Running on Empty...

So 28 hours of call and 8 babies later, I finally got home after my first night alone on L&D at Joes. It was a pretty scary night, considering the entire freakin OB residency was at conference in Scottsdale except for one attending who apparently was doing emergency GYN surgery all night and NEVER ONCE returned a page! Geesh! So they paid a midwife to come in and be my acting 3rd year resident, but she decided it sounded better to go up to the midwife's callroom and crash for the night while getting paid bank. I barely saw her, although she did help me by doing one repair (which was nice).

I started at 4:30 am yesterday morning, and between me and the FP intern coming off call Friday night, we rounded on about 40 post-partum patients by ourselves. I then went up to L&D and jumped into the fire. Most of the morning and early afternoon were slow, although I did most of my deliveries during that time, so it was nice to not have a bunch of other stuff on my plate. At 5:30pm, however, all hell broke loose and apparently every pregnant woman in Maricopa County decided they'd like Nicella to deliver their babies. We had a ton of patients start coming in, so that meant a lot of H&P's, and a lot of notes to be written every 2 hours. Things were under control until a primip decided to abrupt and try to bleed out on me, meanwhile her baby decided it would be a great idea to have his heartrate drop down into the 60's with every contraction and we kept having a hard time even finding heart tones.

My attending wouldn't return my pages, and the patient's private doctor was on his way but it was going to take him 15 minutes to get in. I ran through as much of ALSO as I could in my head, but there isn't much you can do for late decels from an abrupting placenta. The doc finally showed up and we ended up doing a vacuum delivery, although he had to place it because the baby wasn't even engaged yet and was at like -2...the doc had his arm all the way up in her uterus fishing around for the posterior fontanelle...it was insane! And I didn't realize how freakin hard you have to pull on the vacuum to get the baby out. We ended up cutting a massive episiotomy to get the baby out, and it's APGARS were a little low at first but it ended up being fine (Marilyn happened to be the NICU resident on call last night and was at the delivery, which was kind of cool!). The mom needed transfusions, but she ended up ok, too. And seeing an abrupted placenta was pretty amazing- it's just this huge clot connected to part of it and looks just like the drawings in the books.
I finally decided to go try to catch a nap, but after 10 minutes of blissful sleep, my pager started having a seizure. Apparently post-partum hadn't been aware that there was an intern there for them to bug all day, but they all got the memo...

at around 1:30am...I seriously had 8 calls from them within about 10 minutes...including everything from "can I give Tums to my patient with heartburn?" to, "my patient is anemic but completely asymptomatic, doctor- can I start her on iron?" (SERIOUSLY PEOPLE?! Is it necessary to start iron at 1:30 am?!?!). The scariest call from them was that a post-partum preeclamptic lady had pressures of 170s/110s and had a headache and was on serious doses of labetalol already. I immediately ordered the labetalol to be D/C'd and to start Robertolol, stat...but when that order didn't go over well, I ended up ordering a Medicine consult, which was another fiasco and took about a half hour. I went back to bed and slept another 5 minutes when I got paged by L&D to let me know that now everyone in Yavapai County was coming in for delivery...I had 6 patients waiting to have H&P's done. So I never did end up going to sleep, and rounded on all but one post-partum by myself this morning before the new intern came on. And then to top everything off, I got berated by the midwife for ordering a social work consult on a patient that was cracked out and delivered her baby on the kitchen floor at home and was brought in by the fire department. WHATEVER! Geesh!

So I hope everyone else had a good weekend! Hopefully Amy survived this weekend too- she was covering the Copa side of the OB program while they all played golf and lounged by the pool at some ritzy Scottsdale resort. I'm SO glad the rest of you won't have to go through this and will actually have senior residents at the hospital with you when you're on call- not to mention that most of the state delivered last night, so most of you will be on within the next 9 months and it should be pretty slow...oh wait, I'M on again in exactly 9 months at Copa...DANG IT! I feel like a fool! I can give you this encouragement, though- I actually felt a little bit like a doctor last night...even though it was just for a split second...and I'm starting to feel comfortable doing routine OB stuff...and it's only been a week. I'm writing everything down for you guys, including where to be at, and how to do notes, and hopefully other helpful stuff. Just remind me to give them to you when you're up at Joes.

Miss you guys!