Yesterday evening I carted my phone and beeper all over with me, in case – surprisingly – anyone should actually want me. Nothing happened.

I went to bed, and set them on ring, not buzz, to be sure I would hear them. Fifteen minutes after I lay down, the phone went off. I jumped – catapulted – out of bed. Triumphant – I actually do wake up for phones! Disappointed – I was hoping for more than fifteen minutes before the night’s events began. Excited – a baby must be coming!

It was one of the third year students, who thought bed-time would be a good time to call and chat. (I suppose it’s only bed-time if you’re planning to wake up by 5am. She ought to have been in bed herself; I’m sure she’ll realize that within a week.) She’s starting on surgery, and her chief spent the day in the OR, with the case going twice as long as it ought to have, and one attending after another joining in. The nurses shooed the students away, and warned them not to talk to him for at least 24 hours. So, since that was my last service, I advised her what the chief no doubt would have told her to do for the next day, if he hadn’t been distracted. That’s a bad way to start; but he must be feeling awful; he’s a good surgeon, and to have a case get that complicated. . .

This morning I came in to the hospital, confident that I had only three patients to see. What’s this, a new one on the list, in the midwives’ unit? I ran over to see. She had just come in an hour before, and the nurse had only just decided she was for real, and was starting to call people. I ran to see the other patients, and of course had to recheck every lab twice, and every vital sign, and look at the old notes three times, because I was so excited I couldn’t think straight.

The delivery was so different in the midwives’ unit. There were three nurses in the room, continuously. Fetal monitoring was done with a doppler, every few minutes. The mother was walking around until she was pretty far along, and then stood leaning on her husband for a while. He was very supportive and involved. When she was about ready, the midwife did get out a plastic drape, to stick under her on the bed, and we did put on sterile gloves. But no gowns (so of course I got stuff on my scrubs :), and no one really cared what touched the sterile blue or not. It was a little shocking, after I’ve tried so hard to acquire the inhibitions needed to survive in the OR; but also liberating in a way. My main impression was, how brave the mother was. She was screaming and yelling, and at one point saying she was never going to do this again, but she kept going, even towards the end giving her own pep speeches, and got the baby out. The midwife and I were both sitting/crouching up on the bed, and she was letting me do the delivery, but again I didn’t really manage to do much. Partly because I wasn’t confident that I completely remembered what the steps were, and partly because I always feel so shocked – look, there’s a head, how did that get there – that I forget to pull on it, and partly because it felt so safe, on the bed – there wasn’t really anywhere for the baby to go to! As soon as it was out, they grabbed it and handed it to the mother, and she was laughing and crying. She held it while one of the nurses dried it off a little, and I clamped and cut the cord while she was holding it. It was five minutes before she calmed down enough to look to see that it was a girl. So after awhile I helped deliver the placenta. She had a laceration, and the midwife let me sew it. I discovered that it’s much easier to sew neatly on a flat, intentional abdominal incision, than on a perineal laceration that looks almost 4-D, there are so many planes involved.

By the time I got done, it was halfway through grand rounds. I went and sat on the floor in the back, which was a very convenient place to fall asleep, since the speaker was talking in a preacher’s rapt tone of voice about the HPV vaccine. It was funny; he sounded so rich, and solemn, and enthusiastic, and reverent, it was exactly like a sermon. Of course he was paid by Merck.

In the afternoon I came back from the office to the hospital to do a circumcision for one of our patients. Having noted some of the recent internet controversy has not changed my beliefs on the subject, but it did add into the baby’s screaming to distract me even more. In addition, the attending likes one set of equipment, which I had not used before, and find extremely difficult and cumbersome. We finished eventually, without damaging anyone.