Rants from the Crib

An Ob/Gyn gone mad

Archive for the tag “call”

The Glass Is Half Empty (And There’s Cholera In The Water)

I am examining myself and trying to figure out why I am such a pessimistic person. The immediate answer would, of course, be that I have been a depressed person for most of my life, and we are quite prone to pessimism. The slightly less immediate answer would be that I am basically a born cynic, have been since a young age, and believe that some cynical thoughts don’t count as cynical if they are true.

The longer answer is, I am a physician, and physicians are by nature a VERY pessimistic bunch. It’s ground into us early. Before medical school, it’s all about the frantic studying, and a lot of people get culled out applying for medical schools. So you’re not ever sure that you’ll get to go at all, and you have to steel yourself for that possibility.

Before you even START medical school, the pessimists get ahold of you. You are told to read House of God, by Samuel Shem, and this book tells you more than you ever wanted to know about the attitude you’re going to have. I read that book the summer before med school and cried. It’s a must read if you want to understand what your doctor is truly probably thinking, and what they’ve been through.

Then the skull fuckers get a hold of you in med school. Sub-par students try to terrify you into believing you’ll fail. You’re not sure who’s sub-par and who’s not, but once you figure it out you realize that they are the skull fuckers. They approach you before tests, regaling you with tales of how much material they’ve studied and how much territory they’ve covered. This is to trick you and frighten you into believing that you are underprepared. And if they take a test a section ahead of you, they’ll tell you horror stories about how impossible the test was, how you’d might as well give up, so you’ll be so nervous going in that you’ll do much worse. Nothing increases your view of other human beings like these moronic pieces of shit. It goes on constantly.

Once you get into the hospital, as a third year med student, you realize you are the lowest of the low. You are given jobs that not even the nurses or the orderlies will touch. At the VA, if labs were ordered, WE had to go draw them. We had to do our own EKGs and read them. We had to clean out disgusting bedsores and shotgun wounds that nobody else wanted to touch. We were woken up to do a history and physical on a patient (after the residents and the attending had already done one) who was too batshit crazy to communicate orally, and too combative to touch. The residents just laughed when they woke us up.

About this time, you start with the pessimistic magical thinking. This is the polar opposite of magical thinking where you hope for a good outcome. Around this time, you’ve learned that the worst possible thing that can happen probably will. And you’re trained to think that way. You’re paid not to miss the bad things. So you have to look for them everywhere, and expect that the patient will have the worst possible disease, the worst possible complication so that you can quickly detect and treat it when it happens. When it doesn’t happen, so much the better, but you never unlearn that negative point of view. It persistes all the way into private practice.

When you’re on call, you expect the worst. You’re all alone in the middle of the night; it is just the right time for a five hundred pound woman to come in needing an emergency c-section, which you will have to do all by yourself. You lie there in the call room and stare at the ceiling, unable to sleep because you KNOW somewhere out there is that woman with her name on you. You NEVER make plans when you are on call; the simple purchase of a movie ticket will cause a ruptured ectopic pregnancy to show up in the ER before you even get in through the theater doors. Yes, it happened to me. Fortunately they gave us our money back on the tickets. As you get older and older, and less and less optomistic, and have seen some of the truly horrible disasters that can happen in your profession, you just become more and more nervous. Every woman who comes through the door in labor – will this be the baby that dies? That one in over a hundred thousand MOMS that die on you? Every one could be the one. This haunts you so much you begin to lose all perspective.

And things like today can happen to you. The person on call (who is NOT me today – I’m on some time next week) is in charge of all the delivered patients and all the laboring patients, and all the unattached Gyn patients that come through the door. If you’re not on call, you should be immune from having your day yanked out from under you by a wayward patient. But the group across town that we’ve just joined has a rule – we take care of our own Gyn patients EVEN IF WE’RE NOT ON CALL if we’ve operated on them or if they just show up in the ER and say that they are our patient. And that’s what happened to me this morning. My husband and I made dinner plans with friends, which I never ever have time to do (not to mention, I don’t have any friends since I’ve been on call all the time for years) and which I felt perfectly safe doing, because I am not on call. But at 8:15 this morning, the OB/Gyn on call from last night called me and announced that a patient had come in through the ER, with a possible cyst or pelvic infection, she might need surgery, and because she said I was her doctor, she was all mine for the day. WTF? I had to call the nurse taking care of her. I had to order things over the phone. And I had to spend my whole lunch hour over there seeing her. The worst part was, my morning was RUINED. I was CERTAIN that the patient would need surgery this afternoon, because that would be the worst possible outcome for my day. I was CERTAIN I would be missing my dinner fun. Of course, when I went over there to see her at lunch, she wasn’t sick at all and I was able to let her go home. But the morning was spent CERTAIN that my night was ruined. And I was furious. And I still didn’t get any lunch.

So that doctor pessimism has ruined me. It has permeated every aspect of my life. I don’t know how to turn it off. And the magical thinking persists. I feel like, if I don’t think of all the possible bad outcomes, one of them will happen. And if I don’t expect to get my plans ruined – well- that’s when they will be. So this is why I’m taking some time off. I’m going to work as a travel doctor two weeks out of every month, and be off two weeks out of every month, so I can spend some time with the family and break the cycle of constant terror that something awful is going to happen. Not to say I won’t feel that way the two weeks I’m working. But at least I get two weeks free of the terror. And maybe that will be enough for me to turn some things around.

A Typical Call Day

My day started at six AM sharp as I jumped out of bed and into the shower. My husband got up too as he had been tossing and turning for the last couple hours anyway. He went downstairs and turned on the fire for me. I shoved my wet hair up under a cute surgical cap, grabbed a couple Atkins bars and a Coke Zero and ran out the door for my seven AM c-section. My daughter wasn’t even up for me to hug goodbye.

I got to the hospital and parked in the doctor’s parking lot. It was still raining, which it has been doing steadily for the last three days. Things are starting to flood. I had my call bag, my purse, my heavy coat and my portfolio of paperwork I’m working on for my new job in North Dakota. I scurried my way in through the rain and found my way upstairs to Labor and Delivery.

One of the across-town doctors, whom I have not really worked with before, but he and I found we have a lot of friends and contacts in common, was waiting there to help me with the c-section. He just thought it would be nice to operate together before I left. We gowned up and did our c-section, which went quite smoothly. Nice healthy little girl baby.

After the c-section, it was time for me to round on all the OB and delivered patients on Labor and Delivery. Between seven doctors that amounts to quite a lot. I had two inductions, which are patients who are having labor started for various reasons. One was past her due date and had elevated blood pressures, and the other was a diabetic with elevated blood pressures. I was pretty sure the first one was going to wind up with a c-section. I got their pitocin started and it was time to do circumcisions.

The first circumcision was a baby who had been born the day before. This was my first circumcision in the new hospital, and the equipment and the location were unfamiliar. I got his done well with some minor frustration. The second baby was not a newborn – he was a twin who had been born prematurely and had been too small to circumcise at the time he was born. By that time I was adjusting to the new equipment, which contained a nerve-wrackingly sharp pair of scissors – not exactly the sort of thing you want to be waving around a little penis. Everything went fine. One of the nursery nurses was from our old hospital, so it was good to see her there.

Then I had to answer a bunch of phone calls. One was from my husband, who was trying to arrange some things for my new job in North Dakota. I had some calls from patients to answer, and a call from my recruiter for the North Dakota job who was calling to tell me that the hospital had booked the wrong hotel for me and that I didn’t have any call days for my first ten days in North Dakota. Call days equal more money, so I was a bit perturbed about that.

I went to the call room to lie down and rest, since I always lie down and sleep if I can if I have the chance. That way if I’m kept up all night working, I’ve gotten some sleep. I was just on the phone with the computer people who were assigning me a new password for their computer system, since my old one wasn’t working, when I got a panic call from Labor and Delivery – a patient who had come in in labor that morning was about to deliver in the bed and hadn’t been able to get her epidural because there was no time. I ran into her room and she was screaming quite piercingly. The nurse was entreating her to stop screaming. The baby’s head was right there – I could see it peeking out. All we had to do was to convince the patient to stop screaming and flailing around in the bed. She finally got it together enough to push and she pushed the baby out, screaming like a banshee the whole time. Can’t blame her too much, since she didn’t get an epidural. She continued to freak out after the delivery, despite my reassuring her that she was done, the baby was out, and she didn’t need any stitches. I wasn’t sure why she was still so panicky. The baby was fine.

I got a panicked phone call from the husband of one of my patients. She was scheduled for a D&C the following day, but apparently had started miscarrying at home. Her husband sounded very very scared and very very grossed out as he described how heavily she was bleeding, and how he thought one of the clots in the toilet might be the baby. I told him if he could to scoop the specimen out of the commode and bring it with them when he brought her to the ER. The ER was going to assess her and determine if she needed her D&C to go ahead and be done that night, or if it could wait until morning. They never called me back. I called the husband later in the evening and he said they were told she had not passed the baby. They were still coming for the D&C in the morning. He still sounded panicked and upset.

I was notified that one of my induction’s water had broken, and she was going to need an epidural. I OK’d that and then got a very interesting phone call from the ER of my old hospital – they had a lady there who spoke no English and who had two tiny baby feet protruding from her vagina. There was no heartbeat. They put her in an ambulance and sent her across town, since my old hospital no longer has the facilities to deliver or recover a pregnant woman. The OB nurse from the ER had to ride over on the ambulance with her, in case she delivered on the way, because the ambulance drivers were freaking out. When she arrived, the little feet were still protruding from her vagina. They appeared as if they had been there for some time. There was little bleeding. With pushing, she delivered the fetus in the bed. Fortunately I speak enough Spanish to let her know what was going on. The little baby was stillborn. From its appearance, I felt it was between 16 and 20 weeks and had been deceased for at least several days. With a little more pushing, she delivered the placenta, so, thankfully, I did not need to do a D&C to get the placenta out.

At seven PM it was time for shift change. One of my inductions was six centimeters dilated. The other one wasn’t doing a darn thing. I left orders for the night shift and retreated to my cave with several blankets – it’s cold in there. I was waiting to see if the six centimeter one would need a c-section or not. I slept a little while and was woken up by the nurse: “The baby is coming now!” I jumped out of bed and ran down the hall. The baby was NOT ready to deliver. She had gotten me up about an hour early. I went and laid on the couch in the call room until they were ready to call me back.

The patient delivered her baby and did NOT need a c-section. She did not need any stitches either. I was very grateful because for some reason, I felt really dizzy and needed to sit down. That happens to me sometimes with early morning surgery or late night deliveries. I don’t know why it happens. We’ve checked my blood sugar and everything and it’s been fine. Anyhow, I did my paperwork and retreated to my bed. My alarm went off at 6:30 AM and my call day was over!

My First Call Day In A New Place

Well, for the first time yesterday in six months I missed my daily post. I was on call, at a strange hospital, busy, and I couldn’t get a functioning copy of WordPress to come up on my computer over there. What a day it was. First thing, I went to the new Labor and Delivery unit and rounded on all the OB patients. While there, I managed to offend one of the doctors in the other group by questioning whether or not I was supposed to see one of his patients. He went back to their clinic and complained loudly to anyone that would listen that I had refused to see his patient. This was within earshot of my nurse and our office manager, who reported the bad feelings back to me.

Next, I had to go to a strange clinic to see patients. I had to borrow another doctor’s office, and another doctor’s exam room. The powers that be had decided that on our call days at the new hospital, we would see patients at the clinic over there so we would be close by to the action. This necessitated sending one of their doctors over to our clinic, which caused all kinds of hard feelings apparently. In fact, my visit over there must have been so awful that at their noon clinic meeting, they refused to switch clinics ever again. Which was fine with me because it was a royal pain in the ass carrying my work computer over there, along with my nurse. But we will never have to do that again. So, totally failed experiment.

Then I spent the rest of the afternoon and evening on their labor and delivery unit. One of my partners from our office sent me an ectopic pregnancy to operate on, so I did that. A whole bunch of patients came in and out of labor and delivery to be triaged. I did two deliveries, both our patients, at nine and eleven thirty. Then I got to lie down. I got a call from the ER at I don’t know what time – they had a patient about ten weeks pregnant who was bleeding who had to be sent upstairs for observation. Somehow, her bleeding did OK and I got to sleep. I had dreams about her the whole time though.

Come seven AM I was more than ready to hand my call over to the next person.I had to get a rounding sheet ready for my partner and get across town to my usual clinic with computer in hand. It was of course raining on me as I carried all my stuff out of the hospital. I am now in my clinic over here and exhausted. I am planning on taking a nap at lunch if I possibly have the time. I am really looking forward to that. Then I should be able to go home to my family.

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