The night on after the day off

Last post found me winding up an indulgent day away from work. I did go in to the teen homeless clinic at 45th Street last night, which was fun, as always. Got home about 10pm, lolled about and went to bed at around 11pm. At 2am precisely, Brooke informed me that my pager was beeping. I'm either numb to the sound by now or didn't have it set to an sufficiently annoying tone (like "explode").

It was OB triage calling to say that my 40-week pregnant patient was in active labor and I should come in...now, please. This is her third baby, so she was likely to move along pretty quickly. I grabbed scrubs, brushed my teeth, and ran out the door, Brooke wishing me good luck as I ran downstairs. It is maybe five minutes from home to hospital at two in the morning, and I decided that I could speed without penalty, able for the first time ever to pull out the line "sorry officer, I'm on my way to a delivery." Surely that works, no? I didn't have to use it because there was not a cop to be found. I made it door to door in under five minutes. Sweet parking spot, too.

My patient was in heaps of pain and asking for an epidural block, which she got, and then was much happier. She even slept a little, I think. She was there with her ten-year-old daughter and ninety year old grandmother, both totally charming people. Her husband was out of the country for a month. A neighbor had driven the family in, and then gone home.

Long story short. She labored for about four hours after I arrived, and was completely dilated. I was beginning to worry that the baby was stuck at zero station (top of the head even with mom's ischial spines). We tried to have her push. No movement. We had her reposition: legs back, chin to chest, push. Bingo. I saw a bunch of black hair poking out. Since her daughter and grandmother were unlikely candidates for holding her legs while I caught the baby, we set up the stirrups and helped her legs into them. The very moment we got her set, it was clear that, with the spines out of the way, there was nothing that was going to stop this child from making an appearance. I hurried into my gown and gloves, not stopping to put on shoe covers or a mask. Good thing I didn't dally, because even before I could get a sterile drape under my patient, here came the baby. I held the baby's head in place with firm pressure until the nurses around me could get set up, then did a controlled delivery of a lovely eight pound baby boy: anterior shoulder, posterior shoulder, delivering the body while my left hand moved down his back and letting my hands hook into the legs as they appeared. I held the baby to watch for tone, color, and crying, and seeing all signs good, moved him up to his waiting mother. I clamped and cut the cord while the nurse suctioned his mouth and nose and dried him off. He looked pretty good, but the nurse moved him over to the wamer for more suctioning. I stayed with mom: took a sample of cord blood, checked for bleeding, and helped the placenta out. No bleeding, no complications. In all, a pretty good delivery.

As an FP, I now had two patients to care for instead of one. Mom was doing well, so I turned to the baby, who was now pink and vigorous, with a strong cry and great tone. My brief exam revealed nothing concerning, and we moved baby quickly back to mom to breastfeed.

Then came the paperwork, which is ubiquitous and detailed. I finished that, said goodbye for a bit to the sleepy family, had some breakfast, and drove home and went to sleep. The pager kept beeping, first to let me know that I was late for clinic (which I forgot to cancel, but did, then, on the phone). Back to sleep. Pager again. My paranoid schizophrenic diabetic hypertensive Hurricane Katrina survivor has missed her last three appointments with me and has run out of her medications. She needs her medications, and I feel like I should call them in for her, but I also need to see her in clinic to find out how she's really doing. Is she is going to psychotherapy? Smoking crack? Following her blood glucose levels? When did she run out of medications? Can she feel her feet? And I want labs from her, too. I'll have her come in ASAP, but I don't have any open appointments for a week and I'm double-booked for the next few days. I made room for my new mother and her baby next week. I should do the same for this at-risk patient in perpetual crisis.

I'm up again now, having been startled awake after two hours of sleep by the Blue Angels, rehearsing for this weekend's air show. I'll have some lunch, then go back in to the hospital for an afternoon conference and another visit with my newest, youngest patient and his family.

Looks like no running again today. Perhaps I'll do a sit-up.

A day off

Oddly, there was nothing on my schedule. Rather than complain, I filled the day with things I wanted to do. I got a massage. It was pretty good, but not great. Not painful enough. The experience is most worth it when it hurts...a lot. Like I'm getting the most pounds of pressure per square inch per dollar (PSI/$). Still, though, I can't complain, and I got a $10 discount for making a morning appointment, which increased the PSI/$, unexpectedly boosting my enjoyment of the experience, but only in retrospect.

I got my toes buffed. After my massage (and the ten buck savings) I decided that the calluses on my big toes needed to be addressed. Brooke told me about a nice little shop on 23rd with pedicure massage chairs, whirlpool foot baths, and sanitary conditions (apparently there are standards for this sort of thing). The Thai women running the shop thought it was pretty funny that I wanted a pedicure, but they had me come right in and did a fine job and were very friendly. The woman responsible for trimming my calluses was named Lisa, as was the woman working alongside her. Easy enough: I know who to ask for when I return (and I will).

I took Yagi to the dog park. Lisa is still out of town on her honeymoon, which I only discovered when I pulled July off the wall, exposing August and another week of "No Lisa" marked in heavy black ink. Whoops. That seemed to mean that poor Yagi didn't get a chance to crap yesterday. He seemed awfully serene for one having missed his constitutional. I took him up do Blue Dog, which still has puddles on the ground despite record-breaking warm weather and only 0.06 inches of rain in July. Another fellow at the park today speculated that the water is coming from filling and emptying the small dog pool at the north end of the park, but there's just no way. The water covers a huge swath of earth. I think it has something to do with the water table (the park is in a big hole used for winter rain runoff; trips there in January are miserable), but with that statement I am immediately out of my depth.

I went to physical therapy for my aching low back, which is actually much better now that I'm doing the exercises Laura suggested. The trouble is that since nothing really hurts now, it's hard to compare one day to the next. On a scale from 1 to 10 (ten being the worst pain), I suppose I was around six just before I started PT. Very quickly the pain has gone to around 3 to 1 to sometimes absent. So it is with two years of episodic pain. Core strength improves it, running downhill and holding Zoe for a long time make it worse. So now I'm really picking nits when Laura asks how the pain is. "Hard to say. Maybe 0.7? I dunno." Something is odd about all this, though. I'm definitely out of balance. I can't rotate far to the right or bend much to the left. I do rotate my hips (inappropriately, I'm told) when doing exercises. I'm asymmetric, and this appears to be at the root of my episodic pain. It may have something to do with falling--jumping--off a wall about twelve years ago, an incident that had me bedridden for two days, then just fine for ten years. Who knows? The good news is that I'm feeling better.

I picked up my new clip-on sunglasses. Perry will be happy to read that I've retired the glasses I wore in Mexico last winter, the ones that made me look "like a cabana boy," he said. I like the cabana boy look. My new pair are identical to the ones I lost last year at the arboretum. I had not heard that anyone found them unbecoming, so I feel safe wearing them in photos. The woman who fitted them to my glasses is named Mildred. She's a very jolly fortysomething woman with a ninetysomething name. Mildred. I'll save name discussions for later editions.

I did not exercise.

I did eat a lot of fruit. And a tofu dog--disappointing.

I do now, this minute, have to dash off to an evening homeless teen clinic in Wallingford. I'll be casually late. It is a day off, after all.