Well, i got my COMLEX score today and though i didnt do as good as i wanted, i still did well enough.
Karthik knew i was really into OB and i had told him what i got on the boards so while we were all with Dr. W [the chair of the department] he asked for me, "So, what kind of board scores are you guys looking for." We ended up talking with her for at least an hour about residency and what she looks for in her applicants. After a long discussion, she basically wanted us to walk away with this:
LOW MAINTENANCE. residency directors are looking for self sufficient students who will be low maintenance.
i guess i can do that! plus, my scores are def good enough to get into an OB residency of my choice so im pretty excited. that is, if i really end up doing it. i really hope i find something else i like better.
im really trying to find this whole 'loving' OB GYN thing because shit, its a hell of a long 4 year residency and damn is it stressful!!!!
Friday, July 15, 2011
Thursday, July 14, 2011
Thursday was a day shift in L&D. I started the day doing a C section with Dr. H and Dr.L. The patient was under a complete local anesthetic because the spinal tap didnt work. It was crazy because we had her on the table ready to cut and like always, we tested to see if the patient could feel anything before hand. We use these little grabbers that look like tweezers but with big teeth that would def hurt if you didnt have any anesthesia. You clamp a piece of abdominal skin and ask the patient if they can feel it and if so, what side. Each time we did it the patient complained it hurt and could tell us exactly where we were pinching. Obviously we couldnt start the section this way so we had to put her under and do the delivery that way.
Joe, the first year, was with me on this shift also. He seemed to be pretty bored during it because there werent a lot of deliveries but we did have a lot of admits and r/o labors. During the afternoon, one of Dr. G’s patients went into labor. Dr.G does not work for the hospital but he has ‘privileges’ there. He has his own OB practice and when one of his patients goes into labor, he meets them at riverside county and he delivers them there. we are not allowed to do anything with them unless of course he is running late or something. i had to leave the room because there was another admit and i thought i wouldnt be able to do anything with this delivery anyway. after i left, i went back to the front desk about 45 minutes later and saw Joe standing there just beaming with joy. I asked him if he saw his first delivery [assuming thats why he was so happy]. “Not only did i see it, I just DID it!” i was speechless. apparently when dr G got there he had joe scrub in and let him deliver the damn baby. i was so freakin bitter because i still hadnt delivered a baby yet.
A little bit later in the afternoon i was with Dr. H and Dr. L. I casually mentioned to them that Joe delivered Dr. G’s patient and then followed with, “not that im bitter or anything. i mean, im totally happy for the FIRST year who delivered a baby on his first day even though i havent delivered one yet.” they both laughed at me and at that moment i think we all realized i was a potential budding OB/GYN.
SCORES SCORES SCORES
Wednesday i got my USMLE score. i am super happy with my results. i checked during clinic and felt pretty good for the rest of the day. i cant believe that much work and sacrifice is done and over and i have finally found out the result of my efforts!
Wednesday, July 13, 2011
[It’s actually Nov 9 and i am going back to finish up writing about my last 3 weeks of OB/ GYN. its not that i didnt like the rotation and didnt want to write about it, it was the exact opposite. I loved it so much and was working so hard that i really had no time to write, and when i did have time, i was sleeping or enjoying the minimal outside hospital life i had. i hope i can incorporate all the details and feelings i had during this time but really, i dont think i will be able to because i really loved this rotation and am having a hard time trying to convince myself to NOT go into OB/GYN because as amazing as it is, the lifestyle is just so poor.]
Monday morning of this week started with a grunt as i pulled myself out of bed. I had just done my 24 hour shift and got home Sunday morning and then now i had to go back to work to another 5 day week. no bueno. It was just a clinic day and we ended really late, i didnt leave until 6:30pm.
Getting home around 7:30pm on Monday night, i ate dinner, showered, and went to sleep. I had to be at the hospital for rounds that started at 6:30am so i left the house around 5:30am. In the middle of rounds i left with Dr. S [a resident] to go into the OR to start an entire day of surgery. I was pretty excited given the fact that the last laparoscopic surgery i was in was rad!
The first surgery thing i did that morning was an exploratory laparoscopy on a female who they thought had endometriosis [it was the same procedure i was in last week.] the lady ended up not having any major endometriosis in her abdomen so we closed up. my biggest accomplishment was scrubbing in correctly and not looking like an idiot :)
The next 2 procedures were D&C’s [dilation and curettage]. Both were to make sure there were no products of conception left in the uterus after both women had missed abortions [aka a miscarriage, aka a NON therapeutic abortion.]
Then the big one came up. We were doing a total abdominal hysterectomy. Thus, we were taking out a woman’s uterus by cutting open her abdomen. reason for her surgery was that her uterus had become a very large fibroid and was causing a lot of post- menopausal bleeding and some major abdominal pain. The attending [Dr.W] and the resident [Dr.H] stood on either side of the body and i stood between the legs as they were spread apart in stirrups [i know this sounds gross but everything but the operating field are covered in blue sterile drapes so really it wasnt that bad.] We started the surgery around 2pm and i had no idea what i had gotten myself into. actually, the resident and attending felt the same way. we started dissecting down to the uterus and every time we cut or cauterized, the patient would bleed more. the fibroid had been there for so long and was so large that it had creating a million different new blood vessels to sustain itself. this thing was huge, it measured 19cm on ultrasound [to put this into perspective, your uterus should grow 1cm each week during pregnancy. thus, this ladies uterus was acting like she was 19 weeks pregnant].
The procedure took us hours. we had to be so careful every step of the way to make sure she didnt hemorrhage and all of us were exhausted. most of all, the attending. she actually got a really bad cramp in her arm and had to stop for about 15 minutes. this procedure takes a lot of muscle. im talking ripping open stuff, using muscles to get to the right location, etc. Dr. W was sweating like a pig [and of course we are under hot hot lights.] She must have gotten so dehydrated that her arms started cramping up and needed a hydration boost. we all joked about hooking her up to an IV and rehydrating her with some saline.
when we finally got the uterus out it was the most disgusting thing i have ever seen. it was huge. it also was extremely funny looking because it had an aborting uterine fibroid. she had let this thing grow without getting any medical care for so long that the middle of her uterus began to fibrous and it got so large and heavy that it began to DILATE her cervix and fall out. DISGUSTING.
Of course, we finally finished the procedure [even though i thought it would never end] and before we closed up the abdomen, Dr. W looked over at the resident and said, “let’s look around and find something cool for Dorothy to look at.” I was ecstatic. Mostly because she knew my name,this attending was a hardass and as cool as she was, she never really learned anyones name. But hey, she learned mine. point me!
I left the hospital at 7pm that day and didnt mind a bit. i was so freaking tired but it was a really great day. sadly, i had to be back at 5am on Wednesday to see my post-surgical patient’s before rounds. damnit.
I woke up late on Wednesday and got to the hospital around 5:45am. oops. i was talking to my patient who we did a TAH on and in comes the resident, we ended up talking to her together and doing a quick physical exam, then left the room. i got some major attitude from Dr. H. she pretty much scolded me for not being there earlier enough. “you are supposed to be there waaay earlier than me.” she kinda rolled her eyes and left and i felt like crap the rest of the morning. we had a pretty good relationship i thought so it was surprised. but hey, we all have our moments and i have to admit, i was really late that day so i guess i deserved it.
After rounds and lecture i went to clinic. there was a first year from UCR there that was shadowing [why he was spending his last remaining summer shadowing at a hospital i will never figure out...] He came in with me to watch a pap smear and pelvic exam and when we got out of the room he went, “wow, your really good at that.” i didnt know whether to be flattered or not. is that really something to be proud of? i guess...
This was the first day i had an inmate as a patient. she was a young girl named Mikeala and at first i was really hesitant to go in the room. she ended up being really cool and i kinda felt bad for her. she was pregnant and in jail, that cant be fun. even worse, we arent allowed to tell inmates any plans or dates of things [because of the potential of setting up a way to escape] so i couldnt even tell her her due date. bummer.
Tuesday, July 12, 2011
Monday, July 11, 2011
monday- early AM notes, home at 8am
-tues-was a pretty fantastic day. Tiring, but fantastic. It started at 4:45am when i got up and got to the hospital for 6:30am. I attended rounds and then at 7:45am headed up to the surgical ward to be in my first surgery [well, i guess 3rd if you are counting c- sections]. This was on a 26yo female who was having severe abdominal pains and was scheduled for an exploratory laparoscopy to rule out [or in] endometriosis. We started out by waiting for the anesthesia team to sedate the patient and then we set her up for how we wanted the body to be positioned during the surgery. Once that was done, I scrubbed in along with the resident and the attending. Again, I made myself look like an amateur. I am tellin you, getting into a sterile gown without looking like you are new at it is very hard to do... Process is you scrub at the sink, keep your arms up above your waist and walk into the OR without touching anything. You then walk to the scrub nurse who has already set aside your sterile gloves and gown. To my dismay, the attending and resident had already gowned and gloved so they just stood and watched me do it. Pressure was on. First the scrub nurse handed me a sterile towel to dry off...i messed that up and the attending pointed out the proper way to do it next time [i was still sterile at this point though, just didnt do it the “proper” way], next the scrub nurse holds out the gown and you put your gloves through [thats an easy part... a monkey could do that correctly], after that comes the gloves.....this is where the pro’s are separated from us retarded medical students. The nurse holds out the gloves so all i have to do is put my hand in it and go straight down quickly so my hands slips in. Sounds sooooo easy but i swear its not. Every time i have done it by fingers end up in different finger slots and i have to readjust it once my other glove is on. Oh wait, did i forget to mention that when i put on my first glove this time but ungloved hand hit my sterile gown and the attending made me take it all off and re-gown? :/ oops. Though i am making the attending sound like a hard-ass, i really shouldnt be because she is one of the most patient, kind and helpful doctors i have worked with [in fact, i have gotten really lucky because all of the attendings at the hospital are like her...or at least most!].
So after all this, we began the surgery and on my mind the entire time was “dont put your hands down, dont put your hands down, dont put your hands down.” See, when you are sterile, you are only sterile around your chest and down to your belly button so if you lower your hands too low or too high you become unsterile and that is bad...very bad. The other thing on my mind was, “that is fucking awesome.” We cut a small incision right under the belly button, stuck a needle into this woman’s abdomen to get to the peritoneum [where all your insides are], put some gas into it to blow it up and give us more room to work, and then stuck a camera down the hole. Then we cut two small incisions a little lower on each side so we could stick other tools. It is really that easy. Watching up on a TV monitor, I was so excited to see the uterus, ovaries, fallopian tubes, bowel etc etc. All things I have memorized the anatomy of and can finally but that knowledge to use! One of the coolest things i saw was when the turned the scope around to see the liver and you could see the ribs and abdomen above it. Basically, it was an inside view of the rib cage and it was gorgeous to see. The ribs were rising and falling with each respiration [being done by a ventilator since the patient was under anesthesia and a muscle blocker] and looking at all the arteries and such was just a really amazing sight to see [yeah im a science nerd, ill admit it].
So the patient ended up having endometriosis [look it up] and we cauterized a lot of it, took some pictures with the scope and then finished up. As we closed up the very minimal incisions with sutures the pt started to come out of her anesthesia and began moving her legs around. it scared the shit out of me. i was so scared she was gonna wake up at the end and yell at us that she could feel it all but she didnt...dont worry. she did look like she was in a ton of pain after the surgery though...even if the incisions are tiny and minimally invasive she still have people rummaging around her in inner pelvis...that cant be pleasant any way you do it.
After the surgery I walked with the team and the pt [in her gurney] into the post-op room. Talked with the resident a bit about the surgery and then was told to get some food and go to the clinic for the rest of the day. It was about 10am at this point [the surgery started around 8]. I went down to the clinic still wearing my scrubs and pretty much felt like a bad ass for the rest of the day [i realize how stupid that sounds but it pretty accurately describes my mood]. I was on such a natural high from the morning surgery and was in a really great mood. Everyone i talked to and every patient i saw must have thought i was on something.
One of the first patients i saw was a women who was in her first trimester of pregnancy and had brought her 4 year old daughter who was the cutest lil girl ever. I feel like i spoke so comfortably and confidently to both of them that the little girl started to become less shy and started asking me a ton of question and the mom become very relaxed with me. After spending a lot of time talking to both of them, I presented to Dr.R and when we decided to do a pap smear he said ok, go do the pap. I was nervous as this would be my first pap smear alone [without an attending though a nurse is always there assisting] but i was pretty happy that Dr. R trusted me enough and had enough of an opinion on me to think i was competent to do it alone [though that just shows that when you dont have insurance and you go to a county hospital you ‘get what you pay for’ sorta speak--- AKA, a medical student doing your pap smear by herself]. I ended up being able to do the exam myself and everything went well. I swear, scrubs make you feel good/confident [though they make you sweat a lot...these damn things dont let your skin breathe!]
things i learned:
i miss men-- seriously, 95% of people i see everyday are female. or as Anna would say, every day is Vaginaday
-tues-was a pretty fantastic day. Tiring, but fantastic. It started at 4:45am when i got up and got to the hospital for 6:30am. I attended rounds and then at 7:45am headed up to the surgical ward to be in my first surgery [well, i guess 3rd if you are counting c- sections]. This was on a 26yo female who was having severe abdominal pains and was scheduled for an exploratory laparoscopy to rule out [or in] endometriosis. We started out by waiting for the anesthesia team to sedate the patient and then we set her up for how we wanted the body to be positioned during the surgery. Once that was done, I scrubbed in along with the resident and the attending. Again, I made myself look like an amateur. I am tellin you, getting into a sterile gown without looking like you are new at it is very hard to do... Process is you scrub at the sink, keep your arms up above your waist and walk into the OR without touching anything. You then walk to the scrub nurse who has already set aside your sterile gloves and gown. To my dismay, the attending and resident had already gowned and gloved so they just stood and watched me do it. Pressure was on. First the scrub nurse handed me a sterile towel to dry off...i messed that up and the attending pointed out the proper way to do it next time [i was still sterile at this point though, just didnt do it the “proper” way], next the scrub nurse holds out the gown and you put your gloves through [thats an easy part... a monkey could do that correctly], after that comes the gloves.....this is where the pro’s are separated from us retarded medical students. The nurse holds out the gloves so all i have to do is put my hand in it and go straight down quickly so my hands slips in. Sounds sooooo easy but i swear its not. Every time i have done it by fingers end up in different finger slots and i have to readjust it once my other glove is on. Oh wait, did i forget to mention that when i put on my first glove this time but ungloved hand hit my sterile gown and the attending made me take it all off and re-gown? :/ oops. Though i am making the attending sound like a hard-ass, i really shouldnt be because she is one of the most patient, kind and helpful doctors i have worked with [in fact, i have gotten really lucky because all of the attendings at the hospital are like her...or at least most!].
So after all this, we began the surgery and on my mind the entire time was “dont put your hands down, dont put your hands down, dont put your hands down.” See, when you are sterile, you are only sterile around your chest and down to your belly button so if you lower your hands too low or too high you become unsterile and that is bad...very bad. The other thing on my mind was, “that is fucking awesome.” We cut a small incision right under the belly button, stuck a needle into this woman’s abdomen to get to the peritoneum [where all your insides are], put some gas into it to blow it up and give us more room to work, and then stuck a camera down the hole. Then we cut two small incisions a little lower on each side so we could stick other tools. It is really that easy. Watching up on a TV monitor, I was so excited to see the uterus, ovaries, fallopian tubes, bowel etc etc. All things I have memorized the anatomy of and can finally but that knowledge to use! One of the coolest things i saw was when the turned the scope around to see the liver and you could see the ribs and abdomen above it. Basically, it was an inside view of the rib cage and it was gorgeous to see. The ribs were rising and falling with each respiration [being done by a ventilator since the patient was under anesthesia and a muscle blocker] and looking at all the arteries and such was just a really amazing sight to see [yeah im a science nerd, ill admit it].
So the patient ended up having endometriosis [look it up] and we cauterized a lot of it, took some pictures with the scope and then finished up. As we closed up the very minimal incisions with sutures the pt started to come out of her anesthesia and began moving her legs around. it scared the shit out of me. i was so scared she was gonna wake up at the end and yell at us that she could feel it all but she didnt...dont worry. she did look like she was in a ton of pain after the surgery though...even if the incisions are tiny and minimally invasive she still have people rummaging around her in inner pelvis...that cant be pleasant any way you do it.
After the surgery I walked with the team and the pt [in her gurney] into the post-op room. Talked with the resident a bit about the surgery and then was told to get some food and go to the clinic for the rest of the day. It was about 10am at this point [the surgery started around 8]. I went down to the clinic still wearing my scrubs and pretty much felt like a bad ass for the rest of the day [i realize how stupid that sounds but it pretty accurately describes my mood]. I was on such a natural high from the morning surgery and was in a really great mood. Everyone i talked to and every patient i saw must have thought i was on something.
One of the first patients i saw was a women who was in her first trimester of pregnancy and had brought her 4 year old daughter who was the cutest lil girl ever. I feel like i spoke so comfortably and confidently to both of them that the little girl started to become less shy and started asking me a ton of question and the mom become very relaxed with me. After spending a lot of time talking to both of them, I presented to Dr.R and when we decided to do a pap smear he said ok, go do the pap. I was nervous as this would be my first pap smear alone [without an attending though a nurse is always there assisting] but i was pretty happy that Dr. R trusted me enough and had enough of an opinion on me to think i was competent to do it alone [though that just shows that when you dont have insurance and you go to a county hospital you ‘get what you pay for’ sorta speak--- AKA, a medical student doing your pap smear by herself]. I ended up being able to do the exam myself and everything went well. I swear, scrubs make you feel good/confident [though they make you sweat a lot...these damn things dont let your skin breathe!]
things i learned:
i miss men-- seriously, 95% of people i see everyday are female. or as Anna would say, every day is Vaginaday
Saturday July 9, 2011. My first ever 24 hour shift.
5am- Show up at hospital to write some progress notes. Rounds are supposed to start at 6am on Saturdays. The work day had barely started for me and i was immediately thrown into a delivery and assisted Jen, another PA resident. I have never been so glad to be wearing a gown and big boots as this baby came out with a wave of amniotic fluid. I am not kidding you, there was fluid everywhere....including jen’s hair. I immediately ducked behind her as the baby was flying out and saved myself the DISGUSTINGNESS of having amniotic fluid and blood in my hair. I kinda wanted to vomit. This is the first time i have ben grossed out by a vaginal birth [for a second i had decided OB/GYN was not for me...then i changed my mind when i saw the cute baby after]. When we finished up [she had to be sutured up a bit] we joined everyone for rounds.
6am-ish- Rounds were a little different than the ones i had previously been on before because this time we had a patient in the ‘incarcerated’ ward. Basically, an inmate from a local penitentiary had to have a C section and once she had delivered, she is sent to the 4th floor were all jailed patients go. To enter the ward you have to show your ID, go in one door which is locked behind you and then the next door is opened. I was very intimidated.... Each room door is locked and the patients are handcuffed to their beds. To enter a room you need to be accompanied by a guard and you can’t bring anything inside with you [they could stab you with your pen or strangle you with your stethescope...]. I just stood behind the group and kept quiet. I felt pretty safe though considering the guard with us was around 7 feet tall...and i am not exaggerating! As we were walking out of the ward I looked into one of the rooms and nearly peed in my pants when i saw a 20something year old guy just staring at me...he was standing on the other side of the door window tracing circles with his finger and looked like he was crazy...seriously mental. I looked away and walked as fast as i could haha.
After rounds I scrubbed in on a C/S with a resident and attending. The baby was breech [feet first] so she had to have the section instead of a vaginal delivery. It was pretty fun to see the doctors yank out this baby one leg at a time. During the section there is a blue sheet that hangs above the stomach so you cannot see the patients face. By the time we walked into the surgery room the patient had already been covered up. It was a nice suprise to see the mom after the C/S and realize that i recognized her from the womens health clinic that we work at. As we pulled the baby out dr. L yelled happy birthday! we all laughed.
We had another vaginal delivery soon after the C section and then had some time to relax and eat breakfast. As i am eating i hear a big commotion outside in the hall and when i get up and walk out people are running into room 2. I followed to see what was going on and then heard people shouting to get the crash cart. It was all very dramatic. I helped the nurse push the crash cart down the hall and into the room but by the time we got there the patient was fine. Her BP had dropped suddenly when her epidural was being placed [which is very normal] and the nurse couldnt find her pulse again so she thought she was going into cardiac arrest. The patient was fine but I dont think her cousin was....i could hear her down the hall shouting on her phone to family members telling them to ‘get their ass to the hospital’...she was both very loud and pissed off at someone and i tryed to calm her down but then gave up because clearly she was just overreacting.
Later in the day we had a patient come up from the ER that had been in a car accident and was 27 weeks pregnant. We observed her for 6 hours and then sent her home. She also was fine.
Then we had another ER consult, a 19yo pregnant girl got shot in the shoulder. We went down to the ER to see her and evaluate her. One thing, the ER is a great place...lots going on and lots of men around. Seriously, i feel like my standards have greatly fallen because if i just smell cologne i am attracted to someone...its kinda pathetic. Bad thing is, everyone is wearing scrubs so you never know if someone is a doctor or a janitor [no joke, i came into the hospital one day at 5am and the guy cleaning the floor was wearing scrubs] this makes it difficult to find a legit man...
So we get the patients fetal heart rate and see that her and the baby are doing well so we tell them to admit her to L&D when they are ready. Hours go by and we call down to the ER to see where the pt is and it turns out she left. They literally couldnt find her. She gave a fake name and peaced out.
We had 2 fetal demise patient this shift also. Both were full term pregnancies [38-40 weeks] and the parents were devastated. After delivery, it was found that one of the babies had the cord around their neck and the other had a very short umbilical cord that was not being perfused with enough oxygen. I didnt see either of them being born because i really didnt want to have to go through that. After, the nurses take the babies bodies and the hospital has pretty boxes to hold the clothes, lock of hair etc and then another little box of the babies footprints. it was all very respectful and everyone had a similar feeling of despair at the fact that there is no way to prevent these accidents from happening. 2 in 1 shift is a rare event and it made the afternoon a little less happy.
that night i was in another vaginal delivery but i did not get to scrub in since another intern did. i ended up helping the nurse with the newborn and i really loved it. right after the baby is delivered they are passed off to another nurse to go under the baby warmer and get all the goo wiped off of them. I was the first person to listen to his tiny lungs and try to count his really fast heartbeat [babies can have heart rates up to 160!] he was beautiful and although he wouldnt stop screaming, i kept thinking how much i love my job.
in another vaginal delivery that night we had to use the vacuum pump to get the baby out because it was not descending into the pelvis fast enough. imagine a little suction cup put on the babies head and a handle on the other end. it isnt used often but it does help when the baby is not coming fast enough and they start to get into danger. after delivery this kid had the worst cone head i have ever seen [dont worry, newborns have very pliable skulls and the shape will go back to normal]
the rest of the night was me writing progress notes on all the c section patients that were in the post-partum ward of the hospital. i was up checking on patients, looking up their labs, meds, etc and writing in their charts from 1am to 3:30 or 4am. After, i told the resident i was going to sleep in the call room for about an hour. I slept for almost 2 hours and then woke up at 5:15 because rounds on sunday were at 5:30.
i was exhausted.
i rounded on my patients and then the attending said i could go home. i asked if she was sure and the resident look at me and said "if the attending tells you to go home, get out of here." i laughed and left to get my stuff in the call room. i felt ok to drive so i came home, act breakfast and crashed until 4pm sunday. i ended up going to the movies and trying to take advantage of my 12 hour weekend. it was pretty rough knowing i wouldnt have a day off until the upcoming saturday.
it was a long 27 hours but man was it fun.
6am-ish- Rounds were a little different than the ones i had previously been on before because this time we had a patient in the ‘incarcerated’ ward. Basically, an inmate from a local penitentiary had to have a C section and once she had delivered, she is sent to the 4th floor were all jailed patients go. To enter the ward you have to show your ID, go in one door which is locked behind you and then the next door is opened. I was very intimidated.... Each room door is locked and the patients are handcuffed to their beds. To enter a room you need to be accompanied by a guard and you can’t bring anything inside with you [they could stab you with your pen or strangle you with your stethescope...]. I just stood behind the group and kept quiet. I felt pretty safe though considering the guard with us was around 7 feet tall...and i am not exaggerating! As we were walking out of the ward I looked into one of the rooms and nearly peed in my pants when i saw a 20something year old guy just staring at me...he was standing on the other side of the door window tracing circles with his finger and looked like he was crazy...seriously mental. I looked away and walked as fast as i could haha.
After rounds I scrubbed in on a C/S with a resident and attending. The baby was breech [feet first] so she had to have the section instead of a vaginal delivery. It was pretty fun to see the doctors yank out this baby one leg at a time. During the section there is a blue sheet that hangs above the stomach so you cannot see the patients face. By the time we walked into the surgery room the patient had already been covered up. It was a nice suprise to see the mom after the C/S and realize that i recognized her from the womens health clinic that we work at. As we pulled the baby out dr. L yelled happy birthday! we all laughed.
We had another vaginal delivery soon after the C section and then had some time to relax and eat breakfast. As i am eating i hear a big commotion outside in the hall and when i get up and walk out people are running into room 2. I followed to see what was going on and then heard people shouting to get the crash cart. It was all very dramatic. I helped the nurse push the crash cart down the hall and into the room but by the time we got there the patient was fine. Her BP had dropped suddenly when her epidural was being placed [which is very normal] and the nurse couldnt find her pulse again so she thought she was going into cardiac arrest. The patient was fine but I dont think her cousin was....i could hear her down the hall shouting on her phone to family members telling them to ‘get their ass to the hospital’...she was both very loud and pissed off at someone and i tryed to calm her down but then gave up because clearly she was just overreacting.
Later in the day we had a patient come up from the ER that had been in a car accident and was 27 weeks pregnant. We observed her for 6 hours and then sent her home. She also was fine.
Then we had another ER consult, a 19yo pregnant girl got shot in the shoulder. We went down to the ER to see her and evaluate her. One thing, the ER is a great place...lots going on and lots of men around. Seriously, i feel like my standards have greatly fallen because if i just smell cologne i am attracted to someone...its kinda pathetic. Bad thing is, everyone is wearing scrubs so you never know if someone is a doctor or a janitor [no joke, i came into the hospital one day at 5am and the guy cleaning the floor was wearing scrubs] this makes it difficult to find a legit man...
So we get the patients fetal heart rate and see that her and the baby are doing well so we tell them to admit her to L&D when they are ready. Hours go by and we call down to the ER to see where the pt is and it turns out she left. They literally couldnt find her. She gave a fake name and peaced out.
We had 2 fetal demise patient this shift also. Both were full term pregnancies [38-40 weeks] and the parents were devastated. After delivery, it was found that one of the babies had the cord around their neck and the other had a very short umbilical cord that was not being perfused with enough oxygen. I didnt see either of them being born because i really didnt want to have to go through that. After, the nurses take the babies bodies and the hospital has pretty boxes to hold the clothes, lock of hair etc and then another little box of the babies footprints. it was all very respectful and everyone had a similar feeling of despair at the fact that there is no way to prevent these accidents from happening. 2 in 1 shift is a rare event and it made the afternoon a little less happy.
that night i was in another vaginal delivery but i did not get to scrub in since another intern did. i ended up helping the nurse with the newborn and i really loved it. right after the baby is delivered they are passed off to another nurse to go under the baby warmer and get all the goo wiped off of them. I was the first person to listen to his tiny lungs and try to count his really fast heartbeat [babies can have heart rates up to 160!] he was beautiful and although he wouldnt stop screaming, i kept thinking how much i love my job.
in another vaginal delivery that night we had to use the vacuum pump to get the baby out because it was not descending into the pelvis fast enough. imagine a little suction cup put on the babies head and a handle on the other end. it isnt used often but it does help when the baby is not coming fast enough and they start to get into danger. after delivery this kid had the worst cone head i have ever seen [dont worry, newborns have very pliable skulls and the shape will go back to normal]
the rest of the night was me writing progress notes on all the c section patients that were in the post-partum ward of the hospital. i was up checking on patients, looking up their labs, meds, etc and writing in their charts from 1am to 3:30 or 4am. After, i told the resident i was going to sleep in the call room for about an hour. I slept for almost 2 hours and then woke up at 5:15 because rounds on sunday were at 5:30.
i was exhausted.
i rounded on my patients and then the attending said i could go home. i asked if she was sure and the resident look at me and said "if the attending tells you to go home, get out of here." i laughed and left to get my stuff in the call room. i felt ok to drive so i came home, act breakfast and crashed until 4pm sunday. i ended up going to the movies and trying to take advantage of my 12 hour weekend. it was pretty rough knowing i wouldnt have a day off until the upcoming saturday.
it was a long 27 hours but man was it fun.
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