Eyes opened

(Nerdy medicine post again).

Well-- I can't say that I have too much to report on apart from the day-to-day excitement of residency. I was on terminal Saturday 24 hour call to end my 3-weeks of R2 OB to start second year. It was not a bad call day overall, which included involvement in some interesting cases. I was surprised and had my eyes opened...

Some patients are really crazy.
Saturday afternoon, we did a c-section on a patient with bipolar/schizoaffective disorder with extreme paranoia that prompted a "are you poking and hurting the baby?" with every cervical exam (you can only imagine how she handled the placement of the IUPC [intrauterine pressure catheter] or how long it took to consent her for the c/s for failure to progress [I was wondering if she even had the competence to be consented]). The attending and I jumped sky-high in the OR when, when we used the suction machine to get some clots out of the uterus, she grabbed the [sterile] drape down, glared at us, and shouted, "are you hurting the second baby??" [she was convinced she was having twins and thought that the suction sounded like a second infant crying]. Interesting.

Signs of pregnancy?
Later in the day Saturday was the delivery of a teen girl who had presented to labor and delivery one prior, which was one day after discovering her pregnancy by taking a pregnancy test (positive, obviously) but who had been "leaking fluid" for about 2 weeks. Now, as you can imagine, this was amniotic fluid, she was PPROMed (preterm premature rupture of membranes), found to be about 34 weeks on bedside ultrasound, and was augmented so as to not be at risk for infection. She is on our OB Wall of infamy as the patient with the most recent shortest discovery-of pregnancy-to-delivery interval (although, believe me, other women have rolled into our doors not knowing they were pregnant and were even farther along!! We see ridiculous stuff at our hospital!!!).

Preterm labor happens
A few hours short of the call day/night's end, I went to see a patient in triage who was put up on the board as "rule out preterm labor." Now, you must understand how much we see in triage. Truly, anyone pregnant with any hint of abdominal, pelvic, or back pain/pressure gets put up there as a "rule out (and honestly, 98% of them are truly ruled out) preterm labor" which gets very old. Every patient like this automatically buys herself a workup that includes a sterile speculum exam, doing a wet mount, sending FFN (fetal fibronectin, a sensitive test that, when done between 24-34 weeks and negative, can effectively rule out the likelihood of delivery in the next week), sending cervical/ vaginal cultures, sending a urinalysis, doing a cervical check (or, often, serial checks), and ultrasound. It is labor-intensive indeed.

So when I went to see this new patient at around 30 weeks' gestation complaining of vaginal "pressure," I was expecting to see and feel a closed cervix and counsel her that she was likely feeling the baby's head drop. Until the speculum went in and all I saw was a bulging bag. A cervical exam and ultrasound later showed that she was completely dilated.... and breech, prompting an immediate c-section (due to risk of cord prolapse) and, as she was preterm, had to be consented for a classical c-section (vertical uterine scar, which leaves one unsafe for a later trial of labor). Fortunately, we were able to do it low-transverse and baby did well. However, this really opens one's eyes! I won't take the "rule out preterm labor" patients lightly for quite a while now! Amusingly, while closing the uterus (baby long out), we got a call from the laboratory to inform us that the FFN was positive.... you think??! :)

WOW
Check out these photos of Ovulation seen in the OR captured by a British OB/GYN, forwarded to me by my FP/OB advisor. Cool, huh?

The other side of things
Today, I switched from OB to Peds and newborn nursery. It is actually quite cool because not only do I know the L and D nurses well, know my way around the L and D floor(s), the OB and delivery paperwork, and how to find mom's info. to fill into the babies' charts, I got to round on some babies that I delivered in the past few days (great for continuity!). It's interesting being on the other side of things! The paperwork is quite tedious, as are newborn exams, but it is, UNlike L and D, very low stress. I got out at 5 p.m. today (I don't think that's happened in about a YEAR!!!!!!), and don't have to be in until 6 a.m. tomorrow. It feels like vacation :)

Well, while my eyes are still open, I am going to try to get some reading done!