Night Shift: Friday-Saturday

Another semi-slow night in L&D. I got to scrub in on one repeat C/S and the woman had a whole bunch of adhesions that complicated the delivery just a bit. Other than that...not much aside from H&Ps. We got started on rounds around 5:00 and worked all the way beyond checkout. One of the patients I saw was an African lady who spoke French (sadly I never learned OB French; I don't even know if a French interpreter exists at the hospital) and enough English to answer my questions, so before I left I wished her felicitations. Then Dr. S cracked us all up by saying that he's asked patients if they ever had a "bebe retardo" or something like it (mentally-retarded baby). It just sounded so wrong. XD

Night Shift: Thursday-Friday

Yeah, so I've gotten lazy with the blog...ah well. Today was a bit more interesting because of the two deliveries I sat in on, neither were normal. In both cases, the moms were in their early 20's and G1P0. In the first case, the delivery proceeded as expected (I helped deliver and came close to dropping that slippery baby but caught it in time), but afterwards, the mother had a few lacerations that would not stop bleeding no matter what. Dr. D threw lots of sutures without success, so she removed those and then went deeper. It stopped the bleeding somewhat, but there was still oozing at the site. It seemed like the more she tried to sew, the more bleeding sites the lady had, yet her platelet count was fine. Then when we tried to put a vag pack in her, an earlier laceration that Dr. D sewed properly reopened and more blood spilled out. Poor Dr. D was stressed to the limit since Dr. C and Dr. H (attending) were in surgery, leaving her on her own. On top of that, the woman was developing major labial and vaginal swelling (hematomas?) so rather than attempt to sew anymore, they stuffed the vag pack in there and hoped for the best.

The second case was a woman who had been pushing for almost 2 hours and was so exhausted she couldn't push anymore. Somewhere in the midst of all the pushing, she suffered a huge tear, and her sister was terrified for the baby (who was in the canal for quite some time already). In the end Dr. H had to cut an episiotomy and use a vaccuum to pull the baby out (it did not look fun), but once that baby was out, both mom and aunt burst into relieved and happy tears. The bad news: Mom suffered a 4th degree laceration that went straight to the rectal muscle. Dr. H immediately called Dr. D into the room to repair it, saying she "needed the experience."

Tonight was a busy night in both triage and L&D; there were lots of admission H&Ps to keep us busy. I did get a chance to put my head down, but I wasn't sleeping; when Dr. C told Anita, "Wake your counterpart," I heard her perfectly. Dr. P still does most of the deliveries; if Anita and I want to deliver any more babies before this rotation ends, we have to latch on to Dr. D or Dr. C. Anita and I were pretty much in charge of postpartum charts today since our "three-man team" was stuck in L&D, so together we saw 8 charts before rounding with Dr. A on the patients in 2N. Can't believe it's already Friday.

Night Shift: Monday-Tuesday

As expected, my entries during night shift will be short b/c 1) I'm typing them quickly so that I can get to bed, and 2) by the time I get home I've forgotten half the things that happened during the night. It was another slow night; Dr. P did all the deliveries while Anita and I did H&Ps. There were 2 C-sections, so I went to the 1st one. When the scrub nurse asked me if I got permission to scrub in, I said yes, b/c in our team a student is required to be present in all non-complicated C-sections. When I went in, Dr. C and the attending had not arrived and Dr. D couldn't make the first cut without them, so Dr. D and the scrub nurse began drawing pictures on the plastic portion of the sterile drape covering the patient's abdomen (which read "es un nino"). When Dr. C saw what we did, she was all, "Oh, for the love..." This C section was pretty much like the others. Then Anita went in for C/S #2, and my words about "being required to scrub in" came back to bite me when they were counting equipment b/c the nurse added, "Med student present: check."

We had some downtime from 4-5 a.m. in which everyone had a change to sit down and sleep. Later Anita and I ran into Dr. K in the halls en route to the resident lecture, and we let him know that we missed having him on our team. The good thing about today: we don't have to come in until later!

Night Shift, Sunday-Monday

I stayed up until 5 am on Saturday/Sunday night in hopes of getting adjusted to a night schedule faster, but I ended up waking up 4 hrs later anyway so it was all for nothing. I did have an on-and-off nap that lasted 2 hrs, but it wasn't enough. Our night shift started out all right; got a few H&Ps off the bat, but most, if not all, of the deliveries went to Dr P b/c she still needed the practice. The Yellow team told us about a woman who needed her vulva examined b/c there were "blackheads" down there? "Were they moving?" asked Dr. D (implying crabs). "No," the other person replied. Sometime around 10, we were given the opportunity to order something from Olive Garden, so I got 2 appetizers (and I wonder why I've gained weight on this rotation?) For the most part, this was the most laid-back night ever in L&D. Even Dr. D marveled that she rarely had the luxury to sit down and eat without rushing. Dr. C also found Trichomonas from a patient and showed it to Anita and me. We saw it moving, but I didn't see any flagella (didn't look close enough). The sleepiness didn't hit me until around 4 a.m., when I laid my head down for a quick nap, and at 4:30 we were dispatched to the floors to count charts. I did 3 postpartum notes before we were allowed to go to lecture, where again it was hard to stay awake (but I tried). And later tonight I get to do this all over again.

The Shortest Day

This morning my team was supposed to round with Dr. A (again) at 7:15, but instead Dr. M met us at 7:30. Anita and I had lecture at 7:30 (Anita had a presentation to make, too), but out of respect to our team we stayed on the floors until we were allowed to leave around 8:00. When we arrived at the lecture room, Chris had just finished his presentation and Dr. C was not pleased that we were late. "What was so important that Dr. A would keep you?" he asked. "You're expected to be on time to lecture and presentations every time." Fortunately he wasn't mad at us, but he was annoyed at Dr. A for thinking that rounding was more important than lecture (when it wasn't) just b/c he was the department chair. Ah well.

By the time lecture was over, Anita and I only had time to see about 1-2 patients at HCW before our residents let us go early (since we start night shift next Sunday). Fine enough. We stopped by a scrub store to get some Klogs (my Nikes are not made to stand in for 13 hrs) and then did lunch. Now we'll see how I can adjust to a night schedule over the weekend.

L&D: The Usual

This morning rounds began at 5:30 a.m. and lasted just barely past 7:00 a.m., so we made it to check-out in time. The Blue team chief immediately warned us about a 15-year-old in arrested labor (of some sorts), and her dad was pissed that the baby wasn't coming out as expected. News flash: babies don't always arrive on schedule. The L&D board was full and triage was packed as well, so we immediately started writing up H&P's. Shortly after 8:00 one of the nurses sent me to the Family Health Clinic to pick up "goodies" from the drug reps. I got lost and arrived a bit too late, but I was still able to pick up a few pens for one nurse and several students as well as a burrito for Dr. P. We had a PA student named Russell join us today; it was his second week in L&D. The first C-section came rolling in around 11:30, giving me just enough time to finish up an H&P before scrubbing in. It was a usual C-section, though my duties as a student are increasing with each additional C-section I see. Instead of the usual retracting, blotting, and stapling, this time I got to massage the uterus, hold it during the suturing step, and hold the thread while Dr. D sutured. Not much, but more than before. Maybe next time I'll get to tie knots =)

L&D had its usual craziness. There was construction going on outside that sealed several doorways, making it hard to navigate through the halls, so when Cristy came into L&D trying to get out of the building, I was able to help her out. Then in another room another woman was in major pain and screaming so loud we could hear her many feet away. One of the nurses couldn't help but laugh, and the woman's husband poked her head outside the room saying that it wasn't funny. I got to deliver a baby with one of the midwives, and it had to be one of the smoothest deliveries I'd ever seen. No lacerations, no excessive pain from the mother, nothing. The only setback: I wasn't wearing a face mask (we had to gown in a hurry) so I got some bloodspatter on my cheek. Nothing a little soap and water couldn't take care of. What did piss me off: on the way out of the OR, my arm got slammed by the closing OR door, leaving two bruises on my arm near the elbow. It hurts a little to move my elbow now, so I'm hoping that nothing's broken.

More good news: round start at 6 tomorrow instead of 5:30 =P

HCW: Pelvic Pain

This morning my team had rounds with the department chair, Dr. A, but Anita and I couldn't stay too long b/c of lecture. Dr. H lectured on material that I'd just read in our textbook so I was glad for the refresher course. The girls on Blue team were exhausted from night shift and desperate for lecture to end so they could go home and get some sleep; now they know how the rest of us felt =) Well...Anita and I have night shift again next week so...

Work at the clinic was fairly light today. The FPs weren't there in the afternoon, so Anita and I got to work with Dr. T on the noncomplicated cases. We each got a case of pelvic pain. In my patient, her pain was most likely due to dysmenorrhea/possible PID. One concern she had was why it hurt to have sex, and when we felt for her uterus, I couldn't feel it b/c, as Dr. T said, it was "midline." He then said that for women with midline uteruses, lying down is the most painful position to have sex. His advice for now: get started on the pill, and try other positions. Wow. My next patient was postmenopausal with a hx of vaginal itching and burning post bladder sling surgery. She was using Vagisil to relieve the itching, which turns out to be one of the worst things you can do since it sometimes makes the itching worse. Dr. C said many people are fine just as soon as they stop the Vagisil. So we gave her an Rx for clobetasol instead.

Dr. D expects us to be in L&D for rounds at 5:30 am tomorrow. Guess that means I'd better be in bed by 10:00 or 10:30 at the latest.

L&D: Understaffed

This morning Anita and I arrived too late to do any charts b/c Dr. C had told us the wrong time to arrive (6:30 instead of 5:30). Fortunately my team was in L&D today so we didn't have to attend resident lecture; someone had to stay and catch babies, after all. The attending today was Dr. R (Dr. GR, I should say), whom we'd met previously. He immediately took Anita and me under his wing and went through one patient's chart with us. "You think we don't look at H&Ps, but we do," he said before proceeding to critique one FP resident's H&P. Then the door to that same patient's room burst open and we heard, "Delivery doctor in room 5!" Anita got to deliver this one (as well as suture a lac or two), and I wondered when I'd get a chance to suture.

A C-section was scheduled for around 10:00; I barely had time to finish an H&P from OBT (OB triage) before I hurried to the OR with Dr. D and Dr. R. One thing about Dr. R: the man loves to have "pimp sessions." He asked me how many C-sections I'd seen and I said 4 (but it's probably more like 5-6), and he immediately proceeded to ask me to name structures around the uterus. Round ligament, mesosalphinx, mesoovarian, arcuate line, cul-de-sac, fimbriae, serosa layer of the uterus...few structures were spared. Some I knew, some I didn't (like the infundibulum pelvic ligament, though I did feel the pulse within it). Dr. R asked me what my grade in anatomy was, and I told him anatomy was integrated into systems now. So he asked what my practical grades were, and I said they ranged all over the place. "60's...70's?" he asked. Ouch. I actually did pretty well in repro anatomy, and at the end Dr. R said that I was among the more knowledgeable students he's pimped (whew). One thing that stumped both Dr. D and me, however, was vernix, aka the cheesy substance that babies are covered in when they're born.

After the C section, it was back to writing H&Ps for a while. I wrote one on a lady in triage who was brought to room 5 in L&D shortly afterwards (yup, same room from earlier). A few minutes later, someone yelled, "We need some help in room 5!" My patient, who had previously been calm, was suddenly screaming and writhing like mad. Apparently she shot from 5 cm to 8 cm in a matter of minutes; not good. It was too late for her to get that epidural. I barely had time to get her to sign the vaginal consents before it was clear she was ready to deliver. Delivery doctors were paged to the room, but no one came! I was in a panic and ran out into the hall to see if anyone was coming (Amy, the L&D nurse, later said she thought she would have to deliver the baby after I ran out). Fortunately Dr. D came and we both gowned up. Shortly before this deliver, Dr. R had taught Dr. P and me how to catch a baby properly, so I felt ready for this one. The baby that came out was huge, but amazingly the mom got through birth with no lacerations whatsoever. Wow. Even better was when Dr. D said I did well in both in the delivery room and in the OR (surviving Dr. R's pimp session, not necessarily for retracting the bladder)

Not long after we left that room to write postpartum notes, we heard "Delivery doctor to room 1!" Dr. P asked if she should go, and Dr. D said, "Yeah, Dr. C will be there. You'll learn something from her." Then..."Delivery doctor to room 3!" Dr. D swore under her breath as she and Dr. P hurried toward room 3. Then..."Delivery doctor to room 12!" WHAAAAAAT?! Talk about insane. Dr. D then sent Dr. P to room 12, where hopefully KD was there to supervise (we're all still learning). If there had been a fourth baby about to come out, then I don't know what would have happened. Dr. R went from room to room checking on the patients' progress, and the transitional resident doing his peds rotation was frustrated b/c he couldn't be in three places at once. But yeah...that was crazy.

A 3rd C/S was scheduled for a 45 year old mom who'd already had 2 miscarriages in her quest to become pregnant, and I went to see her C/S after writing her H&P (Anita saw the 2nd C/S earlier in the afternoon). Dr. R was "all pimped out" and didn't ask me any more anatomy questions, thank goodness. This baby was a big one, too (all the babies today were big), and when he was given to his mom, his mother couldn't stop laughing and crying. Now this was a long-awaited baby. Unlike other doctors we've seen in the OR, Dr. R doesn't staple his C/S incisions; he does subQ sutures. In the end though, I think they look the same.

Whoo...long entry today =D

L&D: Slow Sunday

Yesterday my team was fairly busy admitting patients and doing H&P's, but not much else. All those women we admitted (and more) gave birth after our shift ended; the Red Team (who's doing night shift) delivered a grand total of 15 babies last night. Their 2nd year resident, Dr. E, deliverd 8 babies, and one of the moms he treated got a 4th degree lac. That must have been a sight to see. At any rate, after doing charts, Anita and I returned to L&D to find the board practically empty. Dr. C was happy about that; she was still tired from being overworked yesterday and a near-empty board was a welcome sight.

Just in case, though, Dr. C called one of the 4th year OB fellows, Dr. M, to come in since the Green team is currently a 2-person team + one intern. Today was a fairly dull day. I got to watch Dr. D do one delivery (and she showed me the correct way to deliver a placenta) and wrote two H&Ps, but that's about it. One good thing came from this day: Dr. M took the time to sit down and teach Anita and me how to tie knots. It was about time we learned, and if I practice enough, maybe I'll be able to sew a lac on my own before this rotation is over =)

New Month, New Team

Now that it's a brand new month, the interns and FP residents move on to other rotations. We lost Dr. G to ER, Dr. K to clinic, and Dr. B to medicine (I think). In their place, we gained one 1st year FP intern, Dr. BP. This is probably her first time doing OB since her third year in med school, so Dr. C immediately took her under her wing to teach her how to deliver babies, write notes, etc. In the process, she also taught Anita and me a few things to improve on our note writing. Hopefully that means we'll get more teaching time with Dr. C and maybe learn to do sutures (Marcus and Blakely have already done those).

Because the Green team (me and Anita) was working L&D today, we had to write postpartum notes for the Blue Team (who starts their night shift tomorrow), so Anita and I were told to get to the hospital by 5:30 a.m. That was early. We lost track of how many notes we wrote, but in the end, poor Dr. D had to see all 12 patients on her own since there were no other doctors to help her (Dr. BP is still learning and Dr. C was still in L&D). To thank Anita and me for our work, Dr. D got us all breakfast on her account. But...when we were back in L&D, we were restricted to writing H&Ps since Dr. BP was getting all the deliveries. Altogether, I don't think we ever wrote so many notes in one day before. But that's what happens when your team is shortstaffed. *sigh* Dr. C said another resident will be joining us in future days and weeks. Hope so.

There was one emergency C-section today, and since Anita went to OR yesterday I decided to scrub in for this one. This time I caught the scrub nurse just as she entered the OR and she was able to pull a pair of gloves for me. It was just me, the nurse, Dr. D, and Dr. S (who lectured on antepartum and postpartum bleeding). It seems that with each C section I watch, the residents expect more of me (Dr. D even called me the "expert retractor.") My job involved more than just retracting and blotting this time around; I also had to hold the thread tight between suture reloading and learn to cut sutures correctly. Yes, there is a proper way to cut thread; you can't hold the suture scissor like a regular scissor and just cut. I did that the first time and Dr. S said that was clumsy. "Only cut at the tips, and with a small turn of the wrist," she said. I had three chances to redeem myself but each time I'd make a mistake in some form or another. On the last one, Dr. S even lightly slapped me on the wrist for "turning the blade the wrong way." *sigh* No one ever told me there was a method for cutting thread. Well, now I know.

After getting off work, I went to Panera Bread to meet with old friends and exchange rotation stories, news, gossip, the usual =P It was nice to see familiar faces again.