Rants from the Crib

An Ob/Gyn gone mad

Archive for the tag “work”

Come Ride The Rollercoaster

I am an OB/Gyn. For some, the first thought that comes to mind is, what is that? In this case, you are probably a single male. For those of you who are single men, the answer is, I take care of women.

I do pelvic exams. I do pap smears. I hand out birth control. I catch babies. I do c-sections. I do hysterectomies. It sounds straightforward. It almost sounds easy.

I deal with pain, physical and mental. I deal with disease, physical and mental. I deal with disasters. I deal with miracles. I deal with women. I deal with women and all their world around them. All of it.

An OB/Gyn gets to know their patients, unlike surgeons. Surgeons meet a patient because there is a sick organ, they remove the organ, they take care of the patient for the required six week recovery, and say goodbye, unless they find another broken organ to remove. We also remove sick organs. But we remove them from people we have known for thirty years.

An OB/Gyn begans their journey with a woman when she is still a girl. Girls have cramps, they bleed until they soak their clothes, they start thinking about sex, they have sex. Girls get pregnant.

We talk about sex, we talk about pregnancy, we talk about diseases. We try to prevent them and we look for them.

The girls become women. They come to you because they are getting married. They don’t want to get pregnant. They do want to get pregnant. They have never been examined before. They have been examined a million times.

The women have their babies. We deliver them. We deliver delight, we deliver pain, we deliver reality, and sometimes death comes when it shouldn’t.

The women get older. Their marriages get longer, or shorter. The sexual partners increase, or they go away altogether. Things start bleeding weirdly, and hurting. Things start growing where they don’t belong. Things start falling out.

Then things shut down entirely. Here come the hot flashes, the wrinkles, the dead sex drive, the dissolutionment, and the next generation starts making them crazy.

They lose their husbands, when they weren’t ready to. They lose their children, when they shouldn’t have. They spend a decade of their life caring for invalids. They forget who they are; who they were. If they are lucky, their children start driving them around.

Come ride the rollercoaster with me. Spend a day with me.

C-section, early morning. There is blood. You are tired, from lack of sleep. The day is just starting. You have to explain to a woman that you have to cut her open. She doesn’t want to be. Her husband doesn’t want her to be. There is no choice. There is nothing worse than explaining to someone that they don’t get a choice, that any different choice they make may result in death. The baby is born. The mom is OK. There is relief. Life is good.

Late for clinic. All doors closed, with charts in them. Lights are blinking. Phones are ringing. Your nurse is looking at her watch. You are looking at your watch. You start running. You must be terribly efficient.

There is something in humanity that abhors efficiency. The further behind you are, the more complicated the patients become. When someone bursts into tears, you just can’t rush out their door.

Here is my day.

Room 1. There is a little girl in there, a scared, skinny little girl. In the nurse’s hand is a positive pregnancy test. She knew, but she didn’t know. Her mom is in the waiting room. She doesn’t know. Skinny Girl doesn’t know what to do. She is crying, and twisting the friendship bracelets on her arm. How does she tell mom? How can she have a baby? How CAN’T she have a baby? These issues have to be discussed. NOW. You are scared for the girl. You are sad for the mom. You are sad that another kid isn’t going to finish high school.

Room 2. Elation! You have been taking care of her for almost 10 years. She just got pregnant! She has been trying so hard, so long! You can’t help it, you’re ecstatic for her. You’re ecstatic with her. You hug her and whoop.

Room 3. A lonely tiny bedraggled little lady slumps on the table. This is her first exam in 8 years, because she has been home taking care of her sick husband for that long. Now he has died. She is trying to remember how to take care of herself. She doesn’t remember, it has been so long. She hasn’t seen her friends in years. You leave the room, and feel profoundly lonely for her. You feel her loss. You see her emptiness.

Room 4. A black eye. Where did she get the black eye? She fell. You give her the shelter number, tell her to sneak it in her shoe. You document. You pray.

Room 5. One of your favorite pregnant patients. She’s brought her mom to meet you. You’re flattered, and tickled, and happy to meet her! You joke, you laugh, you enjoy each other’s company. You hate to leave this room.

15 minutes. You were alotted 15 minutes for each.

Back in room 1. Tragedy. Your patient has been going through infertility treatments for two years. She finally got pregnant. The ultrasound shows that the little heartbeat is gone today. You are the one who has to tell her. You watch her eager face go to apprehension, to dread, and watch it crumple. The sobs are gut wrenching. Her husband is sobbing too. It is so hard to watch a man so bare, so crushed. They are destroyed.

Back in room 2. She has a rash. It hurts, it hurts so so bad. It hurts to pee. Her glands are swollen. What is it? She is a sweet girl. This has been her first sexual partner since a long relationship. She gambled. She lost. She has herpes. To do the test, the swab, you have to hurt her, scrub the spot with the sore. You have to tell her, she has an incurable disease. You have to try to figure out how to help her live with it. She cries and cries.

Back in room 3. Your patient has brought in her beautiful new baby! You pass the baby around, hold the baby, hold back sentimental tears at his silly little hat. You have your picture taken. You are the hero. You feel great!

Back in room 4. You discuss birth control. Your patient wants to know options. ALL the options. Now. She wants you to help her decide. Now. You struggle not to look at your watch. She wants you to explain how the IUD works again. She might want that. She might not. She doesn’t know. You feel impatient, and rushed, and put upon. So tell me about the IUD again?

Room 5. Again. The woman there doesn’t want to have sex with her husband. She wants to know why not. Is there a pill? A magic cure? You try to explain how complicated female sexuality is, how many dozens of factors that can affect it. Is there a pill? A magic cure? You can’t fix her. There is no pill, no magic cure. Frustration. Sympathy.

15 minutes.

By the end of the day, you are wrung out. Destroyed. And you may likely be on call for the night. All those feelings; you’ve been tumbled around in them all day. You felt them. You felt them all. You couldn’t NOT feel them. You know these people. How could you not feel joy for them, fear, anger and pride? Not to feel is to die. You can die, or you can ride the rollercoaster.

Up. Down. Up. Down. Down again, just to break the pattern.

When you drive home, it is dark. There is no dinner. You don’t want any. You don’t have time to make any.

Your husband wants to know, why don’t you want to go out to dinner with friends? You need friends, you never see your friends, we don’t have any friends. You try to explain your job.

You tell him, honey, this is my job. All day, I enter rooms containing people who are scared, broken, overjoyed, sick, hurting, elated. I have 15 minutes to see them, get to know them, persuade them to take their clothes off in front of me, and tell me their darkest secrets. Small talk. You are the world’s leading expert. Small talk is what gets you through their embarassment, their discomfort, their fear. You are so good at it that sometimes they ask you when you are going to do their pap smear. It is done. You did it while you were chatting, distracting them, making them laugh.

Now he wants you to leave your house, go to a party. A party filled with people. The small talk. You just can’t handle it. You’re small talked right out. You never want to talk to anybody again. You are so tired. Your husband looks at you. He doesn’t understand. He thinks you are introverted, and disinterested, and no fun. What you are is out. Out of emotion. Out of love. Out of hate. Out of caring. Out of conversation. Out.

If you are lucky, you get to go to bed. If you are not, you get called back into work. More joy, more fear, more elation, more sadness, more blood, more babies. Now you are doing all this in the dark, all night. You mustn’t drop your guard. You must be ON for everyone, to explain, to persuade, to rescue them from ignorance and fear, and choose the right thing for them, the good thing. Sometimes there is no good thing. Forget your own issues; you are being paid to maintain their energy, keep them compliant, keep their spirits up.

If you are lucky, you get to go to bed.

The alarm goes off at 5, and you are up again. Another whole day. And another. And another.

Room 1. Room 2. Room 3. 15 minutes.

Come ride the rollercoaster. Come ride it with me. Today, and tomorrow, and tomorrow, and tomorrow…

Super Travel Girl

The next 2 days will be insane. Today I will be flying home to Alabama from North Dakota via Denver, Charlotte, and Huntsville. But will I see my family?  Heck no!  My hubby and my daughter are in Philadelphia for work/ fun and won’t be back until Monday. I, on the other hand, am arriving at home at 11 PM tonight and will have to wildly pack for my next trip, which starts tomorrow, and for which I depart at 2:45 PM. I have to pack for TWO destinations – I am going to Milwaukee first for my fabulous jewelry conference, which I attend every year. I will be there for a week. Then I am leaving DIRECTLY for North Dakota to work, without pausing to go back home first. So I have to pack work clothes, and I have to pack funky clothes and jewelry supplies for my show. How will I fit all this in the suitcases I don’t know. It’s going to be interesting!  I am strongly considering checking 2 bags, which will be unwieldy and expensive, but the locums company I work for does reimburse travel expenses. Then I’ll have a carry-on and a backpack too. Yikes!  And I have to do it all in 11 hours!  Fortunately I did think to launder all the clothes from this trip at the hotel. So I can pack all the work clothes straight out of the suitcase. And I don’t even want to think what will happen if I miss even one connection. I will be totally screwed!  My first flight out of here is already delayed an hour, but I think I will make the connection. So, phew!  I’m just a little stressed right now. Craziness!  Wish me luck!

Super Travel Girl

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The Worst Is Yet To Come

It has been very difficult to come with a daily post lately because there is a depressing sameness to my life.  I come to clinic, day in and day out, and take call every week.  Things are changing so fast.  They have closed the labor and delivery unit at my hospital, and now we have to drive across town to do deliveries and major surgeries.  They have combined the nurses at this hospital and the nurses at the other hospital on labor and delivery, in the nursery, and on pediatrics, and all the nurses from over here are having to learn their way around over there.  On our call days, we will have to go across town and have clinic in the strange clinic where we have never been.  One of their doctors will have to come over here since there is not room for everyone.  We are on two different medical records systems and there is no way to combine them.  Eventually we will all have to learn a third medical record system.

And then I am leaving.  I am counting down the days – my last clinic day is February 14.  So Happy Valentine’s to me!  I can’t wait to be out of here – out of all the confusion of merging two practices, two labor and delivery units, and two hospitals.  Of course, then, I will be learning a third hospital with all total strangers when I go to North Dakota to do my locums.  So I’ll be starting all over again.

Today we held a lunch meeting (while I wanted to be taking my nap) about the logistics of rotating clinics.  I will be the first one to do this, and it will be tomorrow.  My nurse and I are so unprepared.  They haven’t been able to let us know which lab we will be using, which pathologist, or even which clinic room we will be working out of.  We need a pulse ox and thermometers and they don’t even have those over there.  They don’t even read OB ultrasounds over there, or even do them if the patient is on Medicaid.  This is just going to be a major cluster, and I will be here just in time to enjoy the worst of it.  I am stressed out and discouraged.

And then we have the major planning that comes with a job change for me.  My husband and I have to sit down with an attorney and decide if I will form a corporation for my new locum endeavors, or just submit tax forms at the end of the year.  We have to find new health insurance.  We need to sit down with a CPA.  We keep planning on making a list of all the things we need to do, and we seem to just keep avoiding it.  And my husband is a lot better than I am about not sticking his head in the sand.  There is just so much, it’s unimaginable.  And in the meantime, I have new passwords, and a new badge, and new phone numbers, and new passcodes and new dictation numbers for this hospital across town.  And I will just need those for six weeks, and then I will be out of there and on to a NEW hospital. 

I am stressed.  I keep taking naps to get away from myself.  I can’t stand all the stress.  As much as possible, I’m trying to just not think about anything.  But that’s awfully difficult, with all these meetings we’re having, and how upset everyone is about all the changes and all the questions that we have that are unanswered.  We are recognizing that this whole switch will be a total cluster.  And then I’ll be leaving, and doing something entirely else.  I can’t wait to leave.  It means I’ll be done with this place, and these people, and by then all the new preparations for my new job will be taken care of.  I hope.

So that will be the shape of my life until February 15.  Then I’m on my way, to newer and greater things!

Hell Is Other People

Today was our first day at the new hospital.  We had two c-sections scheduled back to back, on an unfamiliar Labor and Delivery unit with (mostly) unfamiliar nurses.  Everyone was nervous to be working with new people.  The scrub tech was zooming around at the speed of light getting things ready because she was so nervous.  We didn’t even know how to find our way up from our (wrong) parking spaces to our destination on Labor and Delivery.  We didn’t know where the surgery suites were.  The masks and face guards were new and unfamiliar.  The surgical equipment was unfamiliar.  The suture was different.  I didn’t have a dictation number, so I couldn’t even dictate the surgeries that I had just done.  The postop orders were different.  We had sheets to sign that didn’t even exist at our own hospital.  We were all completely out of our comfort zones.

After we survived the c-sections, I had to go do my hospital orientation.  That’s right.  I said after.  So I was being given an ID badge and information about how to get around the hospital after I had already fumbled my way around and done my c-sections.  I took a lovely photograph for my new badge, since I had gotten up at the crack of dawn and had had a hat on my head for two full surgeries.  I got a tour of the hospital that was completely incomprehensible.  The place is ancient, and things have been added on and added on until the whole place is one disjointed rat maze.  They have lines drawn on the floor to try to get you from place to place.  I was given a whirlwind tour of Labor and Delivery, the postpartum and pediatrics area, the surgery center on the second floor, various medical plazas, HR (which is OUTSIDE for crying out loud), the other Ob/Gyn office, the doctor’s lounges, dictation areas, medical records, and the doctor’s dining area.  Like I’m going to remember all that stuff.

Then I had an hour training session on the computer system in the new hospital.  That’s right.  We have to learn a whole new computer system.  And we’re supposed to be ready to use it after an hour of training.  All our results are there.  We are supposed to sign all our orders through that system, and look up vital signs, and labs, and consult reports, and dictations.  One hour of instruction.  The girl who was doing the teaching was very nice but she didn’t seem all that optomistic.

I hate to be such a negative blogger, but my life is really not on a positive course right now.  I’m having to learn a whole new hospital, and then, in six weeks, I’m off to North Dakota to learn another one.  I am really unhappy when I am lost and in unfamiliar territory.  Now I have to go all the way across town from my office to round on my patients, do circumcisions, etcetera,  It will waste at least thirty minutes of my time every time I have to go over there and back.  Forget sleeping in in the mornings any more!  There is rampant confusion about the new combined call schedule, and who rounds on whose patients when, and now I find out that on call days I have to go over to the other unfamiliar Ob/Gyn office to see my patients.  My nurse is freaking out.  I am freaking out .  This is all very inconvenient and very uncool.

Then I get to clinic this afternoon and everything is all cattywhompus.  Every patient seems to have some weird problem.  None of the appropriate paperwork has been filled out.  Records are in the wrong places.  The computers aren’t working.  I’ve just resigned myself that today is NOT going to be my day.  And when I get home, I’m sure my husband will have things he wants me to do, like finishing putting away the Christmas things, or Lord knows what, when all I want to do is put my feet up and absorb my day.  I need some down time. 

All I have is six more weeks and I’m outta here.  I know every place has its own set of problems, but this office is a kind of an existential hell.  My nurse and I were just discussing that if we died and went to Hell and Hell for us was sitting in this office for all eternity, we would try to kill ourselves all over again.  I am so ready to work part time and do some traveling.  Even if the traveling is to North Dakota.  It’s got to be better than this.  So I apologize if this blog is a total bummer.  It’s a reflection of me, and right now I’m feeling very put upon, and very lost, and very irritable, and that will probably be my tone for the next I-don’t-know-how-long.  At least six weeks, til I get out of here.  It will take a very special day to cheer me up.  So for right now I’ll be venting.  I hope that doesn’t alienate anyone, but I know it’s good for me.

New Year’s First Day

Well, today is New Year’s Day.  That means there was no Zombie Apocalypse while we slept (at least not in this part of the world – maybe NYC is a smoking ruin for all I know).  Today is the very last day that the Labor and Delivery unit at my hospital will ever be open.  Everyone is very sad.  We are all scared to move to the hospital across town where we don’t know our way around and we don’t know anybody.  The nurses are packing up all their things from the fifteen years that the unit has been open.  I have been there for almost ten of them.

A bigger hospital came and scarfed up both of the local hospitals in our town.  Then it started tearing them both down, piece by piece, moving things here, closing things there.  Our L&D and pediatrics units are the first to go.  As of tomorrow, everything goes to the hosptal across town.  So we have to get new badges, and new parking spaces, and maps, and learn how to use their computer system.  Everything new.  The nurses will be strange to us.  New anesthesiologists, new operating rooms.  Everything.

I turned in my notice two weeks ago.  It wasn’t just the closing of the Labor and Delivery unit, that we worked so hard to build up.  It wasn’t just the consolidation of the hospitals, it was a bit of everything and then some.  My husband and I had been talking about me working part time for over a year.  I’m just unhappy working all the hours I am.  I am missing our daughter growing up.  March 1 will be my last day and then I will become a locum tenens.  A travel doctor.

My first stop will be North Dakota.  North Dakota!  Lord, what was I thinking?  There’s so much SNOW up there!  I’m a Southern girl.  I don’t do snow.  I’ll have to meet all these new people.  I’m nervous and excited at the same time.  Mostly nervous.  There are so many things to take care of before March 1 comes.

I’m trying to decide when I should move my things out of my office.  I guess I should take care of a little bit at a time.  Take diplomas and such off the walls and bring them home.  I won’t have an office where I’m going.  We have to get health insurance lined up before my last day.  Can’t be bare one day without coverage.  But right now it is New Year’s, and I’m just trying to relax.  I hope we can get everything done.

Today we are doing laundry and taking down the Christmas decorations.  Another sad venture.  The end of the holidays, then plunged into cold dark winter.  This is a difficult, sad time for me.  Missing my nurses already.  Missing the holidays.  I hope the new year to come will be all I can hope for.  I hope I will be more fulfilled working part time than I am now.  I have many hopes for this new year.  And many fears.  I will just try to keep my chin up for all the changes to come.

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!

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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