Blow-by-blow: On Call

Here’s what’s going on right now.

I’m eating an apple. By all appearances it’s a Red Delicious. But it tastes too good. It’s not mealy, and it’s sweet plus tart.

I can measure my life, maybe, in Red Delicious apples. I remember when they were just like this, when I was a child. They were my favorite apple, the quintessential fruit. No wonder Eve and Adam fell into sin. But then, a result of grafting the same monoclonal stock onto millions of trees over decades, it was lost. They became mealy, bruised. No longer shiny. I lost interest.

And now this? A last-minute resurgence?

I’m taking a break from my upstairs life. I wandered down a few minutes ago to the doctor’s lounge and found this apple.

Clinic this morning was a mess. Several complex medical patients were either very vague historians to the point where I realized 20 minutes into the interview I still had no idea what we were talking about, or they had stopped taking their medications and but wouldn’t really tell me that until I asked three different ways. For reasons clear to no one I had 6 patients booked in the last hour before I went on call. I’m not sure I ate lunch.

Clinic work spilled into the afternoon because everything in the hospital could be managed by phone. Triage called and I logged into the remote monitor so I could watch a patient’s strip while dictating at the same time.

Then GB called.

“Hi, how are you?”

“I don’t know.”

“Oh, okay. Well, I’m about to put the kids down for a nap.”

“Cool?”

“So I just wanted to see how your day was.”

“Um, busy. I’m on call.”
“Okay. Well, T.P. was jumping out of a mulberry tree four hours ago and cut his hand.”

“Wait, what? Is it bad?”

“Well, yeah, it’s pretty deep. I mean, it’s not into the tendons or muscles I don’t think, and it didn’t bleed much, and I just put a bandage on. So should I just put him down for a nap?”

“Um, I should probably at least look at it. Can you bring him in?”

So they came in. And it was deep. Into the fat on the palm of his little right hand. And of course I decided to sew it up.

Why? I don’t know. The ER would be a long wait, and the wound had already been gaping for hours. But a teeny part of me thought I’d do just as good a job. And that if I didn’t, I’d only have myself to blame. And that if I had someone else do it, I’d have to go through the work of comforting him anyway, and then be powerless to fix the problem.

Yeah, I don’t know. I just did it.

He made a big fuss of it until finally we just held him still and gave him some lidocaine. Then he kind of got into watching the suturing.

The triage phone barrage thankfully held off until almost the end of that.

Next I had to go to the hospital. I checked in with a tachypneic baby and a laboring mom, and sent some other people home.

I was in the hallway trying to remember where I was going next when I got sent to assist on a stat c-section on a trauma patient in the main OR. I put on some scrubs and jogged downstairs to the doctors lounge. I passed some bored-looking orthopedic surgeons and confirmed I was heading the right direction.

At OR 2 the scrub nurse was getting ready. Then I saw that She, my nemesis, would be the primary surgeon. She chatted perkily with Swiss, my pediatrician friend, who looked a bit panic-stricken. The patient was nowhere to be seen.

She left, and Swiss looked at me. “Why do we have to do it in the main OR? They said she’s only 31 weeks, and we don’t even have a warmer down here. I can’t even find the elevator to get the kid to the peds floor if we need.”

So we talked with the nurses who brought down a warmer. We went through the masks and tubes and checked the suction and bag mask until everyone descended at once in the OR.

The patient writhed in pain, blood and stitches all over her face. Her left leg was in a splint. We moved her to the operating table and she screamed. I didn’t know yet that she had a femoral fracture.  Lines went in. They forced a bag onto her face, white milky propofol into her veins. She went limp.

Shenemesis and I hurried out to scrub, the quick kind where you use that gel from the wall instead of water. I gowned myself while She got her gloves. Then gloves for me too. Next the drape while the intubation was finished. Then skin, fascia, bovie, muscle. Bladder blade, uterus, bulging bag, child. Limp, little.

The sewing started. The uterus was floppy and I kneaded it constantly. The bleeding slowed.

In the baby’s corner it was still chaos. Swiss intubated, then I heard a scuffle as anesthesia was upset for some reason. Another pediatrician arrived. The baby needed to be ventilated, but no chest compressions yet, so that was good.

A second layer of suture closed over the first on the uterus. I followed the stitch, kept the uterus firm, dabbed blood off the places She needed to see. “You’re a pro under fire,” She said, not bothering to conceal her surprise.

“Yeah, that’s because I actually know what the hell I’m doing,” I didn’t say.

“Sure, well, we do what we can,” I mumbled.

We talked about where I work, about kids. She called herself jaded. I figured it was an honest admission.

Baby was stable enough to take upstairs, to get ready for transport to the city. We finished up and closed the various layers, finishing with a haphazard subcuticular, honestly the sloppiest layer She did.

Then, my work was done. There’s that satisfying “pop” when you grab your scrub gown by the sides and break the string that ties it, rolling it away from yourself until the bloody parts are inside a nice blue ball. I retraced my steps upstairs as the ortho team set up. “We’re going to put a big rod in the middle of the femur,” the jovial one told me when I asked. “Should be quick.”

Upstairs my tachypneic baby still needed oxygen, so it was time to investigate a bit further. I ordered some tests and visited him again. He wasn’t working hard to breathe. He was eating fine. All the other vital signs were stable. He was a chunky 8 pounds next to his 18-year-old mom.

I started to order the tests when the overhead pager went off “Neo-code, room 3914.”

“Fuck,” I said, at the nurses’ station. I’ve never been clear on whether or not this is appropriate to say at the nurses’ station.

I ran to the other ward. Swiss and the team were already there, but the baby had lost his airway. The other pediatrician was bagging, but it wasn’t going well. A very pregnant nurse tried to get IV access. RT was arranging supplies for another intubation attempt. Another nurse dug through the crash cart for meds, and another kept shouting about the vitals. “O2 sat in the 40’s!” 17 other people stood all around.

“I need another mask!” Swiss said. I crowded past a few folks and dug through the cabinet. No one knows where the hell anything is in a code. We needed a smaller mask. We found one. Then no one could find the right tube. Then the tube was in. Then we weren’t sure. O2 sats still low, kid bradycardic. Bring out the epinephrine. Hard to ventilate. Get some surfactant. Xray. Xray again. Look at the xray.

It wasn’t my code to run, thank God. But it’s hard to watch, not able to do much. Mostly what I did was listen for what folks were saying and try to bring them what they needed, or pass on a message. Because no one else was doing that, maybe. It’s always hard to say.

Finally, there was an airway, a heart rate over 100, and saturations in the 90’s. The transport team was on their way.  There were still too many people around, so I left.

I checked on a woman who was in the throes of labor. She really wanted an epidural. The anesthesiologist, of course, was occupied with the neo-code. “There’s been an emergency. We’ll try to get it as soon as we can.”

Then I was in the hallway again, unsure of how I got there. Some men were installing some kind of screen into the hallway. I had to find something to eat.

I went downstairs to find bars over the cafeteria entrance. I missed it. It must be late? I decided to visit the bathroom next to it.

I walked in and wasn’t alone. A woman, rail-thin, wild hair down her back and a soul-less crazed look in her eye stared at me through the mirror she faced. She furiously mopped up what may have been water from the sink. Her pants fell halfway down her ass, and she had on no underwear. I avoided eye contact, thought about leaving. Somehow, I figured she might be less likely to kill me if I used the bathroom as planned and acted as though I routinely find half-naked women shooting up in the bathroom. Or whatever she was doing, totally normal, you know? I washed my hands next to her and she turned back to the other stall and began vigorously cleaning the walls.

And then I walked past a couple of folks in biker leather fighting with security. And then I hid in the doctor’s lounge, where Fox News was playing, and I was the only one there.

And then I found this apple. And here I am.

I look at the clock. It’s 8. All this, in only 12 hours.

There have been many times, many calls in which I’ve felt the world turns over in 24 hours. Not just one rotation of the planet, but a lifetime goes by. I can measure my life, maybe, by a call or two I remember.

Will this be one of those?

Another bite, and nothing is left but a thin core. My phone rings. A new life is about to begin. It’s time.

I wish I had a dermatologist in my pocket. Instead I have syphilis.

Wednesday was Rashes No One Has Ever Seen Before Day.

A lovely pregnant patient came to see me complaining of an insect bite. It was not an insect bite. Unless insects bite you only on your groin and instead of creating a small pink welt they cause grouped clusters of yellow or blood-filled vesicles crossing several dermatomes and only mildly itchy or painful. I got out the atlas. Then I pulled in the Dinosaur. “I don’t know what that is,” he said.

 Awesome.

In the hospital on call a VBAC awaited. Her bag of waters broke early in the morning and there was thick meconium. She had no contractions yet. This is called PROM, only no one wears fancy dresses, least of all me. The nurses needed me to talk to her also about why we weren’t starting her on Pitocin to induce her. The reason is because it increases your chances of uterine rupture from 4 in 1000 to 11 in 1000. And uterine rupture is a bad thing, since it has at least a 10% mortality rate for baby. But the longer we wait the longer we risk infection, which is more likely, just less dangerous. And she could always opt for a c-section, which is less dangerous for baby on all accounts, but riskier for mom. So, a complex discussion to be sure. Try doing it in your second language.

Arguably more fun than regular prom, though.

After I finished the nurses asked me to stay for 2 minutes and translate for their assessment. They have no translators today. They are woefully understaffed.

I needed them to watch my strip for me because I just got called to the ER.

Dr. ER Green Zone had a baby for me to opine on. “He won’t move his arms. He’s 8 weeks old. His xray looks weird. I’m not sure what it is.” Cool. I’m sure I’ll figure it out right away since I know so much about orthopedics in 8 week old children.  We look at the xray right away. The distinguished radiologist has created a differential diagnosis for the diffuse periosteal inflammation that includes several vitamin deficiencies and a disease I have never heard of, Caffey’s. I go in to see the patient. He’s cute, but he hates it when I touch him. His arms seem weak. And there’s a weird rash on his arms.

I should have put on gloves, but the rash is unexpected. I touch the soles of his feet, where the skin is peeling. A scalloped red border extends to the sides. There are plenty of raised pink and red bumps, but in circumscribed areas. There are some ring-shaped lesions. It looks for all the world like nummular eczema, except the two spots that look like ringworm, and the spot on his chin I can’t convince myself isn’t an early herpetic lesion.

Shit.

I ordered some labs and started reading. I asked Swiss to come look at the rash, too. I called the patient’s PMD, who took care of his mother in pregnancy. She came late to care and never did her labs. The hospital drew a paltry few when she was in labor.

I decide it’s syphilis. Swiss, the resident, the medical student and I go back to the ER to take another look. We keep refreshing the computer screen waiting for the RPR to come back. I call the lab. “Oh it is send-out. 3 to 5 day.”

I ship him to the University hospital. He deserves specialist consultation, which we don’t so much have here. Not for derm, not for ortho, not for 8-week-olds, anyway.

The VBAC PROM is still hanging out. I go home and take a nap.

At 1 am a woman arrives at labor and delivery and goes from 5 cm dilated to delivering a baby on the floor in 10 minutes. The resident was sort of in the room at the time.

And then… nothing. My hands may have syphilis. It is not confirmed. That is all.

Good thing I don't smoke.

Had a delivery last night that I think shaved 2 years off my life. 8 minutes of terminal bradycardia, probably more but the nurse was lackadaisical about the FHT and wouldn't get me an FSE. And I had to ask another nurse who got me an IUPC instead. And the woman was so Mg-ed out we couldn't move her side to side. And then the first nurse told her she just needed to relax and I said "no, she needs to push this kid out" and finally she was barely +2 so I vacuumed the kid out and then he was gray and the nurse said "he's just stunned." and then we resuscitated him.

And then I forgot the name of the 4x4s for the repair and all I could do was ask for "more of those white things. The little ones."

Oh, and there was a resident.

When I Hate My Job

Potter

“He looks like he’s ready to go to the disco,” K said, impressed. It’s been a while (never) since I went to a disco, but I had to agree. Wide collar, sparkly shirt, perfect hair.

Attentive, focused, by his wife’s side. It won’t be long now.

She’s a day shy of 35 weeks, but her body decided to have the baby today. I don’t have records, because it is the weekend and apparently we live in medieval times. Or 1975. It’s never really clear in the middle of the night.

She says it was a normal pregnancy, and she seems like she knows.

To be safe, I checked with Swiss. Sometimes we have these folks deliver in the city. She thinks we can manage here tonight, and she’ll be there.

It takes a while but it’s her first baby. An epidural helps her relax. Finally it’s time to push. Slowly the baby’s head comes down. Slower than I’d expect. An hour and a half into the pushing we’re getting close. She is quiet, focused. He is always by her side.

Swiss comes into the room, checks the warmer. We’re ready.

The baby’s head delivers. But then he’s stuck. I apply extra pressure. K and another nurse pull back her legs and help roll the shoulder forward from above the pubic bone.

Except the shoulder is already under. I can see both shoulders, they’re out. But baby still won’t come.

I don’t get it. This is not in any book. All the maneuvers I ever learned had to do with getting the shoulders out, but they’re out, and the baby’s still stuck. What is stuck? Is there another kid in there? An omphalocele?

Swiss is watching me.

I bring the head anteriorally. No movement. I try some sort of Wood’s screw, if you can call it that with the shoulders already out. I think about cutting an episiotomy. Finally I loop a finger under each armpit and slowly and firmly pull out. There’s belly, belly, and more belly.

The child is before me. A huge abdomen, 40cm in circumference, floppy. Little flipper feet. Tiny chest. Blue. No tone.

Swiss freaks out. I hand her the child as quickly as I can cut the cord. She starts to resuscitate, then moves the whole operation out to the nursery.

It’s quiet again, panic in their faces now.

I have no idea what just happened. I tell them it looks like their baby was born with some problems.

They’re terrified, and want to know what is happening. I duck into the nursery, where about 18 people are trying to intubate the child. A neocode has been called.

I go back in and tell them what I know.

The next six hours I split between their bedside and the unfolding drama. More of “We’re not sure what this means, but this is what is happening and here is the plan.” Transport arrives but hangs out for a couple hours with Swiss to stabilize. More tubes, lines, xrays, consults, taps, needle thoracostomies. The lungs are too tiny. The belly too big. There’s a mass near the bladder and the kidneys are huge, maybe cystic? The oxygen is lower than expected.

Finally he’s ready to go to the city. I bring them over to see their son for the first real moments. I have to give them permission to touch him; the lines and tubes have a way of keeping folks away. A few minutes of the three of them, and then he has to go.

The next morning, at the University, he codes again. This time, he doesn’t make it.

They were on their way. But the first time they were able to hold him, he was already gone.

And why? Well, it was the Potter sequence, you see. He had posterior urethral valves, meaning the urine couldn’t leave the bladder and backed up. The pressure got high enough to blow a hole in a kidney, filling his abdomen with urine. Meanwhile, over weeks, he made virtually no pee, so the amniotic fluid was chronically low. Thus his legs never developed fully, and, more importantly, neither did his lungs. He died because he was born 5 weeks early with lungs that were 15 weeks early.

Yes. I understand. But why?

House of Scorpio

My last few calls had been cake. Not bad. Maybe I even thought I was just a super awesome doctor/efficiency master. And then I’d return to clinic, where reality would set in. But no matter: call was not so bad.

Then it was my Hospital Week.

At no time during Hospital Week did I have fewer than 9 patients to round on in 5 hours, and often more like 15. Most of them had pyelonephritis and were vomiting. Rounding on those patients was totally do-able. I am totally awesome at treating uncomplicated pyelonephritis and vomiting.

Except that I was also in charge of all 30ish-week twin pregnancies who may or may not have been in labor and needed to be evaluated and possibly transferred to the University for seeing spots and having their right hand spontaneously weaken vs. having their bag of waters rupture prematurely. Of which there were 3. During which I was also in charge of all placental abruptions at 35 weeks bleeding half of their blood volume into the bed. Of which there was thankfully only 1.  And of all of the babies who seemed to be doing very well but then immediately prior to discharge developed extremely high bilirubin levels. Of which there were also 3. Or 27. I lost track.

And also of teaching residents. And of taking the amniotic fluid samples to the lab downstairs 55 times because the bulb is out on the microscope on Labor and Delivery.

And of locking my keys in the car in the middle of the night with the car running and not noticing until I came back out after a delivery.

“It’s crazy around here,” I mused as I sat next to a nurse. She was scanning through the computer. “Yeah. It’s the Supermoon, which is in the house of Scorpio. Or something like that.”

Obviously. That explains everything.

The Zoo

Today we went to the zoo for T.P.’s fourth birthday. Standing by the bright blue sea lion pool, I held Beastie up so she could see. She watched all the swimming. I took her little hand with all its little knuckle dimples and kissed it, inhaling a bouquet of sticky ice cream, dirt, and all the love I’ve ever had.

My heart stopped beating. My tongue was like a fat seal stuck somewhere in my throat. My eyes burned.

I thought myself 20, heck, even 2 years in the future. It will be here before I have time to breathe again. This baby will be gone, a child, a woman in her place.

Dammit. No crying next to the sea lion tank, okay? I’m pretty sure that’s a posted rule.

We moved on to look for wallabies. I spent the next 30 minutes, in those exact 30 minutes. And that is the best thing I did all week. My proudest achievement. I was there. Fully there with my kids.

The wallaby was missing, though.

Eve of

War Christmas

She was born this morning around five.  I walked in to meet her and examine her.  It was as if nerve gas had gone off in the room.  Three people, completely unconscious, barely arousable to a shouted “HOLA SOY DOCTORA BISON POR FAVOR PUEDO EXAMINAR A SU BEBE?”

She has curly black hair and looks like what angels might when they’re born.  Or when they spring fully formed from their father’s foreheads.  Or however angels regenerate.

She has a stork bite mark on her forehead.

She barely rouses when I uncover her to check her belly and hips.  Together we wrap her again and she goes back to sleep.

Oh, yeah, my dad is with me today.

He came to follow me on call.  We round together and discuss the cases.  I push aside the nagging worry of appearing incompetent in front of my father, and it’s really fun.  It’s also lovely to talk through the cases with someone else again.

On the way home for lunch we talk about illegal immigration.  We’re of the same mind on this one, I think.  Like, seriously, America, can’t we move on?  These are people.  Most of whom contribute to society.  Most of whom live in what used to be Mexico.  All of whom just want a better life for their children.  Just like me.  Just like you.

Mom’s not convinced.  We talk about their difficulties of the last four months. 

At home we make enchiladas.  My 22-year-old brother wants us to help him decide whether he’s a republican or a democrat.

Dad:  “How do you feel about gun control?”

Buddy:  “There should be less.”

Dad:  “Okay, then you’re a republican.”

Dad:  “How do you feel about women’s right to choose?”

Buddy: “Women shouldn’t have any rights. (ha ha snicker snicker.)”

Dad:  “Then you’re republican.”

Mom (staunch republican): “That’s not a republican value!”

Me:  “Right. He’s an Iranian.”

Later, doing dishes, Mom tells me how upset she got with my father a few months ago, how she almost thought of leaving, for good.

Really?  Mom?  I thought I was the only one who had those thoughts. Months ago now, but still. 

Is there hope for any of us?

I wrap gifts for my kids and can’t help thinking about all the overflowing heaps in dumpsters and landfills and fragments of plastic and worse that all these toys will be in just a few years.  And how so many other mothers’ children lie awake tonight, hungry, without a roof over their heads.  While my children fight over their mountains of belongings. 

But these plastic playthings will outlive any of us.  And since we’ll all die soon, does any of it matter?  The toys, the trash, the hunger? 

God, these are not very Christmassy thoughts.

My heart feels like a noiseless patient spider, sending forth filament after filament until the ductile anchor hold.  No, wait.   That’s Walt Whitman.  Actually maybe it’s just a vagrant, tired, unsettled.  Ideas and yearnings burgeoning, just about to be born, if they could only be organized.  Searching still, nightly, looking for a home.  Or maybe just a hotel room.

The family, all of them, bundle up to walk to the downtown festival of lights.  I put on my coat but drive to another home of sorts, the place where life so often begins and ends. 

Three ambulances stand between me and the back door.

Baby Guadalupe was not in a hurry.  We sat together for more than an hour before she decided to meet us.  But she was beautiful, quiet when she came, eyes wide open.  A family of 20 descended immediately upon her and her mother as I departed.  “Feliz Navidad, y que Dios le bendiga.”

So what can we offer this new innocent wonder?  What do we have to give this life?  Just fragments and plastic, war abroad and domestic disputes?  Parents too tired, from mundane struggles, to make this world a better place?  Minds full and spinning and with television and coffee and bills and weekday and weekend.  Feuding, fighting, acquiescing, quietly stewing.  Rotting, decomposing, dying.

No.  It has to be better than this.  We have to make it so. 

The cold is bitter, dark as it greets me.  My car and I speed through the night.  As I pull into the driveway I see a dawning glow. 

GB made me my own set of lights.  The luminaria glow alongside the path to our door.  I feel the heaviness lifting.

Peace. On. Earth.

Alive

Not Reading Journal Watch

I am not even going to tell you how many unread Journal Watch emails I have in my inbox. I really need to read them.

Instead I have been fashioning splints today. Today was Carpal Tunnel Day at my clinic. No folks with Carpal Tunnel Syndrome had any insurance so I made some gigantic bilateral plaster of paris splints with ace wraps for these ladies. I joked to the one lady’s son that we’d make a piñata next. You shouldn’t joke about these things with 5-year-olds.

It was a very hands-on day, in a way some days aren’t. Holding the splint in place, making small talk for 5 minutes. Sitting between the stirrups, talking a woman through an IUD insertion. Chatting to the ultrasound image of a baby’s face, just 3 weeks before she’ll be born. Measuring a penis for a concerned mother. Fundoscopic exam of a 6-year-old. Feeling the rough boundaries of a weird-looking rash. Didn’t read much at all today.

Another weird thing happened. Like 3 other providers asked me my opinion. The OB/GYN asked me a pre-operative question about hypertension and showed me an EKG. The midwife had me come in to check on a kid’s hernia. The PA with 30 years experience that I curbside all the time ran some ideas by me on a sick guy who won’t go to the hospital.

What is this? Do these people have any idea who they’re talking to? I still have to look up how to do certain joint injections. I STILL don’t know how to spell amitriptyline. Yesterday I sent someone home on accident with a recorded heart rate of 35, according to the medical assistant who took the vitals.

Yes, he was still alive. No, I didn’t notice the vitals before he left, because he was totally fine. Yes I noticed it while dictating. Yes I fell off my chair.

We called him yesterday evening and talked him through checking his own pulse. In 30 seconds he counted 13. “I feel great, doc! I don’t know what the big deal is. I’ll come in tomorrow, ok? I don’t have a ride right now.”

And I didn’t send the ambulance to his house because there was no way his heart rate was 26. But my heart rate was 120’s with frequent accels for the next 18 hours.

He sauntered in over lunch break today. I put him in a room myself and put my hands on his right radial artery. Pulse 88. I placed the blood pressure cuff over his upper arm, and inflated it manually. 140/80.

Still alive.

Call 5

Connected

Well, that's it I guess.  The honeymoon is over, and I'm a resident again.  At least it feels like it.  Call was brutal.  Pretty much everyone in the hospital was my patient.  Stayed up all night wandering bleary-eyed around the nursing station and dashing into rooms for sudden fetal bradycardia after epidurals and such.  Reminded pregnant people not to use cocaine anymore.  Got yelled at by obstetrician on call.  Yep, exactly like when I was a resident, except none of my resident buddies were also suffering in the hospital with me.  Couldn't just escape to the medicine call room or find any disgusting low-fat cheese to eat.  Didn't have the Dragon or associates to run my thoughts by on the preterm IUGR with low AFI and h/o stillbirth.  In a word, it was... lonely.

I like the nurses.  While I was shooting myself for not having long-enough fingers to do an adequate cervical exam on a lady who was contracting with 2 previous c-sections, K was self-flagellating for allowing the same patient to eat 3 bites of a sandwich.  We sat at the triage station together and stared blankly at the repetitive variable decelerations of another patient I was inducing (and slowly, they went away).

Then I ran up and down the stairs several times to the ER to evaluate a couple of kids, and admit one.

By 1am I could almost take a nap.  I got ready to send a triage patient home, a woman at 23 weeks with round ligament pain.  Then I found out she had had 2 previous 2nd trimester fetal losses.  She had no contractions, and her cervix wasn't changing, but she was visibly shaking.  She wanted this baby so badly, and she was terrified she would lose it.  I decided to run a fetal fibronectin, and I laid down for 30 minutes.  It came back negative, which means there is almost no chance she'll deliver in the next 2 weeks.  It felt good to be able to tell her that.  She went home.

Immediately after, it was time to deliver another first baby, who decided to enter the world with the umbilical cord wrapped tightly twice around his neck.  He had a rough time for about 30 minutes, so I was keeping an eye on him while sewing up a bleeding perineal laceration.  The nurses calmly helped him out, and adjusted my light.

As we finished with that baby, the patient with preterm/IUGR/grand multip/no prenatal care/cocaine combo returned, this time in labor with light meconium in the fluid.  I called the pediatrician on call to stand by.  That baby delivered, and it was an absolutely beautiful delivery.  It really was.  And she was a beautiful girl, who came out yelling and transitioned just fine.  She had the longest eyelashes I've ever seen on a 4-pounder. 

Next I let the lady with the previous c/s go home, as her contractions had stopped and she'd had some rest.  The day team was arriving, and I signed out to the next doc. 

As I left the floor, K was back, starting her shift and signing out with the night nurses.  I overheard her asking about the patients we'd seen together.  How they were, if they'd delivered, if they'd been able to go home.  And I realized, that's what we all have in common.  That's what keeps us coming in to work every day.  It doesn't matter how crazy it is, or what a wreck our lives are, or if it's 2 am, we're all just looking to connect with other people.  Even for a minute, or a few hours.  Each of those connections changes our life in some minute way.  I know every time I leave the hospital after a call I've been changed by those connections.  I smiled to myself.  And I felt a little less alone.

Hospital-ed

Death, or Birth

 This week I've been in the hospital.  It's fine.  In many ways I've gotten a lot of other things done because it's not so busy as seeing clinic patients all the time.  A few couplets to round on here and there, someone to induce, someone else to rule-out preterm labor in.  There are some old ACOG green journals in the call room which I've been perusing, and reading "journal watch" online for the first time.  Mostly though I've tried to catch up on life things like responsible people do.  Like figuring out if I have car insurance anymore.  And oops, I don't.  Like getting my eyes checked.  And then realizing I've lost my sunglasses, and having to drive home in a near-total white-out of blazing sun.

The other night I delivered a baby without breaking the membranes.  It was a really nice, induced, but otherwise natural birth.  I didn't break the bed down.  The woman did beautifully.  The nurse working with me that night commented to the student nurse about what a nice "veiled" birth it was.  We got to talking afterward about how long she'd worked here (19 years), and I told her she'd have to help me find my way around.  She told me she initially was in pharmacy school, but everyone she talked to in that field felt like they were in some sort of assembly line/factory.  She got out because she wanted more patient interaction.  First she was a tech at the hospital, then she went to nursing school.  And she loved it.  Now she also has a farm near the hospital with 60 chickens, and she gave me some eggs for my kids.  I told her I was looking forward to working with her again.

This morning as I was sitting at the triage station I learned that she had died, unexpectedly, that morning.  The nurses were all in shock.  I know it's not my tragedy, and I barely knew her.  But it really reminded me of the frailty of life.  It could be any one of us.  We're no more protected because we're in the business of bringing new life into the world. Death, like life, is random.  And devastating.  It never gets less so. 

A few minutes after I heard the news, there was a "CODE BLUE, PEDIATRICS" page.  I grabbed the closest reference book I could find and ran toward the door, hoping against hope it wasn't my patient, the one we were rehydrating for gastroenteritis.  "Shit," I said, as I thought about gastroenteritis, and codes.  When I got to the ward, the nurses said "all clear."  It wasn't my patient, and everything was fine anyway.  I wobbled back to the call room and sat down.  I googled all the PALS courses in the area.  Really need to take one of those.  Probably also ATLS in case anyone falls down in the hallway.  Shit.  I forgot I wasn't actually prepared for every possible contingency.  Maybe if I just know enough algorithms, it'll all be okay.

(But can you ever really be prepared for death, whether it's yours or someone else's?  Or life? Or birth?)