Rants from the Crib

An Ob/Gyn gone mad

Three C-Sections, A Tubal, And A Clinic

Wow.  What a day.  And I’m only halfway through.  We started out with two c-sections scheduled for today.  Then one of my patients had her baby yesterday and needed to have her tubes tied today.  So we had to add that on to the beginning of the schedule.  Then a set of twins came in and needed to be delivered.  Third c-section added.  I was supposed to go over to my new hospital today, get processed, get a badge, get a tour and learn the new computer system, but that was supposed to be done at eleven, when the second c-section was barely over.  And then after a tubal and three c-sections, I have clinic all afternoon.

First, the tubal.  I had to wake up at six AM to be there before my seven o’clock start time.  They had kept the patient’s epidural from her delivery the day before to use as anesthesia for her tubal.  So they dosed her up and wheeled her back.  We had to give her quite a bit of sedation to knock her out.  I injected her navel with a numbing agent and made a one centimeter cut under it.  Her uterus was sitting right there, at belly button height.  I shoved that uterus toward the left and found the right tube and brought it to the surface through the incision I’d made (kind of like ice fishing).  We tied off a loop of it and cut the loop off.  We burned the edges to make sure she didn’t bleed.  Then we shoved the uterus the other way and got the left tube.  Lather, rinse, repeat.  Then we closed her up and off I went, for c-section number one.

My partner was doing the first c-section and I was assisting her.  The patient had had a c-section before, so of course everything in there was all stuck together.  There was barely enough of an opening to squeeze the baby out.  Then there wasn’t enough room to pull the uterus out to repair it, so we had to sew it up while still inside the tummy.  We also had to get to her tubes to tie them.  Second tubal of the day.  Everything went fine and we scrubbed out to await the next c-section.

The second c-section was mine.  This patient had also had a c-section before, and again, everything inside was all stuck together.  Her uterus was stuck to the inside of her abdominal wall and we had to dissect it off to be able to exteriorize the uterus.  This baby came out without a hitch though.  We closed the uterus and it just oozed from where we had unstuck it from the anterior abdominal wall.  We had to stitch and stitch and then apply a special goo that causes blood to clot so it would stop oozing.  That took a good while.  We finally got the uterus put back and closed her up.  This was her fourth baby but she didn’t want her tubes tied.  So, no tubal.

The third c-section was mine:  the twins.  She had originally wanted to try for a vaginal delivery but got concerned because the second twin was sideways and she was afraid it would get stuck.  And her blood pressure was up, and she needed to be delivered.  So, a c-section it was.  The little girl delivered first and looked great.  We flipped the little boy to head down, and out he came too.  Both babies looked great!  Her uterus was a little mushy from being so stretched by two babies.  It took a little while to get the bleeding to settle down.  No tubal for her either.  We got everything closed up and – guess what – I was almost an hour late for afternoon clinic!  So, yay me!

I had patients waiting in all my exam rooms when I got upstairs.  I had to run and play catch up, because I was way behind.  I am now plowing my way through fourteen afternoon patients.  I write when my nurse is working someone up to be seen and I have a minute.  So here I am, gulping my diet Pepsi and writing my blog as I wait between patients.  I am more or less caught up now.  One of my patients had already heard that I was leaving this office to work elsewhere and she asked me about it.  News sure does travel fast in a small town!  That’s one of the reasons I’m kind of anxious to leave here.  I’m more of a city girl, myself.

So I did a tubal, three c-sections and missed my hospital orientation.  I was late for clinic.  Now I have like a million patients to see.  I was on call yesterday, and tomorrow I’ll be on call again, for five days in a row for the New Year’s holiday.  And I have two labor inductions tomorrow.  Bleah.  See why I need a break?  I am so looking forward to working part time in 2013!

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