Wednesday, June 10, 2009

Busy busy part III

I was on call this past weekend and it was crazy the first 36 hours! Here's a blow-by-blow!

Friday night - go to bed about midnight. Get called in half an hour later for a labor patient. It's this lady's third baby and she's 5-6cms so off I go. She doesn't speak any English or Spanish, I think her language is Kiren (sp). But she has these two girls with her that are not friends or family, to translate. Oook. Fortunately we knew each other at least, having seen her a couple time sin the office. She has one dose of Stadol and stalls out at 8cms. I suspect an OP baby is the cause. So I move her to the tub on her hands and knees (I know she thought I must be crazy!) and go to lay down for awhile. Fifteen minutes later, the nurse calls me to let me know she is complete and wanting to push. Damn tub...worked too fast! It's something like 3:30am by this time. She starts pushing and is doing a really ineffective job of it. She asks through the translators if I can't just pull the baby out as that is what they did with her other two. Ummm, no. You are gonna push your baby out. Naturally I was on with the worst doc...again. Grrr. I didn't want to subject her to that and I really felt that, even though this baby might be a little bigger than her two 5 pounders, she could do it. While working with her, another patient comes in. She's 5cms, third baby, wanting stadol.

It takes several attempts to get her IV started and she's screaming. I suggest to the nurse that she check her prior to pushing that stadol. The nurse comes to find me in the first lady's room, where she is still pushing, to let me know that patient is 9cm now and moving fast. My little Kiren lady does not seem to be in any danger of delivering soon so I go to the other room where we have a baby shoot out ten minutes later. She almost screamed that baby across the room! He was two pounds smaller than her biggest! She delivered just under an hour after arriving :)

I go back to the Kiren lady and she is making slow but steady progress. She finally delivers a cute little boy, big for her at 6-9. She promptly zonks out.

By this time it is 6am Saturday morning. I go make postpartum rounds and am home asleep by 8am...

to have the chinese phone torture start.

I received 12 pages in five and a half hours. I threw the pager at one point. Finally at 1:30pm, I get up to go into the hospital. I have another lady of mine there, who is having her second baby and really wanting natural childbirth this time. She was 4cms on arrival. I grab soime lunch and head on in. Which was a good thing because I get a call that she is now 9cms and it's 3:30pm. Geez, so much for labor support. I get there in time for her to start pushing. After 30 minutes she pushes out a beautiful baby. This baby was a lot bigger than her first. She was so focused, once I asked her to stop screaming. I think she was screaming because she felt like that was what she was supposed to do. I told her that making noise was fine, but screaming tends to be more of a fear based mechanism, unlike low-pitched moaning, groaning, etc. She had no problem stopping the screaming at all! While I was finishing up in there, another patient came in.

This lady was a primip, ruptured, contracting but only 1cm (unfortunately the nurse in triage felt it necessary to check her - grrr). This patient was planning an epidural so I decided to go home and get some sleep. Which I didn't get a whole lot cuz I couldn't sleep once I got home. I finally went to bed around midnight after admitting another lady, a G9P5 who was 4-5 and getting an epidural. I realize that was risky but was so damn tired. I slept for three solid hours before having to go in. The grand multip was 6cms, I broke her water and she delivered 45 minutes later. Easy peasy! Unfortunately, the primip had a less than optimal outcome. We sectioned her for chorio with the baby being shipped out...sigh. I was very distressed, because even though I did all the appropriate care and the timeline was appropriate, it just sucks to have a bad outcome.

I think in this particular field, the outcomes are so good so frequently, that a bad one really just is unexpected. Sigh.

I made postpartum rounds and was home and in bed assleep by 9am. I had one page that afternoon from a patient with a question. One page at 4am Monday morning from triage, with the patient being sent back home.

I am so ready to be on vacation. I was in the office yesterday and on call /office today, but only until 7pm. Then gonna hang with my new best friend and watch Nurse Jackie and Weeds. Then tomorrow, I start vaca! 7 straight days.....ahhhhhh. Then 24 hours of call.....then my three day weekend off. :) Happy happy happy! We are heading to Vegas on Friday for three nights. This will be the first time the kids have gotten to go so they are very excited to see this place where mom and dad go so often - lol! This is our first trip this year.

Ok, off to get ready to go round and hit the office.


AtYourCervix said...

Wow! That sure was a VERY busy call time for you. Do you ever try and lay down and sleep at the hospital, instead of going home? I would think that it would be "easier" to try to sleep in-house, rather than drive back and forth.

BTW - I was tired just reading about your recent on call time. WHEW!

Joy said...

When you say the "baby was shipped out" does that mean they were sent to the morgue? I don't always understand the jargon but wanted to make sure I wasn't making the worst assumption.

Anyway, you are one busy doc! Never taking my OB for granted, that's for sure.

Ciarin said...

Oh definitely - there's a little lounge on the unit with a couple recliners. I rarely go home if I have a patient in labor because I live quite a distance from the hospital. However in this particular case, I knew the patient would not be delivering anytime soon!

Ciarin said...

Joy - shipped out just means the baby was sent to a hospital that could provide a higher level of care. For example, the hospital I am at only handles women 34 weeks pregnant and up. If someone comes in and delivers a 30 weeker before we can get them stabilized for transfer, then the baby gets 'shipped out' to a hospital better equipped to handle this pretermer.

And Joy, I just wanted to clarify - I am not a doc, I am a CNM :) Thanks for reading and hope all is going well with your pregnancy!!!!

Prisca: said...

Wow, sounds crazy but you sound like an AMAZING midwife! I wish I could work with you!!!

I need avacay, too! ;)