2 posts in 2 days....

... a record!
Mainly, this is an excuse to (for mom) post my R2 schedule, which is supposed to be way better than intern year but I'm having my doubts!!!

7/1- 7/20 was OB
7/21- 8/17- Newborn Nursery
8/18- 8/31- Outpt peds (Hooray! Outpatient!!!)
9/1- 9/14- Peds wards
9/15- 10/18- OB** (see interesting call schedule below)
10/19- 11/1- VACATION (will be MUCH NEEDED)
11/2- 11/16- UCD Night Float
11/17- 12/14- Peds urgent care
12/15- 1/4- Peds and FP clinic (+ Christmas eve 24h call)
1/5- 2/8- OB
2/9 - 2/22 Sports Medicine
2/23- 3/8- Vacation!!!!
3/9 - 3/15- FP clinic
3/16- 5/3- OB
5/4- 5/31- Mather VA
6/1- 6/30- ER

** for 5 weeks on L and D, my call schedule is as follows:
9/15-9/19- Days + Sat 9/20 (24h)
9/22- 9/16 - Days, + Friday night 9/26
Nights starting Sun 9/28 - 10/3 + 10/4 Friday a.m. post-call clinic.
(Off the weekend of Sat 10/4-5 until 10/5 night when I return to nights).
Nights Sun 10/5- 10/9 + Friday a.m. 10/10 post-call clinic.
Off Sat 10/11 but Sunday day call on 10/12.
Days 10/13 (hey! isn't that supposed to be a holiday?!) - 10/17, + Friday night call 10/17
(then vacation [much needed! Hey, working 80 hours will feel like vacation after that!!!])

(Not) floating/rafting down the American River

Darina has a nice little post about the adventure on Saturday that she took on with the boys that says things better than I can (and which saves me time in blogging because I obviously blog so frequently that it is a huge time sink ;) !). They floated about 7 miles down the American River on the contraptions you will see pictured below!

Needless to say, (according to Shomir), I may have missed out on the fun by ducking out (after learning the estimated time afloat and having to be back by 6 p.m. to be on newborn pager call/take care of Kate's dog Lefty), but Darina was pretty roughed up and I'm not sure she's going back.

Some pictures (half of which I stole from her!)...

The poster child on the box (doesn't he look real? And a lightweight, too, don't you think?!) :) Recall that these rafts were supposed to hold no more than 120 lbs.

Blowing them up.... took a lot of windpower, let me tell you!

All blown up and ready to go

Trying them out (on the asphalt) from left, Alex, (me and Shom in back), Darina, and Dinh Hai
En route to the water's edge... Dinh Hai and Darina posing before the ordealAlex looks a bit skeptical that the raft will hold his weight (Shomir, however, plunges ahead)...

Maybe this will work after all...
Shomir looks very gleeful...Alice points out that, "they're off!"Alice and instead took a walk along the American River bike trail and also went down to the River where we saw this cute doggie swimming for his ball :)

Note that there are no "after" pictures of this ordeal... see Darina's blog for details... However, most of us are back at work and alive.

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!

Golden

Just in case you, like my grandmother, are very concerned that the California fires are destroying my Golden State habitat, do not fear. I am alive and well. I haven't blogged in a bit because of the schedule, not because Sacramento is burning. However, the air quality up here has certainly taken a turn for the worse. It is hazy and even muggy, in contrast to the usually clear and dry Sacramento summers. But it still beats MN winter or DC summer.

In news....
I was blessed with two days off in a row (rare in residency!!!!!!!!!), making this a "golden weekend." I almost didn't know what to do with myself... ha ha, just kidding. I make up for it by being on sandwich OB Saturday calls (2 in 3 weeks--last weekend and then next weekend), but I think it was worth it!

Shomir's mom and stepdad came to visit from Indiana and we had a fun time hanging out with them. On Friday (Shom's stepdad Buford's bday), we had a Christmas in July gathering at Shom and Andres' house, complete w/ a while elephant gift exchange (I scored big w/ mojito mix!) and decorations. I made another marginal german chocolate layer cake. Shom's house actually looks livable now, as he's hit up Craig's list and has, in the past 1 week, doubled his living room furniture that now includes a classy coffee table as well as a comfy couch for curling up on to read. Sorry no photos. Some girl, worn out from a long 2 weeks on OB, fell asleep on the abovementioned comfy couch in the middle of the party, circa 10 p.m.

On Saturday, we made a trip out to Nevada City, a town about an hour from here in the Sierra Foothills which was integral to the 19th cent. GOLD RUSH. It was a very cute historic Old Town with old-fronted shops and such. We had lunch at the National Hotel which, as you can read from below, has been around a long time, and wandered a bit, hitting one winery before heading back to Sac.

GOLDEN boy with his mom and pops

my turn
I (um... we...) like wine :) We spent Saturday night in Old Town Sac, which is also set up like an old gold rush town, where Shom's mom and pops were staying on the Delta King riverboat! We had a lovely dinner and saw a show down below deck before then sitting outside enjoying the crisp evening air. (someone had fun w/ my camera- wish we were all in this photo!)

Today, we went to church, had yummy Indian buffet @ Kaveri's, watched "Bella" on HDTV and then (some) napped a bit before Shom had to go into work (night float).

I will miss my golden honey for the next 2 weeks as he'll be on nights (night float, w/ next Sat-Sunday off) while I'll be on OB --> newborn days (+Sat-Sun call). Totally opposite schedules but perhaps our paths will cross...

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!