Monday, October 12, 2009

Weekend in revue Part I

It was a hectic weekend with lots of fires to put out. The midwife who was going off call Friday night apologized right off the bat for leaving me so many issues that needed to be dealt with. It happens to all of us at one point or another, not her fault. She literally had to makes notes to give me report.

Friday night I got to stay home even though I had 4 patients admitted at the hospital. I went to the WNBA championship game with Beetus and my older daughter, who really likes basketball. It rocked - we had such a great time, even though the hospital kept calling and paging me. I had told them that I would be unavailable except for emergencies and deliveries until halftime and the end of the game. But naturally, that message didn't make it around to everyone. The game rocked, with our team winning :) I was so exhausted though. I am in the midst of a rough week of call. I had just finished call at 7am Friday morning, only to be back on at 5pm for the weekend. By the end of the game I had such a bad headache, and my neck and shoulders were killing me.

As we leave the game, I get a call that one of the four patients, who is there for an elective induction (grumble - the patient was insistent that she was in labor and apparently refused to leave - her cervix was 1/50/-2??!!), had a foley bulb in but it fell out and she's 4cms now and wanting to get in the tub. I'm thinking "f*ck, there goes any chance of sleep". I lay down and finally drift off to sleep about 45 minutes later when another nurse pages me. Dear God, shoot me now. Another patient who is being induced with PO cytotec for GDM, hypertension, and PUPPS needs some calamine lotion and Benadryl. I'm like "are you serious???? You called me for that????" But just as well, as a hypertensive patient should not get Benadryl as it can raise BPs. I go back to sleep, anticipating that I will get a call soon to go be with the elective chick, who is planning natural childbirth (even though she so badly wanted to be induced - this wasn't her first attempt at being admitted to the hospital, and she's only 40.2). Next thing I know, it's 8am!

This was one of those times when I check my pager to make sure it is working.

I call the hospital to get updates...

-primip (#1) induction due to being 41.3 and wanting to be done - she was getting cytotec through the night...she's now 3/100/-2 and wanting something for pain and asking when she can have an epidural

-elective induction (#2) ended up taking a sleeping pill but is now on pitocin but not feeling them

-Patient #3 with GDM, htn, and PUPPS isn't doing anything yet

-Patient #4 had a foley bulb and was scheduled to come in in the morning for pitocin but actually came in, in labor, around midnight with the foley bulb having fallen out. She was 3/80/-2. She was currently comfortable with an epidural and 6-7cms.

So I get up and head on in. I forgot to mention that I was expecting a fifth patient, someone I had been seeing, to show up for re-evaluation of BP issues.

Enough for now....I want to keep everyone in suspense....will post more later.

4 comments:

AtYourCervix said...

I didn't know about the hypertension and benadryl issues. Can you elaborate on that?

Ciarin said...

Oh geez, you would ask! I don't know the mechanism of action off hand but know that it can increase BPs...go look it up in a pharm book oh wise midwife student. And share with us when you figure it out! :)

womantowomancbe said...

The drug label says, "Diphenhydramine hydrochloride has an atropine-like action and, therefore, should be used with caution in patients with a history of ....hypertension."

Interesting -- I did not know that.

-Kathy

Joy said...

Ooh, about to read part 2!