Saturday, September 29, 2007

What are you going to name him?

Whether or not I ask someone what they are going to name their child usually depends on my mood. Do I feel like I can hold in my laughter and then tuck the gem away for later use, or would I rather save myself the trouble and not know?

A long string of rather interesting baby names led me to look up a list of the top 10 baby names for the past year. I remember when these lists used to be made up with names like Matthew and Katherine and I was horrified that 5 of the top 10 boy names from 2006 were:

Jayden &

Seriously? What are you people thinking? This really makes me further reconsider my already shaky thoughts on having children. As someone with a rather common name that usually had to share it with least one other classmate, I cringe at the thought of my son coming home with his birthday party list of rhyming names. Even worse, how would I be able to keep all these kids straight? "I'm not Aiden, I'm Braden and he's Hayden". Oy vey.

Friday, September 28, 2007

We charge extra for crazy.

While usually families come in a big package of crazy, on occasion I will come across a perfectly normal patient with a family that makes me use every tiny bit of self control to 1) not start yelling 2) not make fun of them, to their face and 3) not start laughing, again, to their face. Number 3 is usually the hardest and I am still working on that one.

In this story, my patient, Lindsay, came in for a labor check. She was taken to her room and I came in and put her on the monitor. She seems very sweet and while I can tell she is uncomfortable, she is handling herself well. At this point, I hadn't paid too much attention to her mother in the corner but as soon as she spoke up, I knew I was in for a long day.

I really wish I had an audio clip, because nothing I could type would really give the true impression of what we were dealing with but just try and picture that girl on Intervention that can barely spell her name at the beginning of the episode and frequently stumbles into walls. She is starts rambling about how she knows her daughter is really in labor this time, how she was really screaming earlier and something is wrong because she isn't screaming now, what's my name, that's her little girl, what's that monitor, please start screaming sweetie, something is wrong, her vaginal discharge looks different this time (what the hell?), please help her.

Yeah, that's what I was thinking. She really did me in when she got in her daughters face and told her she needed to scream and really act like she's in pain. This caused Lindsay, who was just two seconds ago sitting in bed calmly, to start screaming like she is being mauled by a Pitt Bull.

Now I need to step out of the room for a moment to take a few deep breaths of my own. I go up to the desk to fill out her out-patient orders and start praying she isn't really in labor. I wasn't out of her room for a full five minutes but that was all it took for a lovely surprise on my return. Her water broke. Damn, what are the odds? I go ahead and start her IV (with her mother screaming and literally trying to crawl up the wall in the background) and get her admitted.

Early into the morning, mom decides she needs to go out for a "smoke break". I take this opportunity to calm Lindsay down and have a talk with her about people who might be causing her anxiety in her room (i.e. we can kick them out for you). Unfortunately for me, and the rest of the floor, she wanted her mom there and we spent the rest of the day alternating between ear piercing screams and peace and quite while her mom was out "smoking".

Finally, everyone had had enough and her doctor decides to let her get her epidural early. I boot the mom out of the room based on her reaction to me starting the IV earlier in the day. She was probably thankful for the opportunity to go smoke some more crack and I was glad for a few moments of quiet. The anesthesiologist comes in and gets started and I am feeling rather proud that I have managed to keep myself together for points 1, 2 and 3 mentioned above.

About halfway through the procedure, the door flies open (there is a sign on the door saying an epidural is in progress and please check at the nurses station) and her sister runs in, looking like she has some sort of drug induced mental disability, screaming, "SISTER!" with tears running down her face. All three of us look up and there is dead silence while everyone looks confused. I walk over to escort the sister out the door and point her towards the waiting room. "SISS-TER! SISS-TER!" she screams as I am backing her out the door. She is literally bawling, red faced and then reaches out dramatically with one hand and a final "SISS-TER!" before I manage to get the door shut.

That was it, I looked up and made eye contact with the anesthesiologist and we both lost it in a fit of hysterical giggles.

Wednesday, September 26, 2007

Not all emergencies end up in the ER.

While we all like to think that having a baby will go smoothly each time, on occasion there are true emergencies. Last week, Carol and her husband show up to labor and delivery because she thought her water broke. Now, just showing up without calling anyone, your doc included, and people that think their water broke are both subjects for another day. Either way, no matter how annoying you are, or how big of a pain in the ass we can tell your family is going to be, you still get treated like everyone else.

Anyway, Carol appeared without calling and there was only one empty bed (lucky for her there was one) but the patient had just been transferred to her new room so it hadn't been cleaned yet. We let both her and her husband know that the room was in the process of being cleaned and we would come and get them from the waiting room as soon as it was ready. Dude takes his wife to the waiting room and then comes back to throw a cussing fit that his wife is having a baby and it is unacceptable to make her wait.

At this point we are all thinking, "OK jerk, everyone up here is having a baby and they are working as fast as they can to clean the room so your wife doesn't have to lay in a dirty bed or deal with a puddle of blood on the floor." Amazingly, everyone held their tongue and we escorted them to their new room ASAP.

One of the other nurses on the floor, Kelly, gathers her paperwork and heads back to her room to get her admitted while someone else makes to call to her doctor to let him know that we have one of their patients there (don't do this, call your doc first). While being admitted, Carol starts screaming that she feels like she has to poop, usually a sure sign that the baby will be there. Kelly yells down the hall for one or all of the midwives and then proceeds to check her cervix. Instead of finding a fully dilated cervix, she finds a prolapsed umbilical cord. This is the point where it hits the roof.

Kelly flips the woman over to the following position to try and relive pressure on the cord but the baby's heart rate is still slow so she crawls into bed and sticks her arm up the woman's vagina to support the baby's head and keep it from putting pressure on the cord, which was cutting of circulation completely.

The rest of us, literally every person on the floor, are frantically prepping the OR, getting anesthesia up there, finding any doc that is qualified to do a c-section, and getting Carol ready. In a matter of minutes, we are rolling her back to the operating room, on all fours in her bed with Kelly on all fours in her bed behind her, arm in her vagina, supporting the baby. Carol is prepped and draped. The drape thrown over Kelly as well, who is now under the sterile field still holding the baby. In less than 10 minutes from the cord being discovered the baby is out.

Now, back to the husband. The entire time is is standing outside of the operating room screaming that we haven't taken good care of his wife and that we didn't really need to do a c-section and how he is going to sue every one of us. Yeah a-hole, we had our hands up your wife's vagina, saving your baby's life and got her back to the OR in under 10 minutes because it wasn't necessary.

Tuesday, September 25, 2007

I'm scared.

I am not sure I can truly put into words the difference between a woman delivering with an epidural and one delivering without. Today, I delivered two women, both without epidurals and it was actually scary (and, if you were an outsider, a little bit comical).

I don't think I will ever forget the look in my patients eyes, like a wild animal about to be trapped. She grabbed my shirt and emphatically screamed, "I'm freaking out now." I had to stop, take a deep breath and then remind her to breathe as well. In the meantime, she is clamping her legs together, coming off the table and moaning that she can't push anymore.

"Alright sweetie, the baby isn't going to come out with your legs shut and the only way for you to stop hurting is to deliver this baby." Um, doc, can I get some support here?

I don't even know where to start describing the screams and pleas for help. The sense of urgency to get the baby delivered takes on a whole new meaning as you watch someone in more than the worst pain imaginable with only one solution.

All I can say is that I am not that brave.

Sunday, September 23, 2007

Birth Plan

Definition of Birth Plan:
- A written outline of a woman's preferences for her labour and birth.

My Definition of Birth Plan:
- A way to guarantee that you aren't going to get what you want.

I have yet to see a woman come in with a birth plan that ends up laboring according to her wishes. In fact, I have yet to see a woman with a birth plan that doesn't end up having a C-section. If I were going to get a PhD I might research why.

Take Lisa (chill, it's not her real name). She came in for an induction with the most horribly annoying three page birth plan that basically included no intervention at all. She settled herself in her room and then refused an IV, pitocin and having her water broken. At this point it was necessary to stop and determine if she realized what induction of labor was, and if she wanted no part of it, send her home to wait for labor to happen on its own. She decided to stay and for the moment, get an IV.

Over the next four days she caved to each intervention one by one. First it was starting some pitocin to get the contractions going. After she had been there 48 hours and nothing had happened, I am sure she was getting antsy. I wonder if she thought her labor would start just by showing up to the hospital. The next day it was having her water broken. After the contraction got stronger, as they will when you no longer have that cushion, she was begging for an epidural when she previously wanted no medicine for pain at all. A whopping four days after checking into the hospital for "induction of labor" with what she hoped would be no help at all, she was rolling back to the OR for a C-section. Maybe it is karma for people that try and control everything?

More to come on this subject as I develop my theories.

Friday, September 21, 2007

Tips for expectant dads.

Here are some things to consider when you accompany the soon-to-be mother of your child to the hospital.

1) Proper attire. Please consider what you are going to wear. Being showered and wearing clean clothes hardly counts if you show up wearing a MILF shirt or a T advertising your favorite strip club.

2) There is a proper amount of attentiveness. Hovering over your significant other and doing a full inquisition of every whimper is just as bad as ignoring her completely.

3) No matter how unplanned the pregnancy was, while she is pushing is not the time to start discussing a better form of birth control.

4) There is no need to video tape all 14 hours of labor. Wait until the pushing starts and unless you have prior approval, avoid the crotch shots.

5) You are not completely helpless. If the mom-to-be starts puking, get her a trash can. Don't casually wander off to get help as she continues to cover herself in vomit.

Most importantly, remember that you are not the star of this show. You may see your woman viler than ever before. She will return to normal, most of the time.

Thursday, September 20, 2007

Are there 10 fingers and 10 toes?

Sometimes you just need a good poker face. For example, today, my patient's baby had not one extra digit but four. Two extra fingers and two extra toes. One of these was a good sturdy finger but the others were fairly repulsive, dangling from long fleshy strings. While overall, this is a fairly common issue, this particular case about did me in. I think I have issues with body parts where there shouldn't be body parts. It was about all I could do to not contort my face into a horrified expression before mom even got to lay eyes on her baby girl.

If you are worried about this child being relentlessly teased once she is old enough to go to school, in most cases, a surgeon will place a suture around the extra finger or toe and it will fall off on its own. If it is a nice fat one, minor surgery is required. In most cases, the kid will never even know that they were once called twinkle twelve toes, unless mom is mean and took lots of pictures to pull out on prom night.

Wednesday, September 19, 2007

You've got mail.

As some of you may know, I took a direct hit of amniotic fluid to the eye last week. I got to spend over 2 hours in the emergency room having labs drawn (but mostly waiting) and the poor lady had to get stuck again for labs as well. I wish I had heard how the scenario was explained to her.

"Excuse me. Congratulations on the baby but we need to check and see if you have HIV since your nurse got your vag juice in her eye."

Luckily, according to my detailed lab results that arrived in the mail today, all is well.

Is something wrong with my baby?

If something were wrong with your baby, I wouldn't be calmly standing here smiling at you. Really.

Tuesday, September 18, 2007

I need to put a catheter in your bladder.

With every epidural comes a catheter, due to the new inability to feel the urge to pee. Those of us who are nice (and I am) wait a little while for you to start to go numb before inserting the catheter. Sometimes, a full bladder can keep the epidural from taking full effect and the only way to ensure you a wonderful epidural is to go ahead and get that catheter in in a timely manner.

If this happens to you, it will be OK. Having a baby isn't a cake walk, something I assume most people know from before the time they realize they are expecting their bundle of joy. Having a catheter placed is going to be the least of your problems. To ensure that we don't have to use 2-3 catheters, and to keep the procedure time down to less than an hour it would help if:

1) You do not jump 3 feet every time I touch you. I will tell you what I am about to do. Coming off the bed doesn't help.

2) Please don't scream that I am stabbing you. I'm not, I promise.

3) Please don't have a panic attack. Breaking sterility to get you an inhaler will only delay the inevitable and leave me seriously questioning your ability to get through the rest of your labor.

With these handy tips in mind, you catheter insertion should be smooth, quick and easy.

Monday, September 17, 2007

Chew on this.

Two women go in to the labor on the same day and show up at the same hospital. One is a happily married woman (or so she thinks), the other is her sister-in-law. A happy occasion for all involved you would think. The problem? Both babies have the same dad. So, how does this work?

One woman gets pregnant. Her husband then also gets his brother's wife pregnant at about the same time?

Two women, who happen to be sisters-in-law, cheat on their husbands with the same pool boy?

A woman gets pregnant and her husband also gets her sister-in-law, his sister pregnant? (I hope not).

A man's sister is married to another woman. He donates sperm to his sister's wife to help them conceive and at the same time gets his own wife pregnant?

I have no clue what the real answer was. Sometimes it's best not to ask too many questions.