Thursday, February 08, 2007

Call, call, call

Last night I was on call again—one more call night to go. In the afternoon I was in clinic. The most interesting (and saddest) case was a 30 year old woman with seven children (from four or five different fathers) who had an abortion in December with her eighth pregnancy. Ever since she has had cramping, and she never passed blood or tissue. She was diagnosed with an incomplete abortion, meaning that the fetus is dead but still in her uterus. She will get an ultrasound today or tomorrow and likely will have a D&C done to remove the dead fetal tissue. She had no suspicions coming in that she had retained the fetus, and was interested in birth control—but she wanted us to be sure to do a pregnancy test first because she thought it was fairly likely she was pregnant again.

In the evening, I was in on one delivery with a family practice resident and attending. The patient pushed for about 45 minutes without anything happening, and the resident failed in two attempts to attach a scalp electrode to the baby to monitor its heart rate. I do not have anywhere near enough experience to know if they were doing something wrong, but it was definitely not going smoothly. The two nurses (L&D nurses tend to be very good at what they do) were very calm, but were clearly getting very antsy. Finally, they started making very neutral comments asking the attending if he wanted an OB doctor to come in, and at one point telling him straight out that he needed to make a decision (over whether to do a C-section). One of the nurses quietly stepped out and came back in, a minute later the attending told her to call the OB doctor and she told him that she already had. Naturally, at this point the baby decided it wanted out and three minutes later it was delivered. When I left the room the other medical student on call told me that all the nurses in the workroom had been freaking out.

At ten a woman came into the ER with left lower quadrant pain, an ultrasound showed that she had a dermoid cyst (aka teratoma, a benign tumor that contains many types of tissue, sometimes even teeth and hair) on her left ovary with possible torsion. She went to the OR, we found a massive tumor (and torsion) and removed her ovary. I got the honors of cutting it open, it was quite possible the most disgusting thing I’ve seen in medical school. There were no teeth, but there was a lot of sickly yellow goo.

Right afterwards, another lady came into the ER with vaginal bleeding. She was diagnosed with a miscarriage. When we were done seeing her, I went back to L&D just in time to make it to a delivery. It was one of the resident clinic patients, usually the student gets to catch the baby—something I’ve not yet done. When we got there the intern took over and I didn’t touch it. She spent the rest of the night apologizing for stealing the delivery.

After that, I slept from 1:15 to 4:45, and was home by 8:00. Unfortunately I will be on call again on Saturday, which is by far the worst day to be on call.


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