Yesterday was the best day so far this rotation. Coming upstairs for rounds in the morning, I loitered around the L&D desk long enough to hear a nurse saying one patient was complete, and the doctor arguing that that wasn’t possible so soon. So all during morning report I was watching the interns, and half an hour later a resident and the attending were paged out in a hurry. None of us four girls were assigned for the morning, because we had lecture all morning, so we just sat there, till the other attending said, “Well, somebody go!” So I jumped up faster than the others and ran out, and caught up to the two doctors. When we got to the room the resident hastily put on a gown and gloves. I did too, but not too fast, because it didn’t look to me like the patient was crowning, and anyhow I didn’t expect to participate. Then the attending said, “Come on, Alice, hurry up and you can catch it!” Well, by then it was too late; the resident delivered the baby, and I did the placenta. But it was still good.

After lecture, in the afternoon, I came upstairs to find 1) one lady at term almost complete 2) a lady I had met in the clinic the day before, postterm, sent up for induction, who’d been in slow labor for nearly 24 hours (to the disgust of the attending, who wanted to know what the residents thought they were doing, to let her keep going so long) and 3) around 3pm, a woman who came in complaining of bleeding and cramping that morning; she was about 36 weeks along. So the other girl and I discussed it, and when the residents came back from lunch I announced, “The plan for this afternoon is that I deliver the lady from the clinic, and C—- does the one who’s already complete.” They laughed and said all right. But it turns out the other student wasn’t as excited about actually delivering the baby as I was. So when the first lady was ready to go, I got to gown up and try to help. It took her a long time, pushing. She just had a very small opening for the baby’s head. The intern showed me where to put my hands, and how to help pull on the baby’s head. It was right there; you could see the hair, and feel the bones, but she wasn’t getting anywhere. The attending was standing in the back, making comments like, “I’m not saying to do an episiotomy; it’s completely up to your judgment. . . But if I was going to do an episi, I would do it already, and I would put it right there. . . ” After half an hour of no progress, and several comments like that, the intern went ahead and cut the perineum a little bit, and baby came out with just a little tugging on the shoulders. But as it was getting complicated I took my hands out and let the intern do it. I’ll try again next time. I was amazed by that girl, though. She looked fairly mature, and she wasn’t panicking at all, even with all the tension, and taking so long. She would follow our instructions completely, and didn’t complain at all. She was only 17, and I took her for at least 25. She might make a good mother.

Next thing, several patients arrived in triage. A nurse dashed up to the intern and reported, “This lady and her partner came in, she says her due date is in one week and she ruptured this morning, and has been having regular contractions; no prenatal care.” The intern needed to finish some paperwork, so she sent me to get started on the history, as it seemed to be needed in a hurry. I went in with the nurse to check for fetal heart tones. She looked around with the monitor-belt, and didn’t get anything. All this while the man and woman were describing how excited they were that the baby was coming, and how they enjoyed feeling it move. The nurse got the Doppler, and listened, and didn’t find anything. The parents didn’t notice our looks. As the nurse was checking, I began to think her stomach looked pretty flat for a 39wk pregnancy.

The nurse went out to the intern and said, “I don’t think this lady is even pregnant.” They got her urine sample, and did a pregnancy test, and it was negative. So here’s this patient, in triage, drove a good 45 minutes to get here, expecting to have a baby – and she’s not even pregnant. How on earth do you announce that? We were just considering getting the ultrasound machine, to visually demonstrate to them, no baby, when we got called to do the Csection on the lady who’d been in labor for nearly 24 hours. So I didn’t hear the end of that story.

We went to the OR and did the section, and I again got to deliver the placenta, and clean out the uterus, which was bicornuate. I felt guilty towards the other student, because here I’d got three deliveries in one day, and she had to stay around till 7pm to see the Csection on the lady with bleeding (who did turn out to have a placental abruption, but the baby was still ok).

This morning I checked on the Csection patient. It was so much fun. She was cradling the baby, and her partner (?husband) was standing there with a proud look on his face, taking video of everything that happened in the room. She was awake and cheerful, talking about the baby at the slightest opportunity. She’s almost 30, and it was her first baby to survive, so they were very excited. I imagine that’s what private practice must be like, pleasant, responsible patients who are happy with the baby and happy with the doctor. Not like some of these people, who come in at 29 weeks, with no prenatal care, threatening to sue everyone in sight if something bad happens to the baby. (Not, by the way, that I actually believe in a lot of prenatal care, unless you have risk factors, as most of the patients here do; but if you’ve already had three babies die, it doesn’t make sense not to see a doctor . . )

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