Rants from the Crib

An Ob/Gyn gone mad

Archive for the tag “physician”

Orientation Fun

 

Rapid City Regional Hospital Credit: Flickr Creative Commons – Emilio

 

I started a new locums travel doc adventure in Rapid City, South Dakota yesterday.  I was to report to the hospital for my “orientation”, a word to those in the know as “soul shattering meaningless tedium”.  My schedule was as follows:

0645 – 0701:  Lean up against the wall opposite the Medical Staff Office where I was supposed to report at 0700.  Watched 3 (count them, 3) employees come up, unlock the office and ignore me totally, despite the fact that I was obviously the new doctor who was getting processed (much like the beaks and assholes that go into luncheon meat) and that I was holding up a wall in the hall out of sheer sleepiness and boredom.  I did manage to get a picture of Traveling Guck sitting under the Med Staff Office sign, post it on Facebook, and email it to my daughter.

0701:  They actually stick their heads out and open the door for me.  Apparently they take the 0700 start time very seriously.

0701 – 0707:  Introduction to the 3 dickheads who left me standing in the hall.

0707 – 0720:  Taken to get a photo badge processed.  When I asked them if they needed ID verifying my identity, they said no.  Apparently they don’t mind issuing medical staff badges to random strangers.  I was of course lined up against a blue wall without opportunity to inspect my hair, and allowed one deer-in-the-headlights shot with no Mulligan.  I was told to go do something else; the badge was processing.

0720 – 0735:  Taken to IT to get computer passwords and immediately change them.  Since they wouldn’t tell me the criteria for the passwords (I swear, they didn’t know whether I needed capitals, lower case, special characters or numbers), I had several do-overs until I found a password that the freaking computer would accept.

0735 – 0740:  Back to pick up ugly badge. Future spoiler:  they set it up wrong and it didn’t open any of the doors that I needed it to.

0740 – 0815:  The ultimate in mind boggling tedium.  This is the same standardized spiel you are given at every single hospital that you work in:  it is dictated by OSHA and JCAHO and a few other acronyms.  Therefore I have heard this 3 times in the past 3 months.  It involves:  Hospital Mission – a retch-inducing phrase or two about Service, Teaching, Health Promotion and Other Grandiose Bullshit, Fire Procedures – seriously, who doesn’t know about RACE and PASS?, Infection Control – a list of all the nasty bugs floating around in the hospital and the special antibiotics used to treat them, if you are lucky and they can be treated at all  (Flesh-eating bacteria included), HIPAA – letters stand for “you’d better not give anyone any information about any of your patients and it we find out you did, we will fine you, fire you and set fire to you”, Code of Conduct – they now must produce a written list about how not to be an asshole (official name:  disruptive physician) because people apparently don’t have the sense not to be assholes and must be given a specific list of asshole things not to do,  Peer Review – we will be watching you, new doctor, and auditing your charts because you are probably incompetent, and Software Use and Access – the passwords never work.

0815 – 0830:  Ridiculously long-winded talk from the head pharmacist, who has a way overdeveloped sense of importance, and who gave me 8 (yes, 8) business cards of pharmacists who I would probably not encounter were I to work at the hospital for 10 years.

0830 – 0930:  Computer training.  This seems to follow a basic pattern – taken to a dark room where a pasty antisocial individual is hunkered down,  sat in front of a computer and given a mouse to click on various things without explanation.  This is all punctuated by, “oh, I don’t know why that’s not working – it usually works”, from the IT person who seems to have no idea about real-life applications of the material they are teaching.  An hour of, “Oh, let’s back up, oh, no, no, no, we didn’t want to go there, OK, try clicking on that” where really, I would have done just as well playing with the damn program myself.

0930 – 1000:  “Do we have anything else for her to do?  I’m not sure, do we?  Did she see the pharmacist?  Oh, I guess we should try to show you the hospital.”  Remember that I must see Medical Records for instructions for record dictation.  Meet with sourpuss from Medical Records.  Receive incomprehensible instructions and dictation cards.

1000:  Phone call from the doctor who is already turning call over to you, explaining that you already have a labor patient to take care of, despite the fact that you haven’t even seen Labor and Delivery yet.

1000 – 1020:  Taken at a gallop past the OR, doctor’s lounge, ER, radiology, and finally, Labor and Delivery where you are kindly intercepted by the chief MD of the Ob/Gyn department, who gives you an actually civivlized and useful tour of the area.  You are introduced to at least 25 people, none of whose names you will remember.

1020 – 1030:  Shown where the locker rooms, scrubs and break rooms are.  Both the MD call rooms are occupied, so no place to sit there.  Insructed to throw backpack on the floor in the nurse’s lounge.

1030 – 1040:  Locate and change your scrubs to their scrubs, because the ones you have on (although perfectly functional) do not belong to this hospital and are thus assumed to harbor awful bacteria.

1040 – 1500:  Sit around on Labor and Delivery because the patient in labor is having her third baby and it should come fast.  It does not come fast.  Chat with nurses (who are too busy to chat) and a Family Practice resident who is waiting to do a delivery and who is hoping you will let him do yours.  You don’t want to let him do your delivery, because you don’t like how anyone does deliveries except for the way you do them, but you have to be a good sport, because that was how you learned back in the day, and people have to learn, don’t they?

1500 – 1530;  Actual delivery of the baby.  You let the resident do it.  He does OK except for the suturing part, which is so slow and fumbling and incompetent that you want to kill yourself.  You would have finished 20 minutes ago.  The nurse is uncertain whether the stitching job is adequate.  It is adequate and you politely tell her to bugger off.

1530 – 1600:  Attempt to take care of strange paperwork and computer work, none of which functions the way you were shown by the creepy IT person in the basement.  Swear under breath.  Repeat.

1600 – 1615:  Use Google Maps (which totally rocks, by the way, and it’s free) to find your way out to Bumfuck where the Ob/Gyn clinic is located.

1615 – 1700:  Meet the doc you are working for and her office manager husband, who regale you with how awful and unfair the politics at the hospital are, and how they hope they will not make you suffer too much.  Yippee.

1700-1715:  Find way back from Bumfuck to the hotel using Google Maps, which by now has used up the battery on your phone.  Pray that you get to the hotel before the phone dies and you are stranded forever.

1715:  Collapse on the bed with the stuffed duck and eat an Atkins bar.  Plan TV watching.  Sulk because tomorrow the patient that delivered wants her tubes tied, a procedure you hate doing and you will have to get up early to do it.

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I’m Done!

Last.  Day.  At.  My.  Soulcrushing.  Job.  Forever.

Best.  Valentine’s.  Day.  Evah.

Saying Goodbye

I packed up my office yesterday.  I would like to say it was a bittersweet parting, but it was sweet, sweet, sweet.  This move was so different than the one last year.  Last year marked the end of eight years of ownership and administration of a private medical practice.  I was a partner.  The practice broke up because my other female partner left.  She had had enough of the trials of running a practice, and of the politics in this town and she found another job.  We had both been considering leaving.  We had discussed it.  We knew it was only a matter of time until somebody did.  So last year we folded up the corporation, because I was the only remaining partner.  I joined the hospital’s Ob/Gyn practice as an employee because I was tired of running a business too.

Last year’s move was different.  It felt like a sort of failure.  I had to leave my bright corner office and move into a windowless room.  I was joining two women with whom I had shared call, but they were the best of buddies and were used to working with each other.  I was an unwelcome intrusion.  I can truthfully say, that after a year, I still didn’t really fit in.  My nurse and I were stuck off to the side, an afterthought, while the two other doctors, their nurses and the ultrasound tech sat in the central area and chattered merrily away.  Sometimes we were briefly included in a conversation.  Mostly we just talked to each other.  I didnt even use the office I moved into.  With our computerized medical records system, we were chained to laptops just inside of the exam rooms.  My nurse actually had a bigger area than I did.

So moving the office last year then, was just that, moving an office.  I didn’t have any anticipation of happiness when I moved, although I had hoped.  I got rid of some stuff, and just moved the rest down the hall into the new office.  The office was much smaller than the old one.  I tried to make it a home; I covered the door and walls with drawings and notes from my daughter, and funny clippings I had saved over the years.  It was always cold in there.  My plants died because there was no sun, and because I didn’t think to water them much because I was never in there.

A lot of politics happened over the year.  A big hospital conglomerate came and bought both hospitals in town.  They completely shut down our sweet little labor and delivery unit and moved all the nurses and all the deliveries to the bigger, drabber hospital across town.  Then they put the three of us docs into the call rotation with the four-man group across town.  We didn’t like having to go all the way across town.  They didn’t like us.  We didn’t like them.  We had to learn an entirely new hospital system.  Call for seven Ob/Gyn doctors was very busy.

My husband and I had been discussing my getting part-time work for a while.  This year we decided to make it a reality.  It just seemed like the right time.  I was so unhappy, and things were just getting worse.  So we made it happen.  My husband sold our airplane because my part-time work would not allow us to pay for it comfortably.  I joined a locum tenens company to do travel doctoring, which had always been my dream.  I turned in my notice.  Everyone was shocked that I was leaving.  I enjoyed the biggest, most stable practice in town, because I had been practicing there for so long.  And I was letting it all go.

I happily counted down the days to the end of that miserable job.  As of this writing, my last day is February 14, 2013.  So this weekend, I cleaned out my office.  This time I really cleaned it out.  I got rid of tons of books and papers that I didn’t use.  I shredded pounds of confidential paperwork, because I had been Chief of Staff of the old hospital.  I went to the U-Haul place and bought boxes and boxed everything up.  As I packed boxes, I had memories of my time at the hospital.  I defrosted the mini refrigerator.  It had been a gift when I first arrived, in 2003.  One of the office staff said, “It’s for you, as long as you don’t ever leave us.”

I packed up an entire box of breakable collectibles.  I collect storks, and things related to pregnant women.  I packed up the Lladro storks I had bought on a trip to Jamaica.  I packed up a beautiful ceramic female Ob/Gyn in scrubs, holding up a  baby, that my mom had bought me.  I packed up ceramic babies, and an entire Willow family of pregnant women, and women and familes with babies.  I packed up gifts from my nurse and my patients.  And I packed stuffed animals.  Scooby Doo with scrubs on.  Little Beanie Baby doctors.  A “Histo”-potamus my friend the pathologist gave me as a joke.  Stuffed pregnant bears.  Stuffed storks with babies in blankets.

I packed files of letters and cards from my patients.  I read some of them, and thought about how I would miss those patients, and they would miss me.  I packed files of cartoons that my mom has clipped for me over the years, all about doctors and babies and Ob/Gyns.  I left the bulletin boards with the pictures of my babies on the walls.  Those belong to the practice now.  People like to find their baby pictures when they come to the office.  No point in taking them away from their families.

So I packed up boxes full of memories, most of them good.  They were all from a brighter time, before I came to the new practice.  And as I packed, I felt liberated.  And overjoyed.  I was leaving this town, which I never liked.  I was leaving this practice, which had completely failed to welcome me.  I was leaving the politics, and the ridiculous unwieldiness of the merging of two hospitals and two practices.  I was free!  Free to travel from state to state, meet new doctors and nurses and patients and different kinds of people!  Free to spend time with my family!  Free from the endless grind of working every day, in the same unhappy job.  Free from being shipped across town, to a hospital that I didn’t know.  I can’t remember the last time I felt so happy and free.  I am anxious, of course, about the changes to come, but they are my changes.  They are not being foisted upon me.  I am free to determine my own destiny.  For the first time in years, I feel real.  And whole.  And alive.

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.

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!

My Doctor Passed Away

My GI doctor passed away this week of renal cancer.   I liked him very much.   He was a very brilliant verbal person with a razor keen wit.  He always had the funniest retorts and comebacks.  But his cancer didn’t respect any of that. 
My doctor was always “catching ” me eating all the wrong foods in the doctor’s lounge.   He had carefully explained to me about my bad gastric reflux, and about the medicines I was taking and how and why they worked.   He explained why I had the dietary restrictions I did.
He worked in the same hospital I did every day and I always saw him in the OR and the hall and the lunchroom. 
I remember when he was first diagnosed with cancer- he had been losing weight and was somehow ignoring it.  They found out the cancer was in his kidney and at first they weren’t even sure he would survive the surgery.   Then it wasn’t as bad as they thought it would be and that he might be OK.   He came back to work and then a couple months later the cancer came back in his lung.  Then he quit work for the last time.   We all hoped he could come back but we knew he wouldn’t.
He really will be missed.  He was a good man.

The Great White North

This blog entry will be Epic Fail after yesterday’s compelling look into the world of vaginas. Sometimes I outdo myself. Other days, I just sit and stare at this blank New Post page as if it will write itself. I think about all the funny things that everyone else has written and I get, just, well, stumped. You can’t force funny. You can’t fake it either.

What I am thinking about is how much I am looking forward to my work travel to North Dakota. In a way, I am freaking horrified because I was raised in the South and except for a few memorable winter trips to Nebraska, Land of the Parents, and a couple of frigid skiing trips to Montreal, I am pretty much inexperienced in The Land of the Ridiculously Freezing Cold. I learned how to drive on ice and snow once, and did it a couple of times, but really, I’m petrified. I’m going to be driving a rental car when I get up there -and – do rental cars come with snow chains in the Big Bad North in the winter? What if I’m in a hotel right next door to the hospital and I can’t even get over there to deliver a baby because there is a huge fucking blizzard?

I have a bunch of what-ifs about the Big Snow Thing. What if I get to the airport and I get lost in the snow? What if there aren’t snow chains? What if I spin off the road and right into a ditch and am not found until spring? What if I get lost in the wilds of North Dakota? You see, I come from the land of Alabama, the Land of 47 Degrees Every Day All Winter Except For a Couple of Cold Snaps in the Twenties That Make Us Cry. It only snows maybe once a year for Pete’s sake. And it seldom sticks. So what do I do? Seriously, what if I can’t make it over to the hospital and the baby delivers without me, while I am floundering around in a ditch?

But there are some things I’m seriously looking forward to. One of them is, well, the snow. I am bringing my camera and plan on taking lots of snow pictures. Isn’t everything more beautiful with snow? My daughter wants to come up and visit me while I am working just so she can play in the snow. Another thing I am looking forward to is hearing the accents of people who live in North Dakota, which are freaking hilarious to me. I am also enjoying the idea of working my SOUTHERN accent. It will just crack people up. They will ask me questions just to hear me say the answer. I can hit them with all my pithy Southern witicisms (and believe me, there are PLENTY). We will enjoy each other’s accents immensely.

Mom said there might be an Indian reservation nearby. Ehem, excuse me. NATIVE AMERICANS. How cool would it be to have some as patients? It has been years since I have been around any Native Americans. We had a pretty big Native American patient population when I was a resident in southern Lousiana – down in Houma were the Houma Indians and they were pretty fascinating. They were neat people. Very nice. And very sheltered. They seldom left their part of the bayou.

The most I know about North Dakota is watching the movie Fargo. Which is a scary thing. If that movie is to be believed, my life will be full of pregnant police officers who say, “Oh, Yah” all the time and scary kidnapping axe murderers who put people in wood chippers. I must watch that movie again so I know what to expect. I especially must inspect the snow. And whether or not there are snow chains.

But seriously. There is the matter of CLOTHING. I do have a pretty long down parka but it doesn’t have a hood. I have some Thinsulate-lined snow boots, but I can’t wear them in the hospital. Will I have to carry my work shoes in with me? I’m not sure where my ski stuff is. I am, however, CERTAIN that I have gotten too fat to wear any of my thermal underwear. Ehem. And I’m not about to buy new ones in fat sizes. Scrubs just don’t provide a whole lot of protection against the cold. Even with a down parka and Thinsulate boots and a tuc and a scarf and a HAT. I do have a lot of knit hats. Wait. I saw winter hats with ear flaps at TJ Maxx. They were there as (useless?) Christmas gifts – since what do we need ear flaps for around here? All those hats are so BAD for my hair though. I have really fine hair and it gets all smushed and staticky. But I’m afraid I’m stuck with hats in North Dakota. Because one thing I hate is being COLD. (Another thing I hate is that the Italics key seems to be missing from my New Post template now and I am forced to use all caps for emphasis).

So I am at once looking forward to my Travel Doc adventure and am terrified. I’m sure people will laugh at me, afraid of a little snow. Actually, I’m afraid of a LOT of snow. Really hope I don’t get stuck in a blizzard. I guess if I hear there’s going to be one I’ll go on over to the hospital and stay in the call room. That way I won’t get snowed out. If anyone out there is from the Great White North, maybe they can give me a shout with some recommendations for a) clothes and b) driving. Anyone? I’ll be the one in the scrubs and the ear flaps.

Some Things About Vaginas (My Own Monologue)

A few thoughts on vaginas. I see the word “vagina” batted about a good bit, and not just in my professional journals. Ehem. I see a fair number of vaginas on WordPress, frequently in the name of humor and or just plain old shock value. I agree, the word “vagina” is hilarious. Especially given its frequent overuse. It is, however, frequently used incorrectly, and we must set the record straight.

The vagina is the INSIDE of the lady parts. The part you can stick a finger in. The OUTSIDE part, actually, is called a VULVA. Another hilarious and somewhat disgusting word. I just think the world should know, the outside part (the furry part) is not a vagina, it is a VULVA. (Also referred to as the Bearded Clam). I think people frequently confuse vulva with vagina. If I can see it without sticking a speculum in it, it is a vulva.

The vagina is like a self-cleaning oven. There is no need to overwash it or flush it out with unfortunate commercial cleaning products. Left to its own devices, it will clean out anything that is left in it. Provided that that something is not stuck. Stuck requires special care. A trip to your gynecologist may be in order if something is STUCK. Most commonly STUCK things are condoms and tampons. These can be retrieved without a great deal of difficulty. The sooner the better. The longer something is stuck, the worse it will stink. Stuck things can clear an entire exam room for the day if left in too long.

Vaginas have an interesting nerve supply. The lower third (toward the outside) of the vagina is well supplied with sensory nerves. The upper two-thirds, however, have a limited number of sensory nerves. That is why, when inserted deeply enough, we are not really aware of inserted objects such as tampons, or contraceptive rings.

Vaginas are very effective at drug delivery. Many drugs are designed to be administered per vagina. The mucous membranes and wrinkly surface insure a thin, extensive surface area for drugs to dissolve. Some odd people have tried taking drug administration to extremes, such as douching with whiskey to induce drunkenness or applying cocaine. I’m not saying these things don’t work. I’m saying they aren’t a very good idea. At all.

Sometimes people insert items into the vagina for titillation. Sometimes this works. Sometimes it doesn’t. Sometimes things get STUCK. Refer back to paragraph three. I suggest against pointy things, and things such as empty bottles that can create suction. Suction equals STUCK. I have retrieved some interesting things from vaginas over the years. A frozen fish. A razor blade. Staples. A wedding ring (not belonging to the patient’s husband).

I am all in favor of vaginas having personalities. I have been greatly amused over the years by tales of a vagina’s urges and quests. I have read great blog posts about vaginas with minds of their own. Frozen vaginas. Antisocial vaginas. Vaginas protecting uteruses. Women hardly ever attribute personalities to their uteruses. Possibly because uteruses are sterile. They should contain no bacteria. Vaginas, on the other hand, are TEEMING with bacteria. There is no way to sterilize them. Don’t try. Like the colon, there are friendly bacteria that you WANT to have in there. Don’t kill them off with household cleaning products.

There is no such thing as a vaginal rejuvenation procedure. Ignore anyone trying to sell you one. They are snake oil salesmen. Lasers and vaginas were not made to go together. There is nothing you can do with a laser to improve on a vagina. It is true some vaginas become a bit saggy with overuse, particularly in the form of birthing large babies. You can tack up things that are sagging, but I would not call that a rejuvenation procedure. Sometimes gravity works on vaginas so much that they turn inside out like a sock. This typically does require some kind of surgery, if you don’t want that to drive you crazy.

Just wanted to set the record straight though. Frequently patients call to complain of something like “a bump on my vagina.” They are referring to their vulva, actually. You can’t have anything ON a vagina, just in it. Unless it is inside out. So by all means, be on a first name basis with your vagina. Name your vagina. Have conversations with your vagina. Just remember, it is the part on the inside.

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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