"It is what it is"

This is a saying that one of the OB attendings says all the time when people start talking about "what happened" and why, what could have been done differently, what currently is going on, and when people (i.e. I) start worrying about what could happen.

Last night was really the night from hell. It was Triage and admission night, where nothing really slowed down and I think we kept about 7-8 patients. It was spontaneous abortion night, where 2-3 patients came in with bleeding and were found to be miscarrying. It was pain night, with women coming in with 10/10 back pain and wanting narcotics. It was preterm labor night-- we admitted one woman at 34 weeks, another with twins who PROMed at 33, and had to move to C-section for another woman who was on bedrest but who started to bleed and whose cervix started changing. It was twins night, with the twins I mentioned before code C-sectioned because one started to come out, with hand presentation, and another preterm twins started on tocolytics. It was women-who-speak-Spanish-only night, with two of those SABs being hispanic women, an admission in active labor, a woman who had to be sectioned unexpectedly, prompting me to serve as translation for both the OBs and for anesthesia, and two discharges. It was rapid delivery night, with two people I admitted delivering within 2 hours of their walking into triage. There were three c-sections, three vaginal deliveries, one needing a repair, which the attending did over the course of an hour with two of us using retractors in the vagina because of a really strange tear that was poorly visualized and kept sort of bleeding. I was called on an onc patient for foot swelling and had to rule out DVT and another one with loose stools that plastics wanted to take to the OR today, but I could barely get off the floor because of everything that was happening. Because of the deliveries, I missed rounding on my postpartum patients and had to get covered by my other two co-interns, which I hated asking of them.

I have never worked so hard as on these nights. I honestly don't know how people can get used to handling the stress of this. Every day before I go in, to start my shift, I start to get an ill feeling in the pit of my stomach and constantly feel anxious/nervous the entire time I'm there, when sometimes I have someone talking to me on the vocera while I'm delivering someone else and have my gyn pager buzzing too. What bothers me the most is not that I'm working hard-- I have no problem being diligent and all-- but that I think we are all spread so thin that it compromises patient care. Patients wait in triage because there are emergent deliveries, sick patients off the floors, and c-sections being done. I know I still need a decent amount of supervision and have to always run things by the chief resident, but she is often busy and I hate being a huge "bother." I wish I could be more independent, but I just don't want to do anything wrong (which I definitely have done. Last night, I felt that I couldn't get anything right-- I neglected to ultrasound [for EFW/dating] one woman who came in in labor with post-dates but who'd gotten care at Planned Parenthood [the chief told me that if we don't have documentation of U/S dating, we have to do it ourselves]. I checked the one twins lady who PROMed, which apparently was a no-no, even though she was obviously ruptured and twin A was vertex).

Patients sometimes see me only for the delivery, as they call in the intern quite late, when the baby's delivery is imminent, which really bothers me. I mean, I know I'm supposed to try to get a lot of volume of deliveries, but I just really wish I had more contact/knew the patients better. But there's just not enough time. The second (or third) year on has to answer the ER pager and consult on/admit OB/gyn patients that are seen down there while at the same time taking care of antepartum patients and managing the laboring patients (and helping me). You would think that four people-- intern, resident, chief, and attending-- would be enough to manage all this, but I don't think it is true. It sure didn't feel like it last night.

The good news?

• I don't think there can be any more pregnant people in the Sacramento area because I saw them all in triage last night and they probably all delivered on our shift.
• Tonight is my LAST NIGHT on nights for this OB rotation. I cannot tell you how thrilled I am about this fact. I am sick of being the only intern on and cross-covering on gyn patients I don't know, while at the same time trying to do deliveries and learn the ropes and get familiar with everything on L&D.
• Tonight could not be worse or more busy than last night. I'll let you know if turns out to be.
• I am getting better about not dripping amniotic fluid on my pants-- this only happened one time last night despite all the SROMers.
• We are supposed to have Thursday potluck to start our shift tonight-- I'm crossing my fingers we have time to actually sit down, as last night, I never did.
• After tomorrow (and Friday a.m. clinic), I do not have to come into the hospital again until MONDAY MORNING. This is a beautiful, beautiful thing :)
• We got paid August 1st for our first month's work! Soooooooooo nice to have a bit more moola in the bank, although I wish we were paid biweekly.... :). I guess beggars (i.e. measly residents) can't be choosers.

Deep breath. Time to get ready to go in.