A Sunday morning bike ride isn't leisurely...

... when it's a five mile ride up and down hills after a night on call on the labor deck to get home. Here's the route, which I do twice a day (coming and going), because I have to get to work before the Metro is running. Great fun.

My night on call actually wasn't too bad. We had a fairly consistent flow of patients through triage, which is pretty much my domain. The med student follows around the second year resident to help with deliveries, and comes help me in triage when nobody is close to delivering. She was actually a huge help through call, because she was so eager to help with everything, even after I told her she doesn't have to try to impress me with anything. I think she really likes OB, but isn't really sold on the lifestyle (ie, still having to spend the night in the hospital as an attending). Since it is almost the end of her third year of med school and she doesn't know yet what she wants to do, she's thinking of doing a transitional year internship (what I'm doing this year) and then being a general medical officer for a few years. She's also getting married in a few months, which complicates matters further (she's Air Force, her future husband is Army but might be leaving the Army next year, etc).

Anyway, we weren't terribly busy, which gave me time to cyber-stalk one of my patients. One of the questions on the admission form, for some reason, is "level of education". So I looked through her pre-partum questions, and found "doctorate", which isn't that unusual, except for the fact that she was a sergeant first class, and there aren't many SFCs with Ph.D.s. I went through her medical record, all the way back to her entry physical, which listed her occupation as "Special Bandmember", and then got on Google. Here she is below (the one in the maternity uniform):

Yes, she is a professional flautist in the United States Army Field Band (one of the specialty bands, like the Marine Corps' "President's Own"). I thought that was pretty neat. And at about two this morning, they had a little girl.

So now I have all sorts of Memorial Day plans (no work tomorrow--yay!), including the Memorial Day concert at the Mall tonight. Maybe I'll get some pictures from that to share.

End of rotation celebration

Well, the written exam for OB was yesterday afternoon, so I'm now completely done with OB/GYN (assuming I passed, of course, which hasn't been a problem yet). My oral exam score was posted, and I got a 95%, so I guess Suchi and Adrienne were right when they told me I have nothing to worry about. I won't get my written exam score for another week or so, and it'll probably be two months before all my evaluations get in and I get an official final grade for the rotation. Grading is a little bit different here at OSU College of Medicine. There are no A's, B's, etc. Instead, the top 10% in each rotation get honors, the next 15% get letters of commendation, and the remaining 75% who pass (which is almost everyone) get satisfactory. So, whether you are the 76th percentile or the 1st percentile of the rotation, you get the same grade. Needless to say, I've earned satisfactory in most of my rotations (I did get honors in my research elective :)). Each rotation has slightly different criteria for grading, but for all of them, evaluations carry the most weight, then the written exam, and then for the rotations with other tests, like the oral exam in OB or quizzes in Internal Medicine, those carry the least weight.

So after we all finished the exam, we celebrated in typical medical student fashion. We got cleaned up (that was a big deal after rarely wearing anything but scrubs for six and a half weeks) and went out to a bar for dinner, drinks, and sitting around decompressing for a few hours. I have pictures.

That's me and Adrienne.

There was pool being played--Erin, Madhu, and Adrienne (Erin was at Grant Hospital, Madhu was at OSU but on a different team, and Adrienne and I were on the same team).

Sam was obviously happy to be done with OB, and Sunny was either so exhausted from the last six weeks that he fell asleep at the bar, or was so relieved that he couldn't stop laughing. I think he was laughing.

So that' s what we do when we're done with a rotation. Unfortunately, we had class today (we have a week and a half of clinical skills immersion), which was a flashback to the first two years of medical school--we just sat around in the classroom for 8 hours while people lectured to us. It was kinda nice not to have to think, though, and I'll never complain about two extra hours of sleep.

Aloha!

As I'm sure you can guess from the title, I'm going to Hawaii! It's not until November, and I'll be spending most of my time inside the hospital, but Hawaii is Hawaii. I just got approved to do an Army rotation in outpatient allergy and immunology at Tripler Army Medical Center. The only problem is, I had to change most of my plan for fourth year to do it. I was originally scheduled to do my active duty training at Madigan in August and Walter Reed in September. Now, it's Walter Reed in September and Tripler in November, which meant I had to ask for my orders to report to Madigan be revoked, make a request for orders for Tripler in November, notify Madigan that I'll be doing the rotation without orders, get a memorandum of agreement to be made between OSU and Madigan, and let my vice dean of academic affairs aware of the change. Oh, and I'm dealing with a total time zone difference of six hours. No, dealing with the government isn't complicated at all.

Onto other happy news... today was our last day of OB/GYN! Well, we still have the exam tomorrow, but we don't have to get up early to round and we don't have see laboring patients, so as far as I'm concerned, it's over. And what a way to end the rotation! I think the diabetes clinic was giving us a special deal on patients with pre-eclampsia... they sent us four or five, all of which had to be admitted for induction or c-section. Throughout the day, all of the L&D rooms and all the triage rooms were full. At one point, we had to put a pre-eclampic patient in the c-section recovery area because there was no where else to put her, and she had to be admitted. And then there was the Spanish-speaking only woman who was pregnant with twins--that was a fun discovery. It took about five minutes of the husband's rudimentary English and the total of ten words of Spanish tht Suchi and I knew to find out that there were two babies in there, not just one. The only break I had all day was the lunch break Suchi let me take and the half an hour for my oral exam. I don't think that went all that well, but both Suchi and Adrienne (my roommate and also on this rotation) told me that it's going to be okay, so I have to believe them. Guess we'll find out soon enough.

Birth plans and other strange things

As I'm sure you can guess from the title, it was another day on the labor and delivery floor. Fortunately, it was a very light day--there was only one woman in labor, and she was a private patient (there are two classes of patients: private and clinic. Residents and med students deliver clinic patients. Private patients are the ones who pay money to see a real OB/GYN). Anyway, said private patient came in with a birth plan which somehow involved one of those birthing balls. Also in her birth plan was no internal fetal monitoring. Fortunately, this particular private patient was reasonable enough that when the baby didn't look so good on external monitoring, she agreed to internal monitors. That's not really the point of this story, though. As soon as the night team said the words "birth plan", that prompted all the residents to start telling their own stories of patients arriving with birth plans. The one that took the cake was a couple who had a six page plan, the last step of which was to give the mom a plate and utensils after birthing was complete so she could eat the placenta. Ewww. I still get grossed out thinking about it. (It didn't happen--placentas are considered biological waste, so patients who deliver in the hospital aren't allowed to eat them).

The only other patient who did anything was a woman at 29 weeks gestation who came in complaining that she hadn't felt the baby move in the last two days. When they took her blood pressure, it was about 210/120 (normal is 120/80), and when they put external monitors on her, they found the baby's heartbeat, but the tracing was not very reassuring--there was almost no variability to the baby's pulse, which should be seen. So, she went from presenting to triage to the OR for a c-section within an hour. Baby is now in the NICU.

And speaking of the NICU, I got a little scare this morning when I checked the NICU census out of curiosity and didn't see the baby from the c-section Friday night (the one with a hemoglobin of 1.5). So I looked him up and read the notes. He was transferred to the NICU at Nationwide Children's early this morning. By that point, his hemoglobin was about 7.8--not normal, but much better. Lots of baby blood transfusions will do that. So since he's at the children's hospital, I can't check up on him anymore, so all that's left is to pray for him and his family.

After we signed out to the night team, I headed for the pool for my weekly 2 mile swim, then the smoothie place for my weekly "you went swimming today, good job" smoothie. Dinner was a bowl of cereal, and now it's time for a shower and getting to bed to do it all again tomorrow.

Let's give this a try

Just for the record, I find the whole idea of blogging a little bit silly, and I'm a little bit embarrassed that I resorted to starting one. However, when I was way too tired this morning at some ungodly hour after being awake for far too long, I thought it would be a good idea. Fortunately for everyone involved, I didn't start it then. I don't think it would have been all that coherent.

Okay, now that that's out of the way... for those of you who don't know what I'm up to these days (which is most people... my level of communication has really declined recently), I am two weeks away from the end of my third year of medical school at The Ohio State University College of Medicine, and four days away from the end of my OB/GYN rotation, and I am thrilled with the idea of being done with OB. I don't think words could adequately express how much I dislike this rotation--some of that comes from the fact that I'm post-call and my brain isn't very good at coming up with words right now, and some of that is that I just find it that horrible. I have about a million reasons for why that is, but I'll sum it up by saying the hours are really long and the residents are really stressed most of the time, and for good reason. There's a lot that can go wrong in the whole pregnancy/labor and delivery thing, and it's their job to keep those bad things to a minimum. That, and they work even longer hours than I do. The difference is, they're doing what they want to be doing for the rest of their lives. I am not.

Call last night was, as far as call nights go (at least my call nights) not too bad. I was working in the low-risk OB clinic during the day, and there is no Friday afternoon clinic, which meant I had a few hours off before beginning my overnight stretch on the labor and delivery floor. A few hours off means a pre-call nap, which is just about essential for surviving the night. I did get scolded by a roommate for coming home to take a nap instead of staying at the hospital, but I wasn't too worried about that. She seemed to be the only one who thought I shouldn't have done that.

So I returned to the hospital at 5:20, which, as it turns out, was 20 minutes late--I didn't realize the night team started at 5 on Fridays (they start at 5:30 Sunday-Thursday). So I was late for a c-section and didn't scrub in for that, but to me, most c-sections are the same, so I don't feel that I missed anything. There were two others last night, run in staggered ORs, so I only helped with one, a woman who was 27 weeks and six days pregnant (for non-medical people, pregnancy is 40 weeks. 37-42 weeks is considered full-term, 42+ is past-term, 24-37 is pre-term, and 24 and less is not viable). So even just from the dates standpoint, this was not going to be a happy baby, but to add to it (and the reason why we were doing the cesarean), the baby had fetal hydrops, which is severe anemia of the fetus. This baby was so anemic that when he was delivered, he was white. Not white like Caucasian (which he was), but white like a piece of paper. The maternal-fetal medicine specialist estimated his hemoglobin at 3 (normal for a newborn is 14-20). As it turned out, it was 1.5, the lowest the neonatologist has ever seen. When I left L&D this morning, he was still alive and in the NICU at OSU. If he makes it the next couple of days, they might transfer him to the NICU at Nationwide Children's. Sad situation, but the parents are hopeful.

The rest of the night was fairly mundane. While in that c-section, I missed a delivery of a woman I had been following for the first few hours of the night, so there really wasn't much to do other than writing notes on the patients receiving magnesium for pre-eclampsia every two hours. Then a woman came into the ER "in labor" (as I'm being to discover, many pregnant women think they are in labor up to weeks before they actually deliver. The OB residents are pretty good at figuring out which are really about to deliver and which are not). Anyway, we get a call from the ER saying that she is crowning and they're bringing her up. So we're confused about why they're bringing her up, because they should know how to deliver babies in the ER (ER docs do a couple of months on L&D during residency), and crowning isn't exactly a controlled situation that you would risk an elevator ride with. Well, she gets to the floor, and there is no crowning going on--she's about 4 cm dilated (have to be 10 to deliver), and it was her first pregnancy. Things usually present a little slower for the first one. That gave us a good laugh for the rest of the night, though. She did end up delivering before I went home in the morning, but the resident I was with seemed to think that I couldn't handle it (despite having delivered three babies already), so I didn't really do anything. And then it was back to the magnesium checks until the Saturday team arrived at 8, at which point I stumbled back home and slept until noon, then got some studying done. I have to go back tomorrow for the Sunday day shift (fortunately, it's short--only ten hours as opposed to the 12.5 during the week or 26 when on call). So I have to live through Sunday, Monday, Tuesday, and the exam on Wednesday, and I'll be able to put OB behind me forever.

Anyway, that's my life right now. Hopefully I'll be in a better mood and writing about something happier in the future.