Nicole and I went in early to round - I know that doesn't count as "early" when talking about rounding in any other specialty, but this doc gets to sleep in since he damn near always has midnight/early morning deliveries. So we went and saw the patients who had delivered over the weekend (incidentally, none of the other med students who were supposed to show up actually did), and decided to grab an early lunch. Nicole and PA-girl went out for Pollo Tropical, but being of a mind to get some work done, I sat in North Shore's little gift shop/cafe and reviewed primary amenorrhea. The text came from Sub-I girl that the doc had been held up, and we went to L&D to wait for him, back to our little Nook. We'd checked the board earlier in the day, and knew that he didn't have any patients who were going to deliver soon. He arrived shortly, broke some patients' water to hasten delivery, and we all shuffled off to his office in the professional building.
I saw one patient who'd had some dysfunctional uterine bleeding, had been frighteningly anemic due to fibroids, and had undergone a pelvic ultrasound. Unfortunately, her results were at the hospital. After I interviewed her and while she went to get those results, I interviewed another patient who was going through perimenopause complicated by COPD, diabetes, and heart problems. Finally the first patient returned, but without her results; that department of the hospital was closed. So we repeated her pap smear and set another appointment for her. It may appear that we didn't do a whole lot, but the doc was running between 4 different rooms, seeing the patients interviewed and examined by Nicole, PA girl, Sub-I girl, and myself.
Once those patients had been seen, we headed back over to the hospital. The next vaginal delivery in the rotation was mine, and when we got there, I glanced in to see how she was doing. She was a young first-time mother, frustrated, tired, and afraid of the pain. Her labor was progressing, but too slowly; the baby's head wasn't descending properly - and so the doc decided on an operative delivery. In tears at the end of forceful contractions, the mother cried that she couldn't do it - I'd thought for sure that she'd be taken to the back for a C-section, but the doc delivered the baby's head using a vacuum suction device called the Kiwi (at first, I'd thought the nurse had said that the baby's crowning scalp looked like a kiwi.....which was true). Once the little boy's head had been delivered, a few more forceful pushes completed the joyous birth. The baby was hollering, the family was thrilled, and mom was incredibly relieved - but she'd suffered a pretty severe second degree perineal laceration. The doc guided me as I sewed her tissue back together - a surprisingly more difficult task than simply closing the uterus and fascia in surgery. Here I was working in an area no more than a few inches wide and had to not only attend to two different layers of tissue, I had to make nearly hairpin turns with the needle in order to align things properly. Her epidural started to wear off halfway through; she was feeling the needle, nd had to be kept from flailing by Sub-I girl. I told her she could squeeze my arm, but that, in the long run, she'd be much happier if she didn't hit my hand. And so we paused while a nurse ran for 1% lidocaine, which I injected into her skin, and then finished.
That must have been somewhere around 11:30 at night. We all went back to the nurse's station to check the board - he had three patients who seemed to be in a race to the finish, dilated 6-7cm, 8-9cm, and 9cm (with 10 being the maximum). And, as always seems to happen, everything started to go down at once. The first one to start seriously pushing was one VIP (Very Important Patient) from his other office - I don't know why exactly she was a VIP, but this woman had paid some $60k for in-vitro fertilization, and so was treated with kid gloves. Next door was another first time mother who'd lost several pregnancies. Nicole took Mrs. In Vitro, and Sub-I girl took her neighbor next door. Mrs. In Vitro was very calm and placid, pushing forcefully until finally her little girl popped out, and we called the father into the room (he hadn't wanted to watch the messiness). They were thrilled and relieved, and their little girl was screaming; all was well. I stepped next door for the first-timer (nullipara) who was so happy she cried when she saw her baby's head. The doctor moved back and forth between the two rooms, making sure everyone was alright and congratulating the families.
The third patient was dilated to 8-9cm by this point, though the nurse said that she thought it was more like 6-7cm. We'd seen her earlier in the day, and she'd had a bad reaction to some of the anesthesia - it wasn't quite an allergic reaction, but she'd become strangely lethargic, and so the anesthesiologist was treating her carefully and conservatively. This was PA-girl's delivery, and so she checked on the poor woman every once in a while. I say "poor", because she was in exquisite pain and discomfort; I sat in her room and one point and just held her hand (the baby's father was curled up asleep in a recliner in the room, oblivious). The doc had opened up to us the on-call room because, apparently, he knew it was going to be a long night, and so Nicole and PA girl went and grabbed some Zs. I stayed out at the nurse's station with Sub-I girl, periodically checking on the slowly progressing patient. Finally the anesthesiologist came and gave her something for the pain, which slowed her labor even more, and eventually, she slept.
And so I ran to the ER for cheap coffee and pretzels, sat watching fetal heart monitors and discussing various tracings with the nurses, and watched the hours creep past like the indifferent minions of some blind tyrant. Around 5:345 in the morning, EMS brought in a young lady on a stretcher. she was wrapped in a bubble-gum pink bedspread and seemed strangely perky despite what they were telling the nurses - that she was about 17 weeks pregnant, and had begun to deliver. I won't get into the gory details (which are disturbing), but that ended in miscarriage. It was difficult; Sub-I girl didn't want to look, but I don't think I'll ever forget the sight. I suppose I'd known that I'd seen something like this all along, and I guess one never really can be prepared.
The other patient still hadn't progressed, and so at 7:00 in the morning, we took her to the back for a C-section (with as much pain as she'd been in, I hadn't though she'd delivery vaginally anyway). PA-girl got to assist, mom and baby were fine, and we all left the hospital to jump into 8:30 am traffic.
Looking back, there was a lot of sitting around. I got to do some reading, but in those wee hours there really wasn't much point. I thought it was particularly interesting just how annoyed PA-girl was at simply being there, not doing anything. The rest of us - Nicole, Sub-I girl, and myself accepted it as par for the course; I guess it was what we expected. Long, physically and emotionally draining days are what we expected.
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