When labor comes too fast

Check this story out-- it is about Jodi, a labor and delivery nurse here at UCD who had a "BOA" (generally, a "birth on arrival" or before!) in her car before making it to the hospital on Friday! Too funny! Less paperwork when this happens :) Congrats, Jodi!

There's a cute video you can watch at the right after clicking on the link.

Labor Nurse Helps with Emergency Delivery: Her Own!
The text, from News10 online (George Warren):

"SACRAMENTO, CA - A UC Davis Medical Center labor and delivery nurse is resting with her new baby daughter after giving birth by the side of a freeway.Jodi Fankhanel, 38, went into labor early Friday morning at her home in Rancho Cordova and got a ride to the hospital where she works and planned to deliver her baby.But things didn't quite work out as expected."I knew we weren't going to make it," Fankhanel told News10 from her bed in the maternity ward at the hospital.Fankhanel's husband Paul, who is also a UCD nurse, was at work. So she awakened her sister-in-law who is visiting from Minnesota.Jennifer Sweet said the baby was already crowning before they got halfway to the hospital. Sweet, who doesn't know her way around Sacramento, pulled over when she saw a California Highway Patrol unit helping a stranded motorist by the side of Highway 50 just east of Watt Avenue.CHP officer Charmaine Fajardo called for an ambulance, but there was no time.Fankhanel talked Fajardo through the delivery process and the baby girl was born in the back of the Honda Odyssey just after 3 a.m.In an interview in her hospital room, Fankhanel was laughing about the event. She has three other children and eight years of delivery nurse experience. But she said all her earlier deliveries were induced and she expected to have plenty of warning for baby number 4 who, by the way, arrived two weeks early.She and her husband named their daughter Lainey Grace Fankhanel."

I love this about OB! I had an exciting near "birth on bed" and only had time to get gloves on to deliver the baby's shoulders yesterday-- which I was regretting a bit after getting totally splattered with amniotic fluid and blood! Eeww! :)

Gilroy Gardens/Easter weekend!

Shomir, holding Emma, next to Lily, and with me and Anne on the other side of "Garlic Gil"

I had the most wonderful two days off I've had in a while! Maybe part of it was not having to work for two days in a row! I'm now going into my fourth week of this L and D rotation (2nd week of nights) and am really beat; however, one of the perks of being on nights (besides more deliveries, which I got last week [yay!], and no rounding w/ the attending [only prerounding]) is having all day Saturday and most of Sunday (until coming back at 6:15 p.m. for night shift) off!

I had post-nights Friday clinic, which was quite draining (and where I realized I have to refer one of my pts, pregnant with twins, to the OB dept. b/c they are too "high risk" for us to follow :(), but then went home, slept a couple hours, and then got up to head to Millbrae, CA (just south of San Fran) to where Shomir's sister Marie lives with her husband Adam and three kids, Anne, Lily, and Emma. On the way, we made a stop at a wonderful and renowned Chinese place, Hong Kong Flower Garden, where we ate some yummy braised frog and so didn't make it to the house until the kids were in bed, but we ourselves were beat so hit the hay early after a bit of socializing.

It was a good thing, because we needed our energy for Saturday, which was filled with an expedition to Gilroy Gardens (/Bonfonte Gardens), this Family amusement park with rides tailored for young kids in a botanical garden setting (where Circus trees abound), in Gilroy, which is the garlic capital (of CA/the world? I'm not sure. I remember driving through the town with Amy when we returned from Monterey and it really does smell of garlic!).

It was a great time! Weather was gorgeous, scenery beautiful, and we had fun on the kiddie rides (well, with the exception of the Mushroom Swing, which Anne loves but which, every time, makes the adults nauseated. I was the lucky nominee to ride with Anne this time and I was definitely green for a good half-hour afterwards). I took a bunch of pictures! Enjoy!

Shomir on the Merry-Go-Round Anne near the frog fountain

Anne with (my favorite!) the Banana Split Swing. This (like those Viking boats) was scary, even for me!The Swan boats
Family boat ride

Marie and Adam with Emma (all you can see is her bow!)

Dolphin hedge

The smaller girls (Lily on the left, Emma to right) with Gil

Lily the monkey
Shomir with Emma

Saturday night, a babysitter watched the girls while the "adults" went out for AMAZING Indian food at Roti. Mmm. Made me think of JB's cooking :) Then, this morning, we awoke to find the girls already at it at their Easter Basket search. I even got one! After abstaining for sweets for so long, I think I should have taken it a bit slower with the a.m. chocolate, but Cadbury Cream Eggs are just sooooooooooo good.

We headed off to church, where there was beautiful brass music, and then back home for ham, mashed potatoes, green beans, and lunch outside in the backyard. And, of course, there was an Easter egg hunt.

Here's Lily with her goodsAnne with her full basket

It was such a great time. We tried very hard to get a "group" picture before Shomir and I headed back to Sac, but with three kids under 7, that is a tall order. This (sadly) was the best result. It's me on the chaise, Adam's cousin Nicole and husband Reuben, Marie holding Emma, and Anne in the sundress.

Ah. Weekends are so glorious. I can't wait until NEXT weekend, too, when Laura and Tony will be here (they come Thursday! So excited! Gotta think of fun things to do!) :)

Spirits and snow!!!!

Vanessa and Allison (a friend of hers from W & L) came into town on Friday night. As I had Saturday off (yes! A day off!), we took a mini road trip east of Sac to Amador Co., which has some wonderful (and less expensive than Napa/Sonoma) wineries to try, as well as Calaveras Co. for some (snow) hiking! Luckily, Shomir was along so there would not be any risk of a tipsy driver (I am a LIGHTWEIGHT!)

Here is the group of us at Drytown Cellars (ironic name), our first stop.

We then proceeded to drive up into the Sierras near Arnold for some hiking. None of us was expected snow on the ground and in the air! It was like 32 degrees up there! We did some trudging around in the Calaveras Big Trees State Park and saw some majestic Sequoias (I still love Big Trees!).

A real path??

Sap Icicles!
Will he ever learn to smile (with teeth) in pictures? :)

I realize I don't have any pics of us sisters together! My bad!

After we thawed in the Warming Hut (with complimentary Hot Cocoa-- mmm!), it was onto Ironstone Winery in the town of Murphys (they had a big St. Patty's day celebration going on!) for more tasting :)

They also had a beautiful Daffodil display, as well as beautiful daffodils outside.

How do you judge these?

And it was more pretty CA scenery... here's an interesting-looking cloud we saw on the beautiful drive home...

And here, for no particular reason other than it's beautiful, is a picture of Yosemite in winter/spring, courtesy of Sonia when the 2nd and 3rd years went to the Family Medicine Educational conference there a weekend ago. Can you see the bird in the middle?

The day concluded with some dinner Amy, Phi, and Arash joining us for El Salvadorean food and then playing good old Time's Up. Fun times!

Today, Vanessa and Allison are headed to Monterey for some more CA fun, Shomir goes to SF to visit his sister and nieces, and I'm back on L and D for another 24 (29) hour call . . .(Let's have some deliveries!!!!)

Not meant to be? (details from L and D)

I'm not sure what God has in mind for my 3rd month on labor and delivery, but it sure doesn't have to do with getting a lot of vaginal deliveries. I've been on for nearly two weeks and my grand total of NSVDs this month is.... hold your breath... drumroll, please..... six. Yes, that is exactly six. Now, this puts my total so far this year around 50 (around half of those were in my first month!), but I don't think it's nearly enough. Maybe it's because I feel like deliveries never get old and I could just catch babies all day and be totally content with that (Phi, who I see a lot because he is concurrently on his Newborn rotation said, "You will never feel like it's enough! You could get 20 deliveries a day and you'd still want more!" This is true.) However, I'm sure some of my OB classmates have upwards of 100 (they do rotate through high-volume Kaiser) and this worries me because I will have to be supervising interns as well as my own R2 FP classmates as an OB resident next year. As I've gotten more comfortable, I've been experimenting with some new things, such as not breaking the bed down and delivering onto the bed or sitting rather than standing, and I like those methods a whole lot more, but I want to get more practice with the new techniques.

I have made the "white board" of records in the OB board room (has things such as "Oldest patient-- 62 [!!!!!], most nuchal cords at delivery-- 5, largest C-section baby [6300 g or something-- that's like a toddler!], last vaginal breech delivery-- 3/12, etc., earliest triage visit for decreased fetal movement - 16 weeks) as the R1 with the "whitest cloud" (meaning, i.e. that things are slow when I'm on.). TRIAGE isn't slow! Just vaginal deliveries are slow!. Grr. This is a BLACK cloud if you ask me.

Granted, I am on days right now (more deliveries happen at night) and there are a lot of people wanting a piece of the pie-- another FP intern on with me, as well as med students and new attendings that, themselves, have to get "proctored" to have privileges to deliver here. However, I was on BY MYSELF on Saturday 29 hour call (well, I guess it was more like 28 b/c of daylight savings) and here's sort of how things went that night.
1. G1P0 induced for mild preeclampsia .... 4 cm --> 6 cm --> 7 cm -> 7 --> 7 --> 7 --> primary C -section for failure to progress
2. G1P0 admitted with rupture of membranes: 2 cm---> 6 --> 8 --> 10 --> pushing --> pushing --> pushing ---> primary C-section for failure to descend
3. G5P4 with rule out labor for fetus with encephalocoele (brain herniating out skull)..... delivered 1 hour after I left

See a pattern? I felt like I admitted the whole city of Sacramento but none would get their babies out on my watch! Yesterday, Wednesday, when I had OB conferences in the a.m. and family practice clinic in the p.m., there were like four deliveries. Aargh! I think I should put my name up on the record white board for highest hours worked/delivery ratio (with about 150 hours in the past 11 days with 6 deliveries, the ratio is 25!).

So what am I doing on L and D when babies are NOT being pushed out of women on L and D? Well, there's always the joys of triage. But I've actually gotten to go into the OR several times this week. I've been a part of a couple of C-sections (which I may have to start doing soon!)-- today we had one for twins. I did a tubal ligation earlier this week. And then, today, I did my first D and C (well, suction and curettage) for a poor woman whose baby died a couple of weeks ago (she had a D and C scheduled) but who came in to triage today bleeding, with a 15-week size fetus being expelled from her uterus onto the triage bed, and with retained placenta/products of conception.

I'm really loving the procedures. I've also gotten to do more transvaginal ultrasounds to feel more comfortable at those-- I was asked to switch patients with someone yesterday in clinic and ended up diagnosing an early twin pregnancy that I hope to try to follow if able. BUT I WANT MORE VAGINAL DELIVERIES!!!! I actually have Saturday off this weekend (!Yay! Time to spend with Vanessa who will arrive tomorrow night) but work a 24 hour call Sunday going into nights and I hope, being on my myself, I will get some more. Please pray with me for NSVDS. :)

Lenten smiles

In honor of Lent, some anecdotes to make you smile:

from The Lutheran magazine:

"When I arrived at Grace Lutheran Church, Stratford, CT, three years ago, the first baby I baptized was Jimmy. Since then, he has been diagnosed with retinal blastoma in both eyes, requiring many days of chemotherapy, surgery to remove one eye, etc., but he appears to be doing well. Recently, he came to the table with his Oma (grandma). He put his hand out and I placed bread in it. He turned to oma and asked, 'Where's the butter?' Jimmy is not only the first baby I baptized but the first to ask for butter with his communion bread." - Joan Sorenson

"We all came home with crosses on our foreheads after Ash Wednesday worship (2007). Our 5-year-old, Grace, rubbed her cross off as soon as she could and thought the rest of us should, too. As she headed to bed, she said to my husband, 'Daddy, get off your ash and come read to me!'"- Aimee Appell

"As the mother of a preschooler, I always wonder if my child pays attention in class. I know my 4-year-old was paying attention in Sunday school when I overheard him tell his little brother that he was going to nail him to the cross." - Dina Kuhn

Only 10 more days 'till Easter (I am owed several Big Spoon yogurts that I can't wait to cash in on after the Lenten dessert fast is over!).

Where I'd rather be...

So since I haven't taken any exciting trips lately and am stuck on Saturday call this weekend before my second week of L and D days, I thought I'd share some pics of others' exciting vacations (vacation ended WAY too soon for me!)

Eva gave me her permission to share these snaps from her and Matt's recent trip to Australia and New Zealand. I loved looking @ them, b/c I was there with my family when I was about 13 or so and remember some of the same places. If you haven't gone, I highly recommend it! New Zealand, especially, is awesome. I'd love to go back!

Eva at the Agrodome!!


Bungy!!!

Lake Wakatipu
Lake Wanaka
Milford Sound

I also am extremely jealous of my parents (and godparents), who left on Monday for a two-week cruise, navigating from Ft. Lauderdale to Brazil, stopping at some Caribbean islands on their way to the Amazon. Aaaaaaargh! I wish I could be with them to celebrate my dad's 60th birthday, which is today!!!! Happy Birthday, Dad!

The only good thing about being on this Saturday call? (Well, scratch that. Now that I kind of have the hang of things, it's actually nice being on L and D as the lone intern b/c I can claim all the deliveries [there were so many people (residents, students) wanting a piece of the pie this week that I didn't get more than 3]-- already got one today and 2 others are in labor [I'm hoping a few more roll through triage, too!]). It is daylight savings!!! Now, I usually need to be reminded of this. It's great being on call this weekend because that's ONE FEWER HOUR!!! When it gets to be 2 am and when I've been here for 21 hours, I can fwd my clock so it will end up being more like 27 and not 28 hours of being up on call! :)

Hope everyone else is having a nice Saturday (not in the hospital)!!

Ski weekend at Squaw

(Brenden and Phi with the thumbs up)

For our last weekend of freedom before the grind started for all of us interns (I am back on L and D as of yesterday... don't expect any more posts anytime soon!) , we headed up to North Lake Tahoe for a ski weekend! It actually all started with Erin and TJ planning to join me and head up there, but we figured the more the merrier, and it was neat getting to introduce all my friends to eachother! Erin, TJ, and Sylvia drove up to Sac (about 2 hours) on Friday night, and then we left on Sat a.m. for Tahoe (about 1.5-2 hours from here).

I was improved from the last time we went skiing (New Year's @ Heavenly) but still a bit tentative. I did fine on greens, but tended to get very scared on some of the blue slopes. By the end of day 1 I had gotten better at turning (or so I thought... until two different complete strangers approached me on the slopes on Sunday to ask, "could I give you some advice? [on turning]" which was kind of funny) but still have trouble keeping my skis parallel and weight forward. The worst moment of the weekend was on day 2, when I ventured to try some more blues and, although I did fine on some, I got caught in panic on a couple of too-steep hillsides where I couldn't see over the edge. I had great encouragement from Phi and Arash but was paralyzed in fear and, on one slope, somehow got off track and ended up in (what seemed to me!) a forest with too many trees to dodge. After standing in place on the hillside for about 1/2 an hour, frozen in fear, sobbing and panicking that I would die alone on the the mountain, kind Arash came and rescued me to guide me back to the actual slope.

I have mixed feelings about this skiing business. I'm so terrified that sometimes it isn't all that enjoyable, and it's frustrating to see people who are so darn good at it zip around so easily. It's also dangerous!! I didn't get hurt, put poor Sylvia (Erin and TJ's friend from Stanford) dislocated her knee on her first time skiing and missed out the second day. Hmm. Maybe practice does make perfect. We'll see how I do next time. If there is a next time :)

Here are some pics... (thanks, Brenden!)

Sierras

Gettin' ready in the parking lot

Phi probably trash-talking :)Jeremy and Noelle riding the lift
View from the Funitel (gondola)Phi and me on East Broadway lift

Noelle in action, her first time snowboarding! She did GREAT!
me trying not to fall...

Amy, boarding like a proJeremy and Noelle

me and Sylvia (pre-dislocation)with Amy (so squinty b/c it was so sunny!)Laughing about things after the fact

So how did we do this as a two-day trip?! Brenden's brother has a cabin in Truckee, the town in North Lake Tahoe about 20 min. from the slopes! He said that we were all welcome to stay there, and 12 of us ended up crashing there with ample space on Saturday night! How cool and generous is that? After Saturday of skiing, we made dinner, played Time's Up, and were cozy by the stove.

Brenden pointing out kitchen features

Arash and Ben opening wine bottle w/ a screwdriver
Erin and TJwith Phi, Amy, Arash

I still cannot get over how, on Friday, I was running around in a t-shirt and shorts and, on Saturday, was skiing in the Sierras less than 2 hours from my house. California rocks!!!

Fun times! Now, back to 14-hours days.