Night Float with a Big Black Cloud...

So night float was pretty nuts for me...SHOCKER. Figured I'd update this blog with a few highlights. Hope you guys get a chance to do the same. Miss you all!

My first Monday night on, Brent was only able to take one admit during the day, so I had to take 7 more. As soon as he checked out to me at 5:30, the senior pager started having a seizure and I got 5 admits right away...LAME! The OB pager also went off almost immediately to let me know I had 2 drop-ins...who couldn't just want a freakin sandwich and OF COURSE had to be in labor. I ran up and admitted them, and then ran down to the ER and started working on the admits. I got through about 2 of them when the OB pager went off AGAIN to let me know that I had 2 more OBTs...just UTIs, but still lame! I ran and checked in and wrote notes on the 2 laboring patients, and then ran back to the ED. Within an hour, I had another freakin OBT patient come in, and throughout the night, had a total of FIVE...seriously!?!?! What the heck!! Apparently The Memo

got sent out to all pregnant women in Arizona that black cloud Nedella was on ...I seriously had a lady that had an ambulance bring her down from Camp Verde...and guess what she had??? FREAKIN BAC VAG! That's it!
So basically, I was running frantically all over the hospital all night. I could not get caught up. I also got a page to do a death pronouncement in the ICU as soon as I got to the hospital...and it sucked because it was an IPC patient AND there were like 15 family members in the room who had a bazillion questions and I was like, hey, do I LOOK like a doctor?? It pretty much sucked!

And of course all night long, the nurses called constantly to tell me useful things like, "Your patient is in A-fib"...REALLY??? They've been here for 4 days already and been in A-fib that whole time, but thanks for the update! Or, "Your patient's blood sugar is 360 so I'm gonna give some Apidra"...great...DO IT! Or, "the ER lost your admit orders, can you come write some new ones?"...of course! I have nothing better to do! And to make things even MORE fun, my senior left at midnight, even though I still had an admit waiting, and 2 new OBT patients that just came in, PLUS the two laboring patients...that was great! I finally felt like I was getting a handle on everything at about 3am, when one the laboring patient's baby started to look like crap on the monitor. It must've gotten that memo, too. It was having monster variables with every contraction...and no matter what I did it wouldn't improve. I kept hearing in my head the voices of the ALSO teachers..."you never know when a baby is deceling if that heart rate is never going to come back up to baseline".

I was pretty freaked out, especially since she wasn't dilated more than 3cm, and I was pretty sure she was gonna need a section, but the freakin OB on call wasn't answering his pages and I didn't want to bother Dr. W (although I was really close to calling him). I ended up placing an IUPC and did an amnioinfusion. I had never done one before, and none of the nurses I was on with had either...SHOCKER! We figured it out (thank you uptodate!!), though, right after the baby's heart rate deceled from 150 to 30 for the 50th time, and once the fluid started going in, that baby was swimming in luxury and was happy as a clam.

No more problems after that, thank goodness, but I'll tell you that I got one big ulcer throughout the whole 2 hour ordeal! To top off the whole circus of a night, at checkout, I found out that 2 of the patients I had admitted had insurances we didn't take...even though my senior TOLD me he had checked that! I was FUMING!

Other crazy stuff that happened these past two weeks also had to do with OB of course! I had a standby on Wednesday night that ended up being a 9# baby with shoulder dystocia. I walked into the room to see a 400# woman pushing and screaming and the baby was crowning. The head came out fine, but I was like, "OH CRAP, THAT'S A BIG HEAD"!

As soon as the head came out, it looked like it got sucked back up into the pelvis like a cork. I could not the shoulders out. The problem at that point was trying to McRobert a lady whose legs were bigger than 3 of me...there was no way to get them up to her chest...and it wasn't easy for the nurse to push on the pubic bone because it was hard to FIND the pubic bone under all those panni. I ended up having to do a Rubin, and as I shoved on the shoulders and the nursed pushed down from above, that baby suddenly dislodged and shot out into my stomach like freakin little rocket.

I barely caught the darn thing!

Another exciting story- so Monday night, I'm seeing one of my patients in OB triage, when they wheel in a lady on a gurney who's screaming and the nurses say she's one of the OBGYN's patients and she's completely dilated and pushing. They try to get a hold of the doc to tell him to come in for the delivery, but guess who got to do the honors? Yup- the black cloud...and boy when it rains, it pours.

I ran over and checked her, and was like, "dude, she's complete, but I don't feel a head". I looked nervously at the nervous looking nurses, and we ran and grabbed the ultrasound...sure enough, the freakin baby was breech.

They couldn't get a hold of the doctor (Dr. P...which is SO not like him), so I had them call the OB on call, and shocker, he didn't call back and neither did his answering service. We rolled the lady into the OR, just in case Dr. P got there in time and wanted to still do a section, as we yelled at the lady to not push...in Spanish of course...why would I even expect that I could get a freakin break and have at least one ball in my corner and be able to speak to in my own language! Geesh. So I had them bring in a vaginal delivery cart (which was a fight in itself since the scrub tech didn't want to break sterile field...but I was like, seriously people, this butt is coming out, and he's never gonna get here in time to section her!). I ran out to the computer and looked up pictures of a breech delivery...I could only vaguely remember delivering a plastic baby's butt during ALSO. Every nurse in OB was running in and out of the OR freaking out like they always do when things don't go exactly as planned. They also all made sure to tell me a dozen times that none of them had ever seen a breech delivery...gee, thanks! I was trying to stay calm and direct the madness, all the while I'm pretty sure I got about 50 new white hairs, and 2 more ulcers to go along with that earlier one. It's real hard to look confident knowing that A, you have only been a doctor for 8 months and the nurses have been nurses for like 20 years and are freaking out; B, you have no idea what's going to happen and have never even seen one of these dumb things; and C, this baby could die so I better hold it together and suck it up and figure it out. Needless to say, I prayed a lot as I ran back into the OR. I called Tod, who made it just before she delivered (but he'd never done a breech either, so he stood in the background as nursery backup), and just as I was delivering the butt, Dr. P finally walked in and he let me finish the delivery...and in the end, it was one of the coolest things I've ever done!


I feel lucky to have learned how to do this...never know when I might need to use that skill in the future, especially since I want to do medical missions.

Other craziness included having to cut my first episiotomy in another standby when the baby just wouldn't fit out the opening and we lost heart tones completely in the baby. I just picked up the scissors and was like, "oh well, here it goes, this baby has to come out"...and it did, and it wasn't so bad in the end...just ended up being a small second degree. It just sucked to have to do it unsupervised since I've never seen one done before!
I also got to intubate a CVICU patient last night, which was cool.
So, overall, I delivered 14 babies in 10 nights, and did a whole lot of stuff on my own, and even though it was really stressful, I learned SO much!

So that's all for now. Thanks for listening to the ranting!! It's theraputic! Hopefully I'll hear from you guys soon!

~Nicella Black Cloud Nedella