Red, white (or green), and blue

(warning: heavily medical post [dedicated to JB])

So I was lucky enough to get the 4th of July off on Friday. It was a much needed day off (I know, I know! I had only worked 3 days after our intern-year break, and I was already burned out! For some reason, I am very anxious and stressed about 0B 2nd year, code C-sections, fetal decelerations, board signout, supervising, and have not been sleeping well at all. But I think it's getting better.) Anyway, I unfortunately don't have pictures from the evening but after I did basically nothing (except catch up on sleep, bills, and laundry) all day, some of us gathered @ Kyla's (she probably wouldn't have let me take pics anyway!) for barbeque and home-brewed beer (for those who like beer). The food was great! Shomir and I then headed out to Rancho Cordova, about 15 min. east of here, to watch Darina dance and catch some fireworks, which were actually really good, and which I enjoyed more as they were accompanied by a nice touch of patriotic music!

Unfortunately, I was back on call for a 24h call Saturday morning. It was a very busy and interesting day filled with a good amount of drama. For some background, the OB service consists of "red" antepartum patients, "green" laboring patients, and "blue" postpartum patients. It really gets exciting when the lines start crossing-- for example, around 10 a.m., I was called to the room to evaluate a woman who had been there for almost 1 month (this admission; she'd also been hospitalized for a while in May!) with PPROM (preterm premature rupture of membranes) who started bleeding heavily (complicated b/c she was on lovenox, a blood thinner, for a big pulmonary embolus). By the time I got the speculum in and dabbed away a lot of blood, it was obvious that there was a large amount of hair showing and that she was in definite active labor, dilated to 5 cm. She then went quickly from there and I, not even having time to get on booties, delivered her baby at 27 5/7 weeks, who was taken to the NICU and, from what I hear, doing okay but needing a lot of ventilatory support. I also soaked my entire leg in blood which, interestingly, doesn't faze me any more. We needed to give her all kinds of blood products to try to reverse the lovenox (poor girl was not a candidate for an epidural) and for the acute anemia (hemoglobin of 5) that ensued. Now the patient is a "blue" and everyone coming in this morning was shocked to not see her up on the board as a veteran "red" as yesterday she was signed out to us as "same old, same old stable."

There was a lot of FP patient chaos-- at least 4 patients coming in through triage at around 6-9 cm needing urgent admission and delivery! I don't think the FP attending made it to more than 1 of those! One ended up needing a C-section which I got to do, which was good.

Then we had a 35 weeker transferred via helicopter from a hospital up north for fetal gastroschisis (bowels hanging out of the abdomen), IUGR (intrauterine growth restriction), and preterm ruptured membranes; I delivered her early this morning and everyone was very cautious (don't accidentally clamp the bowel instead of the umbilical cord!).

A third delivery this a.m. was a patient admitted at 23 weeks for a genetic abortion.. her baby had trisomy 18. It was a somber affair-- interesting to do a breech delivery, though, and the baby lived for about 7 minutes. Nearly equally somber (after I'd been up for 28 hours) was the massive amounts of fetal demise paperwork I had to fill out after the fact.

And then, just trying to clean up my triage notes in EMR for the night and getting through rounding, the ED calls at 6 a.m with a gyn consult for a vaginal bleeder. Luckily I love vaginal bleeding (not!!!) and am so impatient that I blitz through all the required questions and got that patient wrapped up in less than 50 minutes. I was pretty scared to hold the gyn consult pager but don't think it will be, from now on, that terrible.

And that was the weekend!
I'm back on days tomorrow, where I hope that I'll get to do lots of C-sections and more cool OB stuff!