OB-RAMA part II: Noon - 5am

My last post got a little long on the details of fetal heart tones without actually saying much. This account of the rest of last Thursday (and Friday) will be mercifully thrifty...you hope. After delivering one vacuumed baby on Thursday, I found myself with a dilemma. I'm supposed to be on a General Surgery rotation this month, but my OB patient was a priority and I missed the morning. Missing the 5-7am portion of the GenSurg day is like missing most of anybody else's day--the rounding and planning all happens then so the surgeons can get to the OR and do what they do. I'd missed rounds and a considerable amount of loitering, but there was a noon morbidity & mortality conference beginning just as a wrapped up my post-delivery work. I like the way surgeons do M&M, and lunch was provided, so I went.

Maybe a mistake, looking back.

I discovered that I was to be "paired" with one of the interns who is also a medical school acquaintance of mine. Let's call her Tatum, which happens to be her name. I wasn't thrilled about being teamed up with Tatum, or with the idea of "shadowing" an intern at all. I've been an intern, completed my internship, and enjoy the rhythm and responsibility of my second year much more. Interns have crappy hours and few choices. Surgery interns have horrendous hours and buckets of scut packaged in an oppressive hierarchy. It's not my world. I'm okay visiting for a bit, but not so much with Tatum as my guide. But what can you do?

I got a brief explanation of the team structure from Tatum and an offer to go to the OR to scrub for a case. I declined, thinking I'd rather spend time learning about the patients on service. I'm also just not that interested in hanging out in the OR holding retractors. Instead, I familiarized myself with the in-house patients, returned to my postpartum mom & babe duo, and did some paperwork. Tatum and I had divided up her patients among us for the morning--I was to see half of them (about six) before 7am.

At about 4:30pm Brooke called to see if I could pick up Zoë from daycare on my way home. I said yes and made one last call to clinic to check in. Our nurse there told me that another of my pregnant patients was having contractions and was on her way in. It doesn't take long to assess whether a woman in active labor and needs to be admitted, so I walked up to OB Triage to wait for her. Annabella (not her name, but the surgery intern is definitely named Tatum for real) arrived a few minutes before 5pm. She was still shy of getting a room by my evaluation, but I thought she would be in active labor after a couple of hours of walking, so I sent her out and picked up Zoë as planned, knowing I'd be back shortly.

My colleague Sharon examined Annabella when she returned, determined she was "active" and got her a room. I was back before 8pm, and based on my exam, I calculated that she might deliver at about 2am. I'd be there until 3am, at least, and had clinic the following afternoon, which I don't like to cancel. Based on that, I figured I should do something about the morning (rounds and retractor holding), which might be my only chance to sleep, keeping in mind that at 7am I'd be over my duty hours for patient care, with at least ten hours of care still scheduled.

As an R2, I have a variety of responsibilities and frequently have to prioritize them in unfortunate ways. Occasionally clinic gets canceled due to a delivery. Everything can get canceled if I'm "goated" to fill in for a colleague who is unable to work. In this case, I was looking at three responsibilities, a duty hour conflict, and no sleep for nearly 40 hours. It didn't take long to figure out that if something was going to go, it would be "shadowing" a surgery intern for the morning and doing half her scut. Even if it were an intern I wanted to hang out with, I'd have made the same choice.

Here's what I did. I paged Tatum at home to let her know that I'd be up all night with a delivery and wasn't planning to see her patients in the morning--apologies. No skin off her nose, I figured: she'd be rounding on those patients if I weren't "shadowing." Shortly after I sent my text page, Tatum paged me back with a number. I called, and spent the next fifteen minutes listening to poor Tatum go on about my priorities and my work ethic, asking me what I intended to get out of my GenSurg rotation and grilling me on where I'd been all day.

Was she fucking kidding?

She wasn't. I'm not one to pull rank on anyone, it's not really what my people do (my people are family doctors, not surgeons). But holy shit! I couldn't believe this intern was giving me the third degree about my work ethic. I was at work. She was home eating pudding pops for all I know. After several minutes of actually indulging her line of questioning, I stopped and said, "Tatum, why are you giving me a hard time about this? Have I created some new work for you?" No! She's frickin' lazy and was pissed that she wouldn't have me around to do half her work for her. Argh.

That got me pretty riled, and I stayed that way for a while. I got it together for the delivery, though, which didn't happen until after 3am. Like the delivery the morning prior, it required a vacuum, but unlike that one, I figured out the vacuum myself. One pop-off and then a smooth delivery on vacuum attempt #2. Minimal tearing. Healthy mom and a healthy baby: that's pretty much my whole job.

I was done with the post-partum paperwork at 4am, and was on my way home when I decided that I would make one gesture to Tatum and anyone else on the surgery team that would call me weak and lazy for cutting out on a morning of doing someone else's busywork. I rounded on the damn patients from 4-5am, wrote notes, and sent Tatum a dawn page letting her know I'd done some of her work and that she should not ever put us through such an annoying conversation again.

That was 5am, which brings me to the end of the story, basically. The rest is pretty boring. I slept some, rounded on my moms and babes in the hospital, and spent the afternoon in clinic. It's now Saturday night and I'm off until Monday, when I'm back on the General Surgery team and will either face a hostile crowd (for being lazy & weak)...or no one will have noticed my absence.