Adjusting (slowly)

So I'm two and a half weeks into my OB rotation. If you couldn't tell from my previous post, I am ecstatic at having been switched to days. And, as much as I thought I would never say this (in my previous misery of nights and feeling totally incompetent), I might actually be getting the hang of things.

Things were kind of stressful yesterday, when we had about 5 patients laboring at the same time. One needed a code C-section for a prolonged fetal deceleration, so off went the OB2, the chief, and the attending to the OR. I was a little panicky with being left on the floor by myself (there was one other attending, a UWH [university women's health] doc, I could call upon), but things went fine. I actually got to do three vag deliveries in the span of about an hour and a half, and all were accomplished without perineal lacerations, the way it should be! I just adore delivering babies... it was great to have this reminder of why I DID choose to do this (program), although Labor and Delivery is stressful, grueling, and chaotic much of the time.

I am constantly being called from Davis3, where is where Triage and L and D suites are, over to Tower3, where the postpartum patients are. I get a decent amount of exercise this way, I'm finding. But today, I figured out that we have a tube system!!!! This way, I can tube orders over rather than continually running down the hallway and back. Nice to know this now. It would have been even nicer to have known this two weeks ago! :)

I'm adjusting (albeit a bit painfully) to different chiefs' and attendings' ways of doing things. It has been really hard the past couple of weeks to nail down patterns of "if this, do this...." as we all get incredibly confusing messages from different people. I've checked people I was told not to and then, later, on a different patient in a similar situation, when I refrained, I was asked, "why didn't you check her?" I've ordered a Depo (Provera) shot prior to discharge for a breast feeding mom and was chastised for doing so, as it can "dry up milk" if given too early postpartum, but then am looked at as though I am stupid for asking why, in another case of a BF mother, it was okay to give the shot. I've taken wound dressings off skin incisions on post-op day #1 C-section patients and then been told not to do so until at least 24 hours after the operation, but, today, "got into trouble" (not really, but was talked to) for not stripping it off before 12 hours. Some people like to use miso for induction; others like foley bulbs and pitocin. Some are very conservative; others are minimizers. This is very frustrating for a "learner" like me who wants to just do things right and please everyone, but people tell me to not take things (i.e. "recommendations" of what I should have/could have done differently) too personally.

I'm getting used to seeing strange stuff on our service. We have a ton of patients who come in with little to no prenatal care. There are patients who come in who are either high or sometimes contracting secondary to drug abuse. We have pregnant patients come here from jail. We have people on our service with sickle cell crises. We had, for the longest time, a woman with spontaneous triplets on bedrest (who, unfortunately, went into pre-term labor, delivered, and lost all three babies). We see tons of preeclamptics and gestational diabetics. We've had a woman with a history of a nasty stab wound who had to have a repeat classical c-section for preterm labor. There have been people with perforated uteri, including one who got pregnant after a wayward IUD ended up in her rectum. The team delivered, the other night, a young woman with abdominal and cerebral aneurysms (from ana-positive vasculitis) and superimposed preeclampsia, at only 28 weeks with a 1-kilo baby. There was another woman yesterday who'd had an intra-uterine fetal demise at around 28 weeks. We had a woman with polyhydramnios with an AFI (amniotic fluid index) of 60 (normal is somewhere between 5 and 20), who came in because she had ruptured and was honestly flooding triage. I've delivered teenagers, including a 14-year old, and a 15-year old who was raped and impregnated by her stepfather. I'm not really surprised by too much any more. We see everything.

I'm getting used to (and loving!) speaking Spanish all the time! Words sometimes still escape me, but I feel totally comfortable doing everything en espanol. It gets a bit confusing sometimes-- I think we had three Ramirezes and three Garcias on our service at the same time, but I think it's all good.

I'm adjusting to the schedule. Getting up during the 04:00 hour is not pleasant, but, as long as you go to bed early enough (or, like I did yesterday, take a long nap between 7:30 and 9:30 p.m.!), it is doable. The gyn-onc intern (currently Gaea) gets to the hospital between 4 and 4:30 a.m., which is when she would take signout from me (while I was on nights). How horrendous is that?! As sad as it sounds, 70-75 hours a week has been the "norm" and I feel sort of used to it now. This week will actually have more hours, as I'm on 24-hour (ends up being about 28 hours) call from Saturday-Sunday morning, but honestly, when one's working close to 80, what's another 20? :) You don't have time for a life anyway!

I'm adjusting to life in Sacramento. It really does feel like "home" (or, at least the hospital does!) now, in that it feels like I've been here for a good long time (even though it's been less than two months!)! Minnesota seems a long and distant memory away... I rarely think about life there. I still wish I had more time to explore out here, but I'm sure I will... with time.