I traded with another student to get the afternoon on labor delivery, so she could go home and prepare a speech, instead of me having only an hour or two in the morning before having to go to tumor board. Yesterday afternoon and evening just about snowed babies, six or seven altogether, and there were four in labor when I left this afternoon, but not a single delivery, not even a Csection, while I was there. Tsk tsk tsk. I am really hoping that, on call this Sunday, this big hospital cannot go 24 straight hours without at least one uninsured woman delivering a baby; but with my luck you never know.

The day was also frustrating because the residents, after a spell of warmth and friendliness, seemed difficult to connect with again. The chiefs returned to barely acknowledging my presence, and if I managed to see a patient with the junior ones it was purely through my burr-like tenacity, not that they invited me or taught me. I don’t know what to think. A second-year, arriving to spend the night, accepted the chief staring right through her, saying “I’m just a peon.” I seem to remember feeling that way last year; that I wouldn’t care how the residents acted, if I could just be there. But now, the residents are the ones teaching us. The lectures are useless, and the books only go so far; if the residents aren’t talking, we’re not learning. It’s very frustrating to see from the charts and the rapid conversations that there are complicated patients, and that careful decisions are being made, but no one will look at you long enough to explain anything. Maybe I shouldn’t expect so much when they’re so busy; but when am I going to learn, when there are no patients? Let’s see how well this sticks when I’m an intern, or a senior. Because I know in a corner of my mind that students are so useless, such annoying tag-alongs, so hopelessly uninformed, that I could quite easily become just such a resident. All I want is to be part of the team, of even the slightest use. This morning the intern, out of the goodness of her heart, I don’t know what possessed her, let me do a circumcision. I was floating on clouds for the rest of the morning. If anyone lets me cut anything, hold anything, hand them anything, I’m happy. I just don’t like being invisible.

After tumor board I grabbed lunch and decided to run check L&D in case anything was up, before eating. I accidentally caught a tail view of one of the chiefs hurrying down the hall towards the OR behind a bed being pushed by several staff. The lady was about 29 weeks, and had been induced yesterday for severe pre-eclampsia. She hadn’t been getting far till (as I discovered later) they broke her water at noon. After about three pushes she delivered the baby at 12:20. No one had time to prepare, except the resident got a gown on. Even the NICU people didn’t get there. One of the nurses grabbed the baby, without the usual sterile paper gown, and ran over to NICU. Fortunately the baby was well enough to wiggle around and cry a little bit when it got out, so it was OK. The mother bled for a while till they managed to get pitocin running. For the first time this month I felt faint; I’m telling myself it was lack of lunch, rather than the blood.

One of the patients this afternoon was a pleasant girl in her mid-twenties, first baby, engineer husband with his math books on the table in the room. He looked like a splendid responsible father (so unique on our service!), very curious, asking about the meaning of everything (maybe a defence mechanism for being unable to help his wife?). She was also being induced, around 35 weeks, for pre-eclampsia. She wasn’t having many contractions until another resident broke her water, whereupon she began to have very uncomfortable ones every other minutes. She asked for an epidural right away, but there was some hang-up about a coagulation panel not being available, so she spent a long time moaning and holding his hand. That’s the first time I’ve stayed in a room long enough to watch what it’s like for the mother all the time in between, when we’re not there making a commotion.

Let’s interject some politics. I’m vaguely aware that the Olympics are occurring; I see the last of the skating on the late-night repeats at 4am in the hospital. I understand there is some commotion in the Middle East, I’m not sure what it’s about this time. But I did read that South Dakota is passing a law forbidding all abortions, not even “to save the life of the mother;” the only proviso being that if the doctor is trying to help the mother and accidentally kills the baby it’s not prosecutable. I think that’s splendid. It is so hypocritical and false to say that there is any situation where the baby needs to be killed for the mother to survive. Ectopic pregnancies, you have to remove it so it doesn’t rupture and kill the mother; that’s not an “elective termination,” as we politely say now. Everything I’ve heard of so far where the mother is in danger – mostly severe pre-eclampsia – the danger doesn’t come till the end of the second trimester, in other words when the baby is at least on the edge of viability. So there you can deliver the baby, and if it doesn’t survive for long, well, you didn’t kill it. And I’m not saying you have to be aggressive, with intubation and everything; there’s a place for saying this one wasn’t meant to live. That’s not the same as crushing its skull, or injecting it with poison, or refusing to feed a viable Downs’ baby, as they do in Holland. I’ve heard of just a couple of cases so far where the pre-eclampsia was so bad at 21 or 22 weeks that the baby had to be delivered; but there’s still no reason there to kill the baby, instead of delivering it and letting it die on its own. Besides, almost invariably, in such cases the mother desperately wants the baby; the elective abortions are not “life-saving.” As for why South Dakota decided to pass such a draconian law, maybe they thought, with a good shot in front of the Supreme Court, they want to win as much as possible if they do win. This will be a good test case to see what Roberts and Alito are really made of.

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