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.