April 19th, 2007

Secret Doors

Encouragement.

I have a few hours to sleep after a relatively restful night of OB call. Good news. We did five sections yesterday - one of them on the breech presentation I discovered at anterior lip. Oops. To my credit, I didn't panic. To my proctor's credit, she didn't yell at me. I got the ultrasound and had the nurses call. Twenty minutes later we were in cesarean section, prying a baby out of the uterus. On newborn exam there was a distinct clunk at the right hip - possibly a congenital dislocation. I'll see what the repeat exam shows.

"My knots are terrible," I told my proctor. We did three C-sections together today and she had me tie every single knot. Learning opportunities. The word is getting out that I want to do the fellowship.

At 0630, a patient of my colleague's came in at 31 and a half weeks, in pain and spotting. I did a sterile speculum exam and saw membranes. A careful cervical check showed a 6-8 centimeter opening in a paper-thin cervix holding her baby in. Into a birthing suite, on the phone to NICU, and calling for antibiotics - a new proctor listening to me as I rattled off the details. My shift ends at 7, but there was a section scheduled at 0700 and the next resident on was scrubbing. I did the H&P I'd missed overnight and checked baby for position with the ultrasound. "I'm here until M comes in or B gets out of surgery," I told him. "Someone has to catch the baby."

A grin - teeth flashing. That's the sort of diligence I like to see. Some of your colleagues would be out of here - it's after 7. I'm perpetually fascinated by the idea of shift-work medicine; I can't quite get my head around it. Maybe it stems from my need for control. Maybe it's something different, but I can't abide the feeling of leaving something undone without a clear plan. I couldn't walk away from a 21-year-old woman whose life I had just irrevocably altered and say "someone will be here in a while". The what-if is too big and empty for me.

And when they ask why I'm interested in the fellowship, I have an easy answer. I want to do rural medicine and deliver babies. It is incumbent on me to know what to do in an emergency, and I never want to see a baby die because I'm not prepared. It's as simple as that.
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