Last Night of Ob Call~~~the Most fun Call Night Ever.

Sat. was my last Ob call night for the rest the rotation. It was the best call night I have had the entire rotation. Oh Let me count the ways:

1. My senior and junior resident let me stay in the call room after morning report finished & rounding finished at 10am until pretty much 7:30pm!! This left me ample time to surf the internet and finish so some uncompleted reading. Although it was a lot of time, I never could really settle down and read with concentration b/c I felt like at some point there were going to page me soon like previous call nights where I only sat in the room for 1 or 2hr. Why did I get called back at 7:30 ~~~ have you guys heard of NIGHT ROUNDS~~~ well only with a certain Dr. here we do morning and night rounds. We review our pts that we have on L&D [labor and delivery] and those on the floor recovering after delivery, then we go by and visit them. After night rounding we sat around while the attending with nothing better to do than to begin pimping. Pimping was actually fun, b/c he made it very educational and unintimidating.

2. Both residents let me stay in my room and said not to sweat the small stuff, and if there was a delivery they would let me primary deliverer. Awesome huh, other times I followed the intern around doing orders and reading them over her shoulder.

3. I found Bomb-sticks at the hospital cafeteria!!~~ I realize I only like the banana part and I scraped the chocolate away. I haven't had one since College ~3 yrs ago.

So after a slow start, all the sudden BAM !! everyone decides to do a drive-by the L&D. First a 13yo who is about 36/40 wks pregnant. Whose mother just recently found out that she was pregnant at 7mo [28wks], came in for early contractions and pain. She was going into the 8th grade mind you.

Second, 21yo deaf pt 21 wks GA [gestational age] comes in for abdominal pain and UTI.

Third, a 23 yo G3P1011 at 39 wks for suprapubic pain and contractions after intercourse. So what is the mechanism of intercourse and contractions? Well sperm carries prostaglandins and intercourse causes deposition of prostaglandins around the cervix and causes uterine contractions like actually giving pitocin. So we frequently see pts come in after intercourse with CC of Vaginal bleeding. We went ahead and did a C-section on her but Oh no her:
Hgb: 7.o
HCT: 29
Platelets 33K
She was at sever risk of bleeding and she had suprapubic pain right over her previous uterine scar~~ Risk of rupture high!!! So C-section was a must even though she may be a bleeder
The plan:
1. give her general anesthesia. No epidural in fear of bleeding complications of hematoma
2. Do the C/s in a max of 20 mins and the get the baby out quick~ b/c if mom is not breathing under gen. anesthesia neither is baby.
3. Minimize bleeding as much as possible by cauterizing everything us see bloody.

Plan in action
1. Total C/s time 1hr 30mins.
2. Everyone is double gloved~ a specific requirment by on Dr. for all residents and students.
3. Incision is made, cutting is started,baby delivered pretty fast Oh maybe 15 mins into the action.
4. Confirmed~ uterus had a whole in it she was leaking amniotic fluid with meconium.
5. next 1hr and 15mins is spent A) removing 1st pair of gloves. B) attending being nit picky about how the Senior resident should suture and making extra sure he cauterizes every leaky BV.
Attending to Chief resident: not enough myometrium, ok too much myometrium, now be sure to get enough serosa, ok make sure its very tight... this went on for another hour.
6. Junior resident contaminates his gown by rubbing it against the attendings head--> he gets a new arm shield. --> Junior resident making faces at me b/c Dr. going into a 1hr procedure that normally takes 30mins from skin open to skin closure.
7. Finally she is sewed up and post op-lab shows lab mistake:
Hbg 10.1
HCT 36
Platelets 231 K !!!

We also take phone calls when pts call at night for the outpt clinic. So a pt calls cc of vaginal bleeding and contractions. Here is the phone call conv from what I could hear the junior resident over the phone:
R: So you are having contractions morning, afternoon, and at night.
R: Any bleeding, Leakage of fluids, and pain?
R: Have you been drinking enough water, or doing any vigorous activity, or have intercourse

PT: well now come to think of it: I had sex after breakfast, in the afternoon, and at night.

R: Uncontrolled Bursts of laughter while on the phone.
R: Please excuse me, I have a cough here. Handset is placed on the desk where he starts laughing some more.
R: Ok' I'm back I just have some allergies here.
R: Well now Ms. X maybe you should take a break from Sex tonight and tomorrow night.
R: If you have any more bleeding or its getting more painful let us know~~
End of conversation.

Basically we were all in the call room listening to his converation and everyone was laughing.

Fun night!!! Bye Bye Pregnant ladies.