Thank You, Easter Bunny, Bawk! Bawk!

 
So I was right.  The waning moon meant a "waning" in the amount of patients that we saw last night.  Given that it was also Easter Sunday, we figured most people would want to stay home.  As predicted, we had the overnight patients (all of 3) to deal with in the morning, and then no more patients until after dinner.  A, somewhat steady Easter Parade of sorts that kept us busy until around 1 in the morning.

My first delivery, and the only vaginal delivery of the day, was around 1600.  I delivered her with one of the private attendings who then allowed me to repair her episiotomy.  The first actual suturing I've done other than teaching the medical students on sponges all rotation.  I was almost so excited my hands were shaking... not really, even on a caffeine, double shot expresso, I haven't slept all night and now I have to do one more surgery, morning while in residency my hands didn't shake.  But, metaphorically, I really was that excited.

For the most part, we hung around and talked about some of the more bizarre and sad cases that had come in over the previous 24 hours.  When we signed out the morning before, Saturday, we had 2 patients on the board that we knew were delivering terminal fetuses.  One was a young mother that started to have contractions due to a premature rupture of membranes at 19 weeks.  There was nothing to do but expect to deliver a dead or soon to be dead fetus.  The second was a patient with a recent ultrasound showing a fetal anomaly called holoprosencephaly - essentially, the fetus had no brain development.  I think I wrote once before about a patient that was a "brainstem with a body."  In that case, the skull was developed, there was just nothing inside.  In the case of this baby, there was a very small, misshapen head with the classical features. Picture

Of course, that didn't include the 20 year old who delivered a Trisomy 21 or "Down's Syndrome" baby.  According to the attending, the baby was found to have some cardiac anomalies as well, and it's going to be a long hard road for that young family.  We were left with a woman who had also had an IUFD (intrauterine fetal demise) from a rupture of the placenta.  She came in bleeding profusely, and she was being prepared for the OR when we took sign-out at 8 in the morning.  She and another patient at 31 weeks were the other 2 patients to deliver Sunday morning.

So the rest of the time... kinda boring.  We had organized a pot-luck of sorts and spent a lot of time sneaking back to the staff lounge to eat ham, fruit salad, potato salad and all kinds of chocolate goodies throughout the day.  Then, as I said, around dinner time, the next round of patients started to arrive.

We always have patients who are "past dates" meaning they didn't deliver by their due date who come in to be induced.  So, there is almost always an admission or two in the evenings.  They get their drug of choice depending on exam or fetal status and then labor through the night with the plan being they most likely will deliver the next morning.  I admitted one patient like that.  I then had another who came in that had broken her waters and had some cervical changes, so she was admitted.

We had an assortment of outpatients (pregnant patients not in labor but having some medical issue or other) ranging from an MVC (motor vehicle collision), to nausea and vomiting, to diarrhea from drinking someone's bowel prep without knowing.  (A bowel prep is given to thoroughly clean the bowels prior to a colonoscopy or surgery.  It induces massive watery diarrhea.)  There were also several patients to be evaluated in the emergency department, but since I didn't have to do that, the other intern was busier than I was.

And, that's it.  I went to bed around 1:30 and woke up to my alarm at 5:30.  Rounds, home, a number of errands and then an appointment to do my taxes... finally.  I work tomorrow, Thursday and Friday and that's it!  Until then.... we'll see if I can add a few more to the total.
Baby Counter:
Births witnessed:  9
Babies delivered:  14
C-sections witnessed:  3

Tags: holoprosencephaly, trisomy 21, fetal anomalies, placental abruption, Easter Sunday, ham

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