Rants from the Crib

An Ob/Gyn gone mad

Archive for the tag “Labor and Delivery”

Another Day And Night At The Hospital

Tonight, I am sad. I am on call, and I am all alone in the call room, which can be relaxing with a TV and a recliner and a couch and some beds in some sleep rooms, but I am well past relaxed and on to lonely. I have already delivered one baby today. The mama didn’t speak very much English, which didn’t lead to very much interaction in the delivery. It was her third baby and she only had to push a couple times, so it didn’t take very long. I have another baby on the way, but this lady is taking her time a bit. I am waiting on her to get her epidural so I can break her water, since contractions hurt so much more when the water is broken.

My loneliness was broken pleasantly by a visit from my husband and daughter, who joined me downstairs in the cafeteria for dinner. The cafeteria was actually closed, which was kind of lonely too, but they had brought barbecue from a nearby barbecue place and we had good chicken and turkey and salad. My daughter had a chicken leg and waved aloft some veins and pinkish meat from it to try to gross us out. Unfortunately, they didn’t get to stay all that long. My daughter was out of school for Martin Luther King Jr. Day today, but she has to go back to school tommorrow, so they have to go home and get her a shower and get her in bed.

I spent some pleasant time napping today here on the couch, and some time reading a book that turned out to be pretty depressing. It was a memoir (I’m in a memoir phase these days) about a woman who grew up with a pushy stage mother and a sister who died of alcoholism. When I finished the book I felt pretty stark. I wandered out to the Labor and Delivery desk in search of some company. I discovered that neither of my inductions were doing much. Hence the epidural and the breaking of the water.

I will sleep here tonight because this is a busy enough hospital service, with us taking care of the patients of seven doctors, that if I go home, I will surely be called back. I live quite a few miles from the hospital, and I do not enjoy the drive, day or night. Especially at night when I would rather be sleeping. That way, if someone comes screaming in in labor, they will not deliver the baby without me, because I will be here.

I also spent some time today texting my friend, who lives in a city not too far away. Her sixteen year old son impregnated a fourteen year old, and now they have a baby. They are not even dating anymore. My friend is concerned about the liability of statutory rape, since apparently the girl’s family is beyond pathologic and there is no telling what they may do. She is trying to spend time with her grandson (and she was SO not ready to be a grandmother) and make his life better. The girl’s family has apparently decided that my friend’s family is “rich”, so there is no telling what they may do to try to take advantage of what they see as free money. That kid has really gotten his mom into a lot of trouble. She is NOT happy.

I have eaten a large quantity of Atkin’s bars today, since I am on the Atkin’s diet. The barbecue chicken salad is the only real meal I have had all day. I have also had like four Diet Sierra Mists today. I just got a text from my husband – Target has Atkin’s bars CHEAP! I never even knew they had them. I’ve been there like, a million times. Very odd. He can pick some new ones up for us.

I missed seeing my daughter today. It was so good to see her for such a little while, put her on my lap, smell her hair, tickle and tease her. She is growing up so very fast. One of the main reasons I am leaving this very busy job is to be able to spend more time with her and my husband. I will work two weeks a month, then be off two weeks a month. Hopefully this arrangement will allow us to pay the bills. I am a little anxious about that. I will miss reading my daughter her bedtime story tonight. We have been reading a series of books that were great favorites of mine as a kid, the Great Brain series, about a family of boys in the 1890’s. One of the boys is a genius and a con artist and they get into all sorts of trouble. We have just gotten to a very exciting part where the hero’s little brother has been kidnapped by an outlaw, and they are trying to figure out how to save him. My daughter is very nervous, wondering if the little boy will be OK. Of course, he will.

I am about to head back out to the desk and check to see if that epidural is in. Then we can break some water and get some action going! Maybe I can get some sleep before we deliver. I am not certain if I am sleepy, but I will try to make myself sleepy in case I get kept up late tonight. Either way, tomorrow I have to drive across town to the other hospital, where my clinic is, and see patients all day. It is hard to do that when you have been up all night the night before. It makes you not too sympathetic to other people’s problems. Well – the call room phone is ringing – they say the patient is actually about to deliver now! Good thing I didn’t try to go out to eat!

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!

Wild Cat Birthing

Every once in a while you enter a delivery room and just know that you are doomed.  Something about seeing a pregnant naked teenager hunkered wild-eyed up against the wall at the top of the bed just tips you off.  I entered such a room today and the goat rodeo was in full swing.  The baby daddy and the girl’s mom were yelling “Push!  PUUUUUSSHH!” and trying all manner of ineffectual pushing urgings which the feral girl did not even register.  They had had her pulling on a towel in an attempt to get her to bear down in the appropriate place, which was in her bottom and not in her head as she imagined.

When I walked in, she was yelling, “GIVE ME SOME MORE SPRIIIITE!”  which struck me as an odd thing to say when a baby’s head is half out.  There were two nurses in the room trying to help each other through this awful mess.  Each one held a leg.  Instead of gracefully dropping her legs back and open as the girl had been asked, she was shoving her legs straight out and threatening to crush the baby’s head between them.  She was pushing so hard, intermittently, that her naked bottom with half a hairy baby head protruding from it was waving up and down in the air.  Alternately, she would bring her knees together and threaten to slam them on the baby’s head again.  The two nurses were fighting her with everything they had.

The girl’s momma was yelling, “You got to get it out, baby, you gonna hurt him!” and the baby daddy was hollering, “Get yore LEGS back!  Pull on this TOWEL!”  The nursery nurse was hollering at her to get off the baby’s head.  The nurses were hollering at her to get her legs back and PUSH.  And the poor ward clerk was actually in there attempting to give her some more Sprite in hopes that that might calm her down.

She finally managed, despite her wild-eyed bucking, to get the baby’s head out.  Then of course the baby’s shoulders stuck.  A shoulder dystocia is a possible emergency even in a calm environment and we REALLY had to get her legs back, no fooling.  I had a nurse pushing just above her pelvic bone to try to get the shoulders to rotate.  The girl was screaming, hollering, fighting.  To my relief the shoulders rotated and came on out.  THANK GOD the baby was out!  After a little rubbing and stimulation he started to scream, having survived the squeezing and pushing fairly unperturbed.

“Now I want Sprite,” my patient said.  “Was I bad, Doctor?”  I told her with as much sense of humor as I could muster that she was quite the wildcat and I wouldn’t want to meet her in a dark alley.  Fortunately, she needed very few stitches and she actually submitted to them without too much fuss.  “Did I hurt the baby?” she wanted to know.  We reassured her that the baby seemed to be fine.  We got her cleaned up and united with her baby,  and I escaped from the room.

Outside at the nurse’s station, the nurse who had been in the room helping was shaking her head.  “I haven’t had a wild delivery like that in YEARS,” she said.  “I think I actually hurt my back trying to get her legs in position.  WOW is she strong!”  I shook my head.  “Well,” she said.  “I’m off to get her some SPRIIIIITE!”

The Merger

We are approaching crisis time at this job of mine.  For the past ten years, I have worked at this hospital, gotten to know its halls and its housekeepers and its nurses and its paperwork.  Recently, the hospital was purchased by a large hospital system that has a monopoly in North Alabama.  There is a second hospital here in town that has always had a fairly vigorous rivalry with our hospital, and we have spent time making sure our hospital offers the best and cleanest services so that we can compete with a larger place that has been around longer.  But now this largest of all hospital system has purchased both hospitals, and it plans to merge them in the least graceful way possible.

They are moving all the baby deliveries over to the older bigger hospital with the uninspiring, unrenovated labor and delivery unit.  Our patients, who selected us because we have the young, new L&D unit, with better amenities and perks, such as a gourmet dinner, a complementary massage and free WiFi, are ranging from disappointed to furious to leaving.  The thing is, the bigger better hospital they’re leaving for is the mother ship that purchased us in the first place.  So the mother ship doesn’t care.  No matter what, they win.  If the patients leave us to go to any other hospital in Northern Alabama, Huntsville owns them too.  We are the ones who lose.

We had originally hoped that they would convert our smaller hospital into a mother/baby/pediatric unit.  That would have been perfect; we could have kept our better L&D unit and the patients would have been pleased.  Now they’re shuttling all the deliveries across town, and we have to drive all the way over there to do them.  Even worse, they expect us to change over to the other clinic at the other hospital on our call days.  So we’ll have to pack up our nurse and our computers and our paperwork and head over there to do clinic on the opposite side of town at least once a week.  This couldn’t be a bigger cluster if they tried.  I have been notifying patients all day that their deliveries will be across town and they are UNHAPPY. 

But, the powers that be have told us that this is how things are going to be, and we have no say in the matter.  The patients are disappointed, we are disappointed, and it is difficult to see how anyone is going to be happy with this situation.  The only advantage that I can see is that we may be joining call schedules with the group across town, and if that is the case, we will go from one in every three night call to one in every seven night call.  Of course, that one in seven will be a doozy.  And our patients may be delivered by a doctor they have never met.  And it may be a male – some patients selected our group because we are female only.  So I will spend the rest of this month breaking it to unhappy patients that their delivery will not be here, at their chosen hospital, but at a poor substitute across town, and that they may or may not see one of their chosen doctors at all.  So, Merry Christmas.

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