The morning after

Night call has left me exhausted and oversensitive. I was on call with a spunky young doc who, though she commonly thinks everyone who has any kind of abnormal tracing or labor curve is “getting cut”, she is extremely approachable and normal. Even better, she was up all night with two of her own patients so I never worried about waking her up or not being able to find her. The labor floor was scarily quiet. Only three patients on the east side of the unit which has about 25 rooms.

A woman who had been seen earlier in the day for decreased fetal movement, a reactive nst, a 6/8 bpp and an EFW of 9.13 called back around 11pm c/o ctx q 7 minutes. She was (surprise!) a nullip and extremely happy so I had her stay at home and call me back in 2 hours to check in. She initially called me back in about 15 minutes to tell me that she was still having contractions, still feeling the baby move but now she was having this weird blood on the toilet paper when she wiped and thought I should know. At this point it was pretty clear it was going to be a long night. I reassured her about bloody show and tried to get a couple hours of sleep. I got a call from the answering service around 1am “Guess who called back?” The telecom operator “tom” said to me annoyed when I called him back after getting the page.

She was now c/o ctx q 4-5 and they were stronger. But she literally seemed giddy while she was on the phone with me. “Well,” I said, “maybe you’re just a really happy person.”

“I am.” She said breathing hard. “I’m really, really happy. That’s exactly how I am.” After barfing in my mouth a little I invited her in because, though I think she could have stayed home, she lived an hour away and she was 3cm in the office two days ago.

She was 5cm when she got to triage and because no one wants to budge my 100% epidural rate, she got her placement and assumed the left side lying position. She was tachy, I bolused her. She got some lates, I turned her and, amazingly, they went away! I checked her at 6am and she was 7/100/-2. “You think this baby is coming out vaginally?” My nurse said. I never know how to respond to that question. How should I know? She’s 7! And yes the baby is high, and supposedly big but why is everyone so quick to be distrustful of the ability of the pelvis??

The next time I checked on her she was sound asleep. So, I passed her off to the next CNM on call and am now checking my work email incessantly to find out what happened to her. Did the baby come down? Did the lates come back? Did she in fact deliver vaginally?

The midwife who discharged the pt that I delivered on Friday did a perineum check this morning and called me to let me know that the repair was completely lopsided. As you recall, this was the repair the chief resident did for me. The partial 3rd that somehow became a 2^nd midway through her repair.

The doctor was called in to see it, a note was written about it and sent to her primary care providers in the office. It was stated again in her discharge note that the resident’s hands, not mine, were the ones responsible for the mishap. But I can’t help but think what kind of a job I could have done if I had just pushed myself to try to repair it on my own…

I’ve been flaked on by two people tonight. And I specifically made plans on my post call night to give me a reason to get out of the house. Annoyed and feeling …annoyed. Tomorrow evening my literature and medicine class meets. And I was chosen as the lead part in this staged reading we are doing of a William Carlos Williams play. Maybe I’ll rehearse…