Blame It on the Weather

This is what is looked like on my way to work yesterday morning...  This is what it looked like mid afternoon from one of the hospital windows... And, this is what it looked like coming home this morning....

It was a, gasp, quiet 24 hour call yesterday.  I got up a little earlier because it had started snowing pretty much from the time I got home on Friday morning.  By that evening, the plows were rolling in full force.  When I got up Saturday morning, I just put the Jeep in 4-wheel drive and drove over the piles of snow in our driveway.  None of the streets were plowed, but my colleagues and I were amazed at the number of people driving at 6 in the morning. 

After seeing my patients, including the two new moms I delivered yesterday, we presented ourselves down to L&D at just past 8 in the morning.... and proceeded to wait.  There were six patients on the board at that time.  Three were actually inductions from the night before, and the three others were "pre-termers" (gestational age less than 36 weeks) who had been evaluated for various things and were waiting for a bed upstairs.  (I should explain that L&D is on the 3rd floor and the Mother - Infant ward is on the 6th floor.  High risk is on the 5th.)

The first year intern offered me my choice of patients, and I randomly picked the one in 307.  She picked up the other 2, and I offered to take the next admission.  And, so we waited...

And waited...

And waited...

Around noon, a patient I had seen on Thursday night who was already 41 weeks came in.  I had sent her home because she wasn't in labor, and she had been very upset that I was sending her home.  She just wanted to have the baby and get it over with.  But, now she was happy, well, as happy as she could be having contractions every 10 minutes.

We put her in a room, and I checked her out with the first year (I am still not confident in my cervical exam), and when I went to check the patient, she was prattling on about how she was going to get her epidural, and have the baby, etc.  The OB intern later told me she saw the look on my face as I examined the patient and internally went, "Oh Crap."

I didn't feel anything that felt like cervix, and what I did feel was bony and firm... kinda like a baby's head.  I stepped back and said, "I think she's fully dilated and engaged in the birth canal."  The OB intern felt and quickly stepped back and said, "We've got to get her to a room, like now."  We called for the nurse, got the patient packed in a wheelchair and rolled her into a room. 

The patient was excited about having the baby.  However, this soon changed when we told her that because she was so far dilated, she could no longer have an epidural.  Then the patient's personality underwent a Dr. Jeckell/Hyde transformation.  I won't go into the details of the birth, but let me just say that by the end of the ordeal (about an hour later) everyone in the room had been cursed out in two languages.

She had a lovely baby boy, and once the delivery was over and some IV pain relief was able to be given, the personality switched again, and she was in love with life, her husband (who 30 minutes earlier had been denounced to the nth degree), and especially her new son.  Wild.

Anyway, I had delivered one, my other patient from the morning was moved to another room and had begun to have stronger contractions, and the interns other three patients were trudging along.  So we waited.  I missed lunch and it was around 3 in the afternoon, so we gave the medical students a mission to find anyone who was delivering despite the weather and get a menu and collect orders.

About an hour later, my other patient began to have stronger contractions and it was time to deliver her.  I got a chance to work with one of the private attendings,and she helped me deliver the baby right on the bed.  No stirrups, no worrying about dropping the baby, everything happened right on the bed.  This time it was a beautiful baby girl.  Her older sister ran out of the room at about the time we set up for the delivery, but she soon came back to see her new little sister.

One of the best parts of the process, while we were repairing a slight tear from the birth, was the father walking around the room talking to his new daughter, LM.  He was telling her that she couldn't have anything pierced until the age of 12, that she couldn't have a cell phone until she was in high school, no television in the bedroom, and as for dating, well, they would cross that bridge when they came to it.  It seemed like a very nice family, and they were going to take the placenta home and plant it in the back yard with a tree.  Interesting.

I came out of that room to find the nurses clamoring for dinner.  I didn't know why they seemed so agitated, but soon found out it was because everyone was waiting for me to finish the delivery.  I quickly made my choices, and we ordered dinner.  And, so we waited.

During my two deliveries, one of the intern's patients was sent home to see if she would begin to have contractions at some point, and her other patient continued to sit and wait.  So she sat and waited too.  Dinner came just after 6, we all ate, and then we waited some more.

You might wonder what medical staff does during that down time... or maybe not, but I am still going to tell you... everyone saw my wedding photos, we looked at one of the nurse's photos from her trip to Africa, we teased the senior resident about his relationship with a nurse from another hospital, we talked about the EM residents, we talked about the OB residents, we exchanged horror stories and war stories about the stupid consults we're sometimes called to see.  We learned how to curse in Russian and taught the Russian resident a few choice phrases in English.

Somewhere around 9 p.m., the intern's patient started attempting to push, and there was a small burst of excitement.  Half an hour later there was little progress, but some other excitement as a patient was being transferred from BGH ED "broken waters and fully dilated."  She was only 31 weeks, so about 2 months premature. 

Suddenly everyone mobilized.  The OR team was called,the Neonatologist service was called, anesthesia was called, and the attending was called up to the floor.  When the patient arrived, she was met by about 12 eager people who examined her from every angle, obtained her history, filled out the forms, and after a second exam showed she wasn't as dilated as previously thought, heart rates slowed down, and we prepared to go to the OR.  I didn't scrub in, but I did get a chance to come in and watch the C-section.  She'd had 3 prior C-sections, so there was no question that she'd be getting another one.

A small, but very healthy baby boy was delivered.  He cried continuously until he was wrapped burrito-style and handed off to his father.  They checked on him every 5 minutes or so and kept him in the OR until just about the end of the C-section. 

We got out of the OR around 11 p.m., and it seemed like the C-section brought the patients in with her from the cold as suddenly there were 3 patients waiting to be seen and evaluated, there was a consult in the Emergency Room, and one of patients who was still waiting for a bed upstairs suddenly developed a fever and abdominal pain.

And, the intern's original patient from the morning...?  She was still pushing.  The patients that arrived were all less than 35 weeks, so I couldn't evaluate them.  I don't see consults in the E.D.  So, I went to bed.  It was around 11:30 p.m. but I ended up staying up until around 1 a.m. talking to a friend on the phone.

We lost an hour off our 24 hour call with the time change, but it was no fun waking up at old 5:30 in the morning which was now 6:30 in the morning.

I rounded on my two patients from yesterday.  I heard that the other intern's patient had delivered finally at a minute before midnight, and that it had not been a good delivery, but missed the details.  We had new medical students as they were transitioning over from the first half of their rotation.  It was a quick rush to have all patients seen by 8 in the morning, then sign-out and back out into the real world. 

It was such a glorious morning.  Quiet except for the sound of early morning snowblowers.  The streets weren't plowed, and there were few cars on the road.  I don't know if I've mentioned that morning is my favorite time of day.  Full of hope, full of promise, full of possibilities... A great day to be born and livein.
Baby Counter:
Births witnessed:  5
Babies delivered:  5
C-sections witnessed:  1

Tags: cesarean section, vacuum suction birth, blizzard, PROM