Night Shift: Saturday-Sunday

My last night shift of ob-gyn was definitely memorable. Not long after we arrived a woman delivered a 15 wk old miscarried fetus, and Dr. D carried it out in a little basin for Anita and me to see. The poor thing was only about 2 inches long, but its features were perfect. The arms, legs, and toes were all well-formed, and it was just so sad b/c it looked like a real baby. Later on, Triage was practically empty and our patients were L&D were nowhere near ready to deliver, so we were mostly hanging around the lounge talking when suddenly there was a call for doctors to triage b/c a patient had passed out in the bathroom and was bleeding badly. Anita and I were headed there when Dr. JP (the chief taking Dr. C's place for the night) said, "Where are you going?" and told us to stay in L&D with Dr. P. We discussed possible causes for her bleeding and it sounded like she had a placenta abruption. We heard a call for anesthesia to the OR, stat, but no one followed through. We asked one of the CRNAs what was going on, and she said the baby had no fetal heart tones. The mother had been 38 weeks along, and because she did cocaine about 2 days ago (also the last day she felt fetal movement), she lost her baby, making it an IUFD (intrauterine fetal demise). It's sad, tragic, stupid, and avoidable all at once.

Then, shortly after midnight, there was another call for anesthesiology to the OR, stat. We were all like, "Another one?!" Yes, it was another placenta abruption, but this time they acted fast. Anesthesiology ran to the OR, and a few minutes later a woman in a bed was wheeled to the OR with Dr. P, Dr. D, and Dr. S running behind it. Anita and I debated whether or not we could go observe the stat C-section, but decided against it since there were already at least 3 residents and 1 staff doctor in the OR. We didn't want to overstep our boundaries (though Dr. P later said it was a good teaching case and we could have observed from afar). Dr. S, one of the OB interns, later came out and said that the stat C/S was one of the most exciting things he'd ever seen. They had one minute to get the baby out, so Dr. P did a vertical incision (slash, slash, slash), pulled the skin apart, then did a classical uterine incision (slash, slash, slash), then pulled out the baby, all in about 45 seconds. The baby weighed a little more than 900 grams (about 2 lbs?) and was about 26 weeks along, but its blood gases were excellent (not acidotic) so its chances of survival were good. Thank goodness we had at least one happy outcome.

Dr. D was on an adrenaline rush as she told us what had happened in Triage. The woman had presented with vaginal bleeding and wasn't even sure if she was pregnant (how do you not know if you're pregnant after 26 weeks?), so they decided to do a sono on her to date her pregnancy. Initially Dr. D saw the heart beating, but somewhere in the middle of her exam, the heart stopped. She and Dr. P exchanged "Oh s***" looks and immediately called anesthesiology and all the others to get the OR ready. It was just one of those crazy coincidences that happened at the right time; if the woman had been sent home without the sono, her baby might have been lost. Dr. S told us another story that happened earlier this month (I think) where a mother coded in L&D (not the operating room), and one of the older attendings, Dr. B, sliced open her stomach while others were giving compressions in order to get the baby out. Baby survived, mom didn't.

We had 18 charts to see in the morning (Blue and Green), so Dr. JP sent Anita and me to the floors around 4:30 a.m. so that we could be out by 8:00. We've gotten pretty good at these notes, so with Drs. P, S, and D writing behind us, we were pretty much done by 7-7:30. Dr. D was especially glad since she flew to Nicaragua today for a week of vacation (I'm writing this late, but her plane left at noon) So it was an interesting way to end nights =)