Tuesday, January 09, 2007

First call night

My first call night ever is over. This week I am on the gyn service, so the morning was spent in the OR—I saw two mesh repairs of prolapse causing stress incontinence. I couldn’t see a lot as I was standing outside the field of vision holding retractors for much of the time. It was interesting, but I think I am definitely more drawn to abdominal type surgeries. The doctor was very patient which was nice. The intern made a mistake in the procedure that wouldn’t have harmed the patient, but could have resulted in having to start the procedure all over again (though in the end that wasn’t necessary thankfully) and the doctor was totally calm about it as opposed to hitting the ceiling which unfortunately many surgeons would have done.

In the afternoon I went to clinic, where my presence was totally unncecessary as there were already many students there. I saw one patient who was spanish speaking. I was actually able to communicate fairly easily which surprised me as it’s been a long time since I studied spanish. After clinic I went to L&D with the other on-call student, and everyone else went home.

Nothing much happened at first, so I went to write post-op notes on the two patients whose surgeries I had seen, as well as one of the other student’s patients. The only issue was that one of the patients had low blood pressure and wasn’t making much urine. One odd thing about this hospital is it seems like the nurses think students are doctors—they would give me reports on my patients and ask me questions that they actually expected me to have an answer for. One even asked me if I was a resident even though I was clearly wearing a very short white coat—I guess it must be because this is not an academic hospital, but there are still loads of students here year round.

On L&D students are expected to write update notes on patients every 2-4 hours depending on how active the patient’s labor is. We also do history and physicals on all new patients coming in. Around eight I was sitting writing out an H&P when a resident when running by. As we were told to chase after any resident we see running, I followed—I got into the patient’s room (apparently she had just gotten up there two minutes before), and almost as soon as I walked in a baby just popped out. I didn’t realize deliveries could be that fast. Later in the evening, I went in to check up on a patient and the nurse in the room told me she was about to deliver, so I stayed and gowned up when the intern came in—this time I actually got to see the whole delivery. It looked like something from a science fiction movie. At first, one could just see a bit of hair, then a face slowly emerged—very bizarre looking.

Later, I did an H&P on a woman at 28 weeks who had an incompetent cervix—she had had five pregnancies before and all were miscarried. The baby was a breech presentation (feet first), so the doctor decided to do a C section. By far the bloodiest operation I have ever seen—it was crazy. The intern made the incision, opened the uterus, then suddenly the attending was pulling out this tiny little baby.

Around 1:00 I had a half hour before my next note so I layed down in the call room, got up to write more notes, then went back to sleep for forty minutes (the pain of having to get up almost makes it not worth the sleep), then got up to write more notes, but on my way I got a page saying one of my patients (who I thought was hours away from delivering) was giving birth. Again, the baby popped out almost as soon as I walked into the room—unfortunate, because this patient didn’t have a private doctor so I probably would have been allowed to do most of the delivery—oh well, I don’t think there’s going to be any shortage of deliveries in the next five weeks.

I went back to the call room at about four, but I do not have the skill (yet) of getting up and going to sleep multiple times a night—once I’m up, it’s really hard for me to go back to sleep—plus I was planning on going back to the floor at five, and I don’t trust myself to wake up, so I watched TV (slim pickings at four in the morning let me tell you) since I hadn’t brought a book to read aside from study materials (rookie mistake that I won’t repeat—studying after midnight=fifteen minutes per sentence). At five I went to round on my patients, though I just got vitals and wrote skeleton notes at first because I feel bad waking people up before 5:30. My two surgical patients were both already awake and doing well, so I took out the packing the surgeon had put in, and they should go home today. Then I went to see the C-section patient and one of the deliveries I had seen, both were doing well. The vaginal delivery should go home tomorrow, the C section in a couple days. Then at 7:30 I got to go home—I tried to get a cheeseburger on the way home since I was starving and craving meat, but the barbarians at the fast food restaurants only serve breakfast at that time, so I had to have egg rolls at home. Then I slept until about 3:30. Tomorrow I’ll go back at 5:30.


Anonymous HV said...

Wow! Sounds like an exciting night!

10:14 PM  

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