Bean), we are trying to keep her life as normal as possible and not to break routine.) It goes without saying that sometime during this period we are nursing, changing diapers, etc.

8am-10am - Variably spent napping, nursing, and lazing about in bed with the Bean. We have mastered side-lying nursing, which I highly recommend for maximum sleep. When I'm not sleeping, I am composing the day's to-do list in my mind. You see, I *have* to be productive if I'm staying home.

10am-1pm - The Bean's usual morning "awake" period. I have managed to shower (once) during this time and at the very least am able to attend to some basic self-care like the brushing of teeth, changing of clothes, using the bathroom, and even, sometimes, eating! I can usually entertain the Bean with the bouncy seat or swing while I attend to basic personal needs, and sometimes I am even able to get some chores done. It is this time of day that I am usually contemplating on writing/typing out a to do list. It is day 4 of this not happening yet. Nursing happens toward the end of this time period to put the Bean into a "milk coma."

1pm- 3pm - The Bean is sleeping. I'm finding it very hard to put him down when he sleeps because he is oh so very snuggly and sweet. I usually will compromise and hold him for a bit before putting him down and working on the day's to-dos and, more likely, surfing the internet.

3pm-5pm - I eat my second lunch because I am hungry *all* of the time. This is probably why my weight loss has plateaued this week. Then there is dinner planning, chores, nursing, and napping (both Bean and myself). Did I mention that I am a rotten housewife?

5pm-8pm - Mr. Whoo and CindyLou come home. We have dinner, a little play time, CindyLou has her bath, if I haven't showered, I get a shower, and CindyLou goes to bed. Mr. Whoo gets some Bean time, and Bean sometimes will have a little fussy period at this time.

8pm- 11pm - It is nurse-a-thon time. The Bean is at the breast every hour, cluster feeding like crazy, drifting into light sleep, awaking and nursing again. Once he is sated, we both tend to pass out on the couch until Mr. Whoo rousts us up to go to bed.

11pm - 2am - My blissful, longest sleep period of the day.

2am - Nursing, diaper changing, dozing, watching Disco.very Health, TLC, Brav.o, and WE. I even saw my own OB on one of the "Special Delivery" shows on Discovery Health. Awesome.

4am- Nursing, diaper changing, dozing, watching only Disco.very Health or one of the news channels because all of the rest of the cable channels turn to infomercials after 3 am.

*Aside* Let me just say that DH and TLC need some more commercial sponsors, or at the very least, they need to run different commercials for the same shows. Some of their commercials are burned into my subconscious - The Last Days of Diana (where they have made some kind of dirge out of "Modern Love." Mightily depressing.) and Diagnosis X (where there is an equally depressing snippet of song playing over and over in my head.) I am also convinced that the lead singer from Cake is the vocalist for the Coc.oa Krispi.es "cereal straws" jingle. That's just *sad* y'all.

Lather, rinse, repeat.

Why yes, I *am* slowly losing my mind, why do you ask? I am having a hard time putting the baby down to sleep 1) because he doesn't sleep very well on his back 2) he sleeps great on his tummy, but I can't sleep worrying about SIDS 3) the kiddo is a very noisy breather, squeaking, squawking, and snoring (I have made the totally non-professional diagnosis of laryngomalacia) making me think that he is awake when he is not, and 4) selfishness, he's only going to be this little and cuddly once. This results in me sitting semi-reclined in bed, propped up on pillows, with Bean sleeping on my chest.

Yes, I *know* this isn't the best arrangement. Actually, I slept with CindyLou this way for the first 6 weeks of her life due to her horrible reflux, but we slept out on the couch, not in the bed. I am attempting to get the Bean to sleep on his back during his daytime naps in preparation of trying to get him down at night. It's sad that I get better sleep with him on me than in his own bed.

I'm trying desperately not to think that my maternity leave is just about half over (sob!) because right now I'm just not ready to go back to that chaos. I am seriously considering cutting my schedule as much as I can and cutting back deliveries for a while until we adjust to the two child family. There is nothing I can do about the call, unfortunately. Also looming on the horizon is the Oral Boards. Argh. I don't even want to think about this. Thank you all for your congratulations and compliments on the Bean. You guys are the best, and I promise that I will get back to more witty, interesting posts as I become more witty and interesting. I am starting to think this is directly proportional to the amount of continuous sleep that I get. Back to the laundry for now....

The Delivery (Long and unnecessarily descriptive...consider yourself warned!)

2007-08-05T11:02:00.000-04:00

Eeek. Sorry guys, for leaving you hanging for so long. I fully intended to post this post later the same day, but life got in the way. I guess the picture kind of gives away the ending, huh?

Ok, so where were we? Oh yes, it turned out to be a very good thing that I had packed my bag prior to my office visit. I, however, was fully convinced that since I had the foresight to pack the bag, it would not be needed, as is often the case in my life. My mom and I stopped for lunch at the Oliv.e Gard.en, a rare treat for me as the restaurant is in UniversityCity, about 40 minutes north of MyTown. Then it was on to the office where I had the great news of gaining 5 pounds (and I only had soup and salad at the restaurant!) in the past 4 days, a BP of 150/90, and trace protein in the urine. On recheck the BP went back down to 130/72, and there was no question that I had mild preeclampsia and needed to deliver, there was merely the question of when to do it. I had an ultrasound which showed good fluid, an estimated fetal weight of 8 pounds 10 ounces, and a very, ahem, mature looking placenta. My cervix had actually become more favorable changing from closed/thick/high to 2cm/50%/ -2 station. My OB was on call on Friday 7/20 and I liked the date of 7/20/07, so we "set the date." Then it was time for my NST, where we found that the Bean had other ideas. He was having spontaneous, repetitive variable decelerations in his heart rate, and I thought my heart would stop every time his slowed down, because I wasn't even having contractions yet. Sometimes it sucks to know too much. In between the variables, his heart rate was reactive with fantastic variability, and he was moving all over the place. It was apparent that the Bean had designs on a different birthday other than the one that I had planned. The decels were the last straw, arrangements were made for my induction to begin immediately...and I was scared.

Mr. Whoo went to pick up CindyLou at daycare and leave her with SuperNurse, and also to go home to pack a bag for himself. My mother stayed with me while I got checked into Labor and Delivery. It took some time to get into the room and to be assessed by my nurse because the unit, I could tell, was extraordinarily busy. It was about 6 pm before the pitocin was started. My admission labs, apparently, were starting to bump, as well, and somehow I was able to talk my OB out of magnesium as long as my pressures were stable and I was asymptomatic. They placed me on high dose pitocin, and to be perfectly honest, I didn't feel a thing. I was contracting every 2 minutes, and I didn't feel them at all. It was bizarre. His heart rate remained fairly stable. He did have occasional variables that I could hear, but the monitor was in the cabinet next to my bed, so I could not easily see it (frustrating, but probably by design!) Once the nurse and all of the residents came running into the room together, which is never a good sign, and he was having late decelerations for a period of time. I was a measly 3 cm dilated. The possibility of C-section was seriously discussed, but luckily kiddo decided to straighten up and behave himself with reposition and oxygen.

Around midnight the contractions were starting to not only register but hurt like a mother. My mantra for this delivery was that I had wanted the epidural placed before my membranes ruptured, because with CindyLou they ruptured when I was only fingertip dilated and man, did contractions hurt worse after that happened. I requested the epidural shortly after midnight, but, since my bloodwork was "borderline" I needed an updated platelet count prior to anesthesia blessing me with their presence. Once that was drawn, I knew I wouldn't be able to hold it long enough to have the foley placed, so I wagged myself and my IV to the bathroom. Once I used the bathroom, I couldn't help but think about how my water broke in the bathroom with CindyLou, all over the slippers I was currently wearing. I'm not sure how that visualization affected my body, but as I got ready to leave the bathroom a contraction hit. I held onto the IV pole to breathe and sway through that contraction when, with a pop and a gush, my membranes ruptured all over my slippers...again. "Um, guys?" I called from the bathroom, "My water just broke." The nurses laughed at my puddles as I schlepped back to the bed. Dammit if the contractions didn't start hurting worse, just as I had feared. I think I waited another 30-45 minutes for anesthesia, and even though the resident didn't have the warmest or fuzziest bedside manner, I was ecstatic to see her. I warned her that in my previous delivery, the anesthesiologists had a very difficult time placing my epidural and had mentioned something about small spaces between my vertebrae. She totally blew me off and proceeded to speak to me as though I were mentally deficient. Ok, whatever. She was soon singing a different tune once she felt my intravertebral spaces. She struggled for another 20-30 minutes, grudgingly admitted that I *did* have small spaces, and, mercifully, successfully started the epidural. As unpleasant as her personality may have been, her epidural worked like a dream, and for that, I was grateful.

It was beyond strange to touch the bottom half of your body and for it to not feel like your own. The pain from the contractions was totally gone, but I still had a bit of "pins and needles" feeling at the periphery, almost like my body was lying on a flat board and I could only feel part of it. My OB came in around 1:30 am, placed an IUPC and delivered the utterly depressing news that I was 4cm/100% effaced/0 station. I had been hopeful that I'd progressed farther in proportion to the pain I was feeling. It turns out I'm just a big puss. I tried to settle in for a few hours of sleep, and made the mistake of pressing my bolus button. Immediately I knew something was wrong because the bolus went on for-ever. The medicine just kept going and going. I rang for the nurse to let her know, but by the time she made it to the room, the bolus was in...too late to do anything. Within 5 minutes my pressure was 90/50, I was shaking uncontrollably, and kiddo's heart rate took a dive. What followed was kind of a blur, because I felt seriously out of it, but I know I got ephedrine, 3 liters of fluid, oxygen, and flipped side to side to side. At last the pressure stabilized, and I was then too scared to try to sleep. I positioned myself so that I could see the monitor and waited.

Around 4 am I started to feel the tiniest bit of pressure, but nothing overwhelming, so I continued chatting with Mr. Whoo. Close to 5 am I was really not feeling any more pressure than I had an hour ago, but I knew shift change was coming up and I was curious to know how much progress I had made. The resident came in to check and informed us that the baby was about to fall out (!!!!) Whoa! I was expecting 7 or 8 at the pace I had maintained previously. Since I wasn't feeling an overwhelming urge to push, they took a bit of time to get the table (and later I found out they had a 33 weeker moving back to the OR to deliver, as well) and get organized. My OB was there, but I had consented that the intern could deliver if he was close by and did any sewing/operative delivery that needed to be done. (Seriously, it was mid-July, people!) I think that I pushed for 3 contractions, about 10 minutes, and baby Bean Whoo came into the world at 5:33 am on July 19th. He weighed 7#4 oz. and was 19 inches long (the exact same measurements as his sister, so much for late trimester ultrasound measurements!) and had a double nuchal cord to account for most of his misbehavior. Oh, and he is gorgeous and perfect (of course!) After delivery my blood pressure improved significantly, and I have already lost all of my pregnancy weight. Unfortunately I have 40 extra pounds to go, but I am hoping that breastfeeding will give me a head start on that.

Bean is now 2 weeks and 3 days old. He is a sweet boy, very relaxed and laid back. He pretty much eats, sleeps, and soils diapers. He also is having more alert periods where he contemplates the world seriously and quietly. He rarely fusses, which is so different from CindyLou, who was (in comparison) extremely high maintenance. I'm not getting more than 2-3 hours of sleep at a stretch thanks to breastfeeding, but it seems easier this time around. We shall see as time goes on. Today we just said goodbye to the last of the company/help for a few weeks, so I'll see how well I will fare on my own. CindyLou loves her baby brother and seems to be adjusting very well. I find that my patience with her is shorter than it should be, and I'm trying not to be so impatient with her. I want to thank you all for checking in on us and for all of your great support and comments! I will do my best to update when possible, but forgive me if I don't respond to comments individually for a while. It is almost time to open the dairy bar for lunch, so have a great Sunday and I'll check in soon!

Catching Up

2007-07-31T13:53:00.000-04:00

Sorry to disappear from the blogosphere for such a long time. I've just been a wee bit busy here. When I posted last, my partner was off on vacation, I was on call, and my blood pressure was teetering on the borderline. I made it through the first week of OtherDoc's vacation relatively unscathed. I had lots of clinic patients, but the deliveries remained somewhat manageable. I, on the other hand, was feeling pretty drug out and worn down. (Wonder why?) At my 38 week appointment, my OB was on vacation as well, so I saw another physician in the practice. My pressure was 148/89, my cervix was closed (surprise) and my NST looked great. I got the lecture about taking it easy (yeah, right) and I had to repeat the dreaded labs and 24 hour urine protein. I saved that joy for the weekend. I collected on Saturday and turned it in on Sunday when I went in to round on patients.

I'm not sure if this is a coincidence or not, but on Sunday I admitted and delivered a severe HELLP patient of mine. She had no preeclampsia, only HELLP, and she got really sick really fast. She came in complaining of upper abdominal pain. Her labs were just mildly bumped at that time, but she was term with a favorable cervix, so we began Mag Sulfate and started the induction immediately. Luckily she delivered within a couple of hours. Then the fun with labs started, her liver enzymes soared as her platelets plummeted. The platelet count nadir was around 40,000, just shy of needing a platelet transfusion. Luckily, with the help of Dexamethasone, she turned the corner and recovered very quickly. She was able to go home on her 3rd day post-partum. Later that day I checked my own labs. No signs of HELLP, but my 24 hour urine protein was solidly in the mild preeclampsia range. Knowing that my time was limited, and in anticipation of having the smackdown at my Wednesday afternoon appointment, I attempted to stack my schedule for Monday, Tuesday, and Wednesday morning.

Monday was an absolute blur, lots of clinic patients, charts, and 3 inductions, not to mention my sick HELLP patient. I was waiting on a delivery (around 5:30) when I got a phone call from my physician at labor and delivery. Uh-oh. It turns out that he had been looking for my labs, and when he saw the 24 hour urine protein, he was compelled to find me and tell me to stop working...pronto, and to pick a day for induction. Eeek. I immediately flashed on how sick my patient had gotten in such a short time, and I knew that it was time to start taking care of me. He sounded like he meant business, so I immediately called the back up covering physician, who was wonderful and told me not to worry about him covering my patients, even though I had stacked inductions and sections for the next few days. I then made out an extensive check out list and did the final delivery ( a rather difficult vacuum, at that). Then I went to see my patients that I had scheduled for induction and explained that I had been pulled from work by my own physician and would not be attending their deliveries. Then I cried, in front of the patients, and felt like an idiot. Both women were very understanding. I finally got home around 11pm, cried some more, and felt like the weight of the world had finally been removed from my shoulders. Tuesday I did absolutely nothing but sit and catch up on my patients via computer. Wednesday I (finally) packed my hospital bag and prepared to go to my appointment. Little did I know how important that would be....

To be continued...