L&D: The Longest Day

At check-in, Dr. K stuck a 3D anatomy image of the pelvis and bowel on the computer and told us to guess what we were looking at. "Up there is fecal impaction, and there...foreign body." The "foreign body" in question was a dildo stuck so far up the rectum its tip was in the sigmoid colon (he actually saw this patient last year). A lot of people were shown the picture and asked, "Guess what that is?" Marcus started laughing as soon as he saw it, but poor Jedd was a bit slow on the uptake. (For other TCOMers who are reading this...please don't tell other people about this or ask Jedd about it or else he'll ask how you know and then all fingers will point to this blog, which is for friends' eyes only. I tend to go into more detail than the average blogger so if I get in trouble, this blog will be discontinued)

Jedd: Is that what I...
Dr. B: Yes.
Jedd: What is that thing?
Anita: Oh, he doesn't know.
Dr. B: Well, if you're married, you wouldn't need one of these.
Marcus: Come on, Jedd, you have one at home!
Jedd:...is that a diaphragm?
Everyone: NO!

Well, he got it eventually =) It was a busy day in L&D today. One woman was about to give birth not long after our shift began, so I went to see her with Dr. B. Normally I take my time getting gowned up, but he said, "You won't get to deliver if you don't hurry up." The baby was coming. Sure enough, not long after I got into position, the head started poking out, fast. This time I was able to apply good pressure to the head but had trouble pulling the baby out properly, but it was better than my last delivery so I was glad. Afterwards I did a H&P on a Pakistani woman who had not had her epidural yet and was moaning like crazy. Some of it sounded exaggerated, like she was doing it to make her husband feel sorry for her (apparently a common practice among Middle Eastern women); she wouldn't even let me touch her abdomen b/c it "hurt too much." Ah well.

I got to scrub in on a C-section shortly after 11 a.m. It was not the mother's first C/S so when the doctors opened her up, she had so many adhesions it was hard to see the uterus at all. In fact, the doctors couldn't even pull the uterus out; they had to reach in blindly and grab the baby, and sewing her up afterwards required a lot of work, too. I often couldn't tell what I was looking at. One pleasant surprise: when the baby was brought to her mother, I heard the mother speaking French. In a hospital where Spanish is the most dominant foreign language, it was a shock to hear "Elle est tres jolie" instead of the usual "muy bonita."

Shortly after the C/S I went to a room to help KD (the midwife) deliver another baby. This mother had 3 kids before, so we expected it to be an easy birth. Far from it. We tried to get her to push for up to an hour, but she couldn't do it. KD tried to have her give birth lying on her back, lying on her side, even grabbing onto a bar and squatting, but nothing worked. The baby was occiput posterior and also just plain big. The mother was also doped up on fentanyl to the point where she kept screaming the same phrases over and over again. ("I can't do it! I'm tired! It hurts! I want my mama!" en espanol) Finally it was decided that they would do a C/S on her, and I got to watch. It was just me, Dr. D, Dr. P, and the nurse, and she delivered a 10 lb 13 oz baby girl. After 3 boys, this mom finally got her daughter, so she consented to having her tubes tied. My job as a med student was to help Dr. P blot blood from the organs, staple the incision, and then move the patient's bed into the OR for transport. Good to know

It's been over a week since we've worked 12 hrs in L&D, so Anita and I had majorly sore feet by the end of the day. Time to invest in better shoes =)