Shoulder Dystocias and Coarctations and Hemorrhages...Oh My!
Today was an eventful day, and although I have a completely new team of seniors who, well, SUCK big time, I got to do some cool stuff today and felt pseudo-competent. I delivered a couple of babies, including a dystocia 
that I McRobert'd and used suprapubic pressure and then the attending accidentally broke one of the clavicles while he guided my hands into a Rubin and I felt it pop under my fingers (NASTY!). I also got to watch a forceps delivery, and then delivered, all by myself, a baby whose heart tones were in the 60's for almost 6 minutes (all the while I was having a heart attack and wishing for the life of me that the attending would show up!)- the fluid was mec stained and when I finally got the baby out (floppy and all), there was this huge gush of amniotic fluid that came out in a wave 
and soaked me from the knees down...DISGUSTING!!!! The baby's initial apgar was 4, but it ended up being fine after NICU got done with him...whew!
The most stressful and also most fun part of the day came at around noon, when postpartum called and said they had a patient hemorrhaging big time. I freaked out for a second and then told them to hang a bag wide open and get me pit and cytotec and sterile gloves and 4X4s and to check her vitals and that I'd be down in a sec. I got down there and she was tachycardic but her pressure was alright...and she was bleeding pretty badly. I felt her fundus and it was really boggy, so I started rubbing it. I gave her some demerol so that when I checked her inside it wouldn't hurt so bad. I then was informed that she had coarctation as a kid and had had several open heart surgeries (at which time, I freaked out again inside because I have no clue if pit or cytotec or DEMEROL are contraindicated with that disease!)...and then I thought, oh well, she's gonna bleed out if I don't do something, so I had the nurse add the pit to the IVF, I snapped on my gloves, and went in. Her uterus was filled with huge golfball sized clots. She was screaming, I think I might have been screaming (ok, well maybe just in my head), and the nurses were freaking out. I kept pulling clots out and then all of the sudden, she just stopped bleeding. IT WAS FREAKIN AWESOME!!! I didn't end up even needing the cytotec! I rechecked vitals, had them draw an H/H, and went on my merry way. I found out later that her Hgb dropped from 12.8 to 8.4...scary! She was stable though, so no transfusions... It was SO incredibly terrifying, but after it's all over, it was so cool to be making decisions on the fly and ordering nurses around (nicely of course), and helping out a patient. Even if it was just a PPH where the treatment is pretty standard and I'm pretty sure a monkey could do it...but I'm happy to be functioning at monkey level!! :o)
5 comments:
I hope you are somewhere close by if I ever find myself in post partum hemmorrhage. I can see through your stories that you are doing an amazing job adapting to an incredibly stressful situation. I think our upper classmen had it wrong, sounds to me like OB at Joes is the toughest month, you go girl...And if thats not comforting, we are half way through!!
Hey Kat!
I heard you had some weird Goldenstiensburgdinsloghtenshire syndrome kid and a whole lot of other strange diseases that they don't even mention in med school...and that you're doing great, too! Thank goodness all of residency isn't like this...at least I hope it isn't!
Miss you Kat! I'll try to get down to see you before this dumb rotation is over!
GIRL POWER!! The guys are having anxiety attacks reading all of our horrible stories. I for one am ready to come running back to my happy place where I can eat cookies and sit on Marty's couch.
You're right--I am having an anxiety attack right now reading this stuff! The only thing I can remember about ALSO was bravado something alpha, zed, etc. uummm...you get the point. Nicole, maybe you could dress up as a boy and show up to my OB rotation next month in my place and tell them your name is Jonathan Manwaring? How does that sound?
How about calling myself Janathan? That might be more believable! And seriously, it's starting to get better and more doable- I KNOW you guys can do this! It's all just been a shock as the FIRST rotation with nobody to tell me anything helpful, plus just the whole fact of getting used to being an intern while coping with the OB stuff on top of it that's been a shock. You'll have the intern thing down pretty well by the time you get there, and I KNOW you're going to do great! And I totally forgot about Zed-Alpha-Lambda BRAVADO already, too, so apparently we don't need to know that :o) And the only reason I remember any of the other ALSO stuff is because I see other doctors do it first, and then copy it and it comes back a little at a time. You can do it! (sorry if I scared you guys...I wasn't trying to!).
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