So we drove back to North Shore and rounded on his patients. By chance, the first chart I picked up belonged to the woman whose C-section I attended yesterday. She was up and walking and was surrounded by her other three children; she was a little bloated, but in good spirits. I left to write up the progress note, but the mother/baby floor was surprisingly devoid of the other students (yet another one joined us today; she's a few weeks from graduating and has returned for what should be an obstetrics sub-internship). The others were attending a labor already in progress.
The OB was getting ready to go by the time I got there - we'd sort of decided that this was supposed to be my delivery, and so I scrubbed up and threw on some gloves. First of all, this woman refused an epidural, and so was screaming (everyone could hear her; we didn't need the door thrown wide open by the cantankerous nurse with the bad attitude). I assumed the position right next to the OB just as the baby was crowning, and gripped the sides of her little head to help her on out. In preparation for this moment, I'd been keeping up with my reading on labor and delivery, and there was nothing I was more nervous about than a possible shoulder dystocia (which occurs when one of the baby's shoulders gets trapped behind the mother's pubic bone, effectively ceasing labor) and the list of increasingly morbid things done to correct it. Much to my relief, a few moments after this little girl's face popped into the world and the OB suctioned her, one tiny shoulder appeared, followed by another - and then I was the first person in the wide world to hold her. The little sweetheart was hollering when she hit the table.
Cord clamped and cut, the nurses whisked her away for her APGAR scores while I began to work on delivering the placenta. I'd thought that epidurals made this part easier, and in some respect I was correct; the OB explained that when a woman has pain meds, one can more forcefully massage her abdomen and uterus, which speeds up placental delivery. This one took a while - nowhere near the 30 minute mark, but longer than the others. Cord blood was banked, and then the placenta came.
The whole thing was surprisingly peaceful and natural; my heart wasn't pounding from excitement like it was during the emergency C-section. It felt so calm; despite the mother's screaming (she only spoke Creole, by the way, so she didn't understand my comforting words), I was tranquil - although this is probably due entirely to the fact that it was expected to be a completely normal, completely safe delivery, and it was.
That was happy, and joyous, and we turned right around and entered the other end of the spectrum. One of the OB's patients had miscarried, and we went to the surgical suite for her dilation and curettage (D&C). This woman apparently suffers from bipolar disorder - which is why her procedure was completed in surgery, rather than in his office. Her loss was sad, but I don't think she was devastated; as feisty as she was, this woman was grateful for her other children.
We returned to the doctor's office to see a few patients, and then got lost looking for a Subway that was suppose to be "right down the road". It was a 50/50 shot; right or left - and I chose wrong. So, since the OB wanted us back over at his other clinic, we just headed back over there. Once lunch was over, we returned to his office from the morning and sat and waited. After a while, the patients started rolling in. Of particular note was the one crazy patient who was 5 weeks pregnant; I only say she was crazy because she was. There was some bizarre anxiety/depression thing going on; I almost got the impression that the OB was a little apprehensive to delve too deeply into this woman's bothersome thoughts. Apparently she'd kicked out the father of her baby - because she didn't like the smell of him. However, more interesting than this woman was the one who, upon asking if she could resume sex with her husband, volunteered that the aforementioned sex would involve a bunny suit.
Somewhere in the 10:00pm hour, we returned to North Shore to remove a woman's cerclage - a stitch placed to hold shut the cervix when it opens too early. This woman had lost a baby and was seeing an OB across town, but since she lived near North Shore, that's where the emergency responders brought her when she called and said that her membranes had ruptured. Her mother wanted her across town, and her baby's father wanted the baby born now - this poor woman was pulled in so many different directions, and was trying to please so many people, that I'm glad she did what I thought was best for her, and stayed where she was.
So that was the day. 9am to 11:30 am. My father said that, during his OB rotation, he delivered 27 babies - I'm only at 2 so far (counting both the vaginal delivery and the C-section). Time to get moving.
No comments:
Post a Comment