Rants from the Crib

An Ob/Gyn gone mad

A Day In The Life

I previously did a photo essay by the same name.  I was in a horrible mood that day and I took pictures of my daughter screaming because she did not want to go to daycare, the “biggest” intersection in our tiny town, the cloudy brooding sky, the truck full of tragic decrepit chickens on their way to the processing plant and various evil instruments that I have to use on my patients.  This morning was not that bad but all days are pretty much the same.

We’ll actually start the morning out last night.  I was on call and patients came in and out of labor and delivery as if we were running a special on hot doughnuts for pregnant persons.  The phone rang all night.  Some how my husband managed to escape hearing most of the rings, which is unusual because he is a pretty serious insomniac and he usually hears everything.

When I got up this morning I was quite seriously exhausted.  I have to get up and wake up my daughter and get her ready to go to her bus at 7:03.  And I mean, 7:03 precisely.  That bus driver is demonically obsessed with running his schedule on time.  He could be a Swiss train.  A was Sleepyheaded this morning as usual and wanted to wear her fashionable Puma shorts (only seven and she’s already cottoned on to what is fashionable).  She was so tired I didn’t even have to fight her into her tennis shoes (like every good Southern girl she is a flip flop addict, but flip flops don’t work so well for PE at school).  I got her her chocolate milk and her Cheerios and got my Special K.  She gets special adulterated milk in the mornings – she has had major colon issues since she was about two, and we have to put an adult dose of Miralax into her morning drink.  She doesn’t mind.  Then we woke up Daddy, who has a conference call at 9, and we were out the door.

A was pissed at me this morning because I would (could) not fix her hairbow.  I had carefully put one in before we left the house, but she claimed it was loose and needed to be refixed..  I tried to fix it in the minivan but really, how are you going to fix someone’s hair when they are sittting in the seat BEHIND you?  So she huffed onto the bus with her hairbow in her hand.  Maybe her teacher will fix it for her.

I then drove like a bat out of hell from the bus stop to work, because if I get to work early enough, I can take a nap in the call room before clinic.  Shhhh.  Just our little secret.  I had two patients to take care of this morning, one induction left over from yesterday and a patient who had just walked in.  I am not on call any more, but the new patient BEGGED me to deliver her because she does not like the doctor on call.  Sucker that I am, I agreed.  So now I have two patients to deliver today on my NON call day.  The induction from yesterday has been having funky little dips on her fetal monitor strip and I have been having to watch her very closely.  Her water broke spontaneously this morning and hopefully she will get moving right along.  We are getting an epidural for the new arrival. 

I have already seen three OB patients this morning – three pregnant women in various stages of their pregnancies.  Two of them are actually due in a couple weeks.  We seem to have a lot of patients due right now.  My new Gyn patient appears to be a no show, so my nurse has time to answer patient phone calls, and I have time to mess around with this blog.  Our OB nurse came to see me about a patient who had been seen in the ER last night.  We are trying to find somewhere to put her in my packed schedule today.  We are not having much luck.  We may have to see her tomorrow, if she can wait.

Ooooh.  My phone just rang and it was the labor and delivery nurse taking care of yesterday’s induction.  Suddenly she is eight centimeters!  She should deliver in about an hour and that will be one duty I can cross off today’s list.  And then I don’t have to watch her funky strip anymore.  The other patient is five centimeters – I hope they don’t get into a race to the finish and deliver at the same time!  Obstetricians do not like when that happens.  I would have to enlist my partner, who is, after all, on call today.  She does have an induction of her own. 

Now K is prepping my rooms and getting them ready for the next wave of patients that we will be seeing.  She loads my drawers up with clean speculums (we use the see-through plastic disposable kind), q-tips, pap brushes, betadine swabs and other tools of the trade.  It is not a good thing to have a patient up in stirrups when you discover that you don’t have the instrument you need.  They REALLY don’t like it when you leave them with their nether regions hanging out and leave the room to go look for something.  Not cool.

I can hear my partner (my other one has gone to a conference) and the other two clinic nurses chitchatting over on the other side of the office.  She says she also has a hellish schedule this morning.  We are certainly loaded up wtih patients.  Right now it is time for the next one to arrive.  I can hear K in the hall getting her weight and blood pressure.

I spent a little time on Pinterest this morning.  There are certainly some serious addicts on there.  I think some of these people have nothing better to do from dawn to dusk than troll the internet for pictures and links to post on Pinterest.  I seem to have a pretty good collection of gems and minerals, shoes, jewelry, and flora and fauna.  I love beautiful macro photography of bugs and other tiny things.

I am a bit nervousy on this blog right now because I got some new followers of my blog last night.  There is always pressure when you realize someone is actually READING these things.  Today’s offering isn’t too hilarious, but I think it will be interesting to a non-Ob/Gyn type person who doesn’t really know what we do all day.  Some of my male friends certainly have romanticized ideas of what I do all day and think all my patients are beautiful teen models, but in reality, if they are teens they are probably pregnant.  We have lots and lots of pregnant teens.  I don’t think the epidemic is slowing down a bit. 

I sit in a tiny cubicle all day to work because it is right by the hall where my patients are.  I have a very nice office but I probably go in it about once a week.  My plants are all dying because the housekeepers close the door when they are done cleaning and no light gets in.  I keep opening the door, they keep closing it.  Fortunately I only have a peace lily and a philodendron, both of which are incredibly difficult to kill.  The rubber tree plant has already died because this new office does not have a window.  So here I sit in my little cubbyhole, and I don’t even have a working phone on my desk.  I have a NONworking phone on my desk.  So everyone who is looking for me has memorized my nurse’s phone number, since she sits right behind me and her phone works.  So they ring her phone looking for me all day and drive her nuts.  For some reason we cannot persuade the powers that be to get me a working phone.  I’m only a doctor.  I mean, why would I need a phone?

I am drinking a hospital-sized pitcher of Diet Pepsi.  I drink one in the morning and one in the afternoon, which amounts to about 88 ounces of caffeinated Diet Pepsi a day.  Miraculously, I still manage to sleep at night.  Sometimes I can even nap at lunch, if there’s nothing going on.  Of course, there is always eating lunch to consider.  Most days I don’t have much time and I grab a couple yogurts and some granola to dump on top.  On the days that my husband joins me for lunch, he says watching me spoon granola into the yogurt cup makes him twitchy, since I spill it on the tablecloth.  We certainly wouldn’t want a twitchy husband!  My dear husband can be very OCD about certain things.  Granola, apparently, is one of them.

Our office uses an electronic medical record called Athena.  Just so you know, Athena is the biggest pain in the butt that I have ever had to deal with in a medical office.  This system drives us all nuts.  The nurses really suffer because there are eight MILLION really invasive little nitpicky questions like, “Are you heterosexual, homosexual or bisexual?” and “How many sexual partners have you had, none, less than five or more than five?”  I think they should have a category for “more than fifty partners” because I certainly have some patients that qualify.  The computer really slows us down and we look silly carrying them around like we are delivering technopizzas.

Yikes!  Just got a phone call to RUN downstairs because that 8 centimeter patient now has a baby’s head showing when she pushes!  Ran downstairs and caught that baby.  My patient elected to go without an epidural and she did just great.  There was that one moment where she whimpered, “I can’t do it,” but there is always that one moment in every delivery.  We had a cute little baby boy.  I was all geared up in my gown and gloves and hat and mask and boots, looking like I was about to study ET instead of deliver a baby.  This gearing up is very important so you don’t get covered in baby goo or get placenta feet.  It is foolhardy to deliver a baby without being well covered, or you are going to feel YUCK for the rest of the day.  My daughter is now wise to this delivery thing and she always eyes me suspiciously when I get home and asks me if I have any baby goo on me. 

Now I am back in the office.  I just played catch-up because a couple patients were waiting for me to come back.  Fortunately, this computer system slows K down so much that even coming back after a delivery I am not too far behind.  I put in something called an Implanon, which is a newish form of birth control that consists of a single rod the size of a matchstick that releases birth control hormones into the bloodstream from there.  My patient was very nervous and my nurse had to hold her hand.  I persuaded her that this was much more painless than that tattoo she had, which is true.  Having this thing put in is really no big deal.  You get numbed up with a long spinal needle first – the most important thing is not to let them see the needle or they get really twitchy.  Then the implant itself comes loaded in a fatter needle, which you also do not want them to see.  You scootch it in just under the skin of the nondominant arm, between the groove between the biceps and the triceps.  Hers went in just fine, and she had to admit, her tattoo was much worse.

Now my other labor patient is 6 centimeters and has gotten her epidural.  Her baby looks great on the monitor.  She is comfortable and we are starting an IV drip of pitocin to speed her contractions up.  The nurse taking care of her is actually her sister.  That should make for an interesting family dynamic.  I am always a little concerned about family members taking care of family members, in case something goes wrong, but this little girl should do fine.  I hope.

I am waiting on K to get the next patient in.  This patient had a 4D ultrasound done on her baby today, which is really cool.  The new pictures actually look like real babies, and you can see them move in real time!  This was just a courtesy scan to try to get her a good picture.

Ohmygosh!  My little world just exploded.  My partner got pulled downstairs to do an emergency D&C and I will need to see the rest of her morning patients.  In addition, there is a patient here who is pregnant and who has been bleeding who on ultrasound may have a tubal pregnancy.  I have to discuss this with her while seeing all of my patients and all of my partner’s patients and come up with a plan for her care.  We will recheck her pregnancy hormone level tomorrow.  It was checked in the ER last night.  We need her blood type to determine if she needs a shot of Rhogam, and we will repeat the ultrasound in one week.  In the meantime, she is given careful precautions in case she has a tubal pregnancy.  She will hurry to the ER if she has a severe pain on her right side where the anomaly on the ultrasound is.  We discuss the treatment of an ectopic pregnancy, which is either surgery or an injection of a chemotherapeutic agent.

I grab a quick piece of Hawaiian cake made by a coworker’s mom, since it is looking uncertain whether I will get any lunch at all.  I finish my patients and my partner’s patients up and run downstairs for a quick bite of yogurt (yogurt, of course).  Won’t do me a lot of good after that piece of cake.  Then back upstairs to check on my remaining labor patient.  She is still 6 centimeters after the pitocin drip was initiated, so I break her water to hopefully get her going again.  I fill out all her admission paperwork and head upstairs.  Then I go through all of the patients in my inbox who need results checked, dictate a history and physical for tomorrow’s surgery, and meet briefly with an equipment rep who wants to show me a device that is available to us in the operating room.  Then a patient is in the room and it’s time to start with clinic again!

Man, do I have a lot of patients this afternoon.  It feels like this day will never end.  And I don’t know whether or not that patient will deliver before I have to leave, since she begged me to deliver her.  I do know that I am postcall from yesterday and on call again tomorrow and I can’t be sitting around late in the hospital tonight because I may have to do it all over again tomorrow. 

YUM CAKE!  I just had to run and get another piece of that delicious homemade cake.  Lord, protect me from the evil that is that cake.  That will be the last of the cake for you, missy.  Drink your Diet Pepsi.  K is working up the third afternoon patient.  My partner is laughing about how one of our patients refers to us as “the white doctor” and “that other white doctor.”  She said it is a good thing our hair is a different color, or we would be completely interchangeable.  I am pleased that one of my afternoon patients has not shown up, because that will make the schedule slightly more bearable. 

There is no SAVE button on this blog.  There is only a PUBLISH button.  I am not yet ready to publish this thing, so it will just have to sit while I scootch back to our internet clinic program.  We are “in the cloud” which is apparently very sophisticated and desireable. 

Another lull between patients.  I will do some paperwork and fill out a bunch of forms for the pharmacies – we get requests for refills not just from the patients but largely from the pharmacies.  A lot of times the patients don’t even know their pharmacy has contacted us for a refill.  This takes up a lot more time than it should.  In my opinion we should refuse to refill the prescriptions unless we hear from the actual patients.  Right now it is three o’clock and my three o’clock patient has not yet arrived.  I am reading other blogs and K is answering phone calls.  My three o’clock is now 7 minutes late.  Maybe I will get lucky and she will no-show her appointment.  If they are fifteen minutes late they get canceled automatically.  My 3:15, however, is now here.  K has gone to scoop her up.  I am wondering if my downstairs labor patient has changed her cervix any.  This blog is bogging.  I confess I am NOT hoping for an exciting finish to my day – excitement in my line of work is NEVER a good thing.  Yay!  The three o’clock failed her appointment!  More time to catch up for us!

My next patient had her two daughters with her and said she thought this baby would be another girl because her daughter’s magic eight ball said so.  They were all quite convinced.  Patient after that:  very demanding.  Wants to know RIGHT NOW when we are going to deliver her baby.  Wants to know RIGHT now why her blood sugars are getting lower (um, you’re following your diet correctly?).  Next patient is insulted because we want to know how many sexual partners she’s had.  “Really??” she wrote on the form.  “How about one in the last 25 years??” 

I just called downstairs to find out how the labor patient is doing.  I was told someone would have to call me back because security is down on labor and delivery sorting out a brawl.  There is always major family drama going on.  Either the patient doesn’t want anyone to know she is there, or the baby daddy is not supposed to know she is there, or HE is not supposed to be there, or the mom doesn’t want the mother-in-law in there, or the police are coming because the patient had drugs in her drug screen, or two possible baby daddies are having a knockdown dragout, or the Hatfields and the McCoys have settled into next door rooms, or grandma is sky high on vodka and xanax and has to leave before she heaps any more insults on her family, the nurse and the doctor.  So I am still waiting for word on my patient, because apparently a brawl is still going on.  We had Hatfields and McCoys all the time when I was in residency in New Orleans, only they were Boudreaux and Robichaux.  There were just certain families that we knew could come nowhere near each other in the hospital, or there was gonna be a killin’. 

My parents are coming in from two hours away because tomorrow is Grandparent’s Day at my daughter’s school.  They will be here in about an hour and hopefully we will all go out to dinner.  That is, if I can disentangle myself from my little labor patient, who will have to be turned over to the on-call doctor after all.  I think she will not be pleased, but it can’t be helped.  I am still waiting to see my last patient, who is still asking questions, and I am really in a hurry to get out of here.  We are discussing the possible reasons (and guilty parties) responsible for the altercation downstairs.  I wish K would hurry up, but I know she is going as fast as she can.  I am tapping my feet nervously and anxiously.  I am really wondering what the heck the labor patient is doing too. 

OK.  My day is coming to a fairly uneventful end.  The altercation was a family being notified that they would not be taking their baby home because they abused their last one.  Security did their job.  My labor patient is a rim, so I will not be delivering her baby and I made her nurse aware of that.  Now I will leave and go meet my parents and my husband and my daughter and we will go “be like family” at Olive Garden.

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