April 17th, 2009

Nescafe rabbit

(no subject)

Sauntered in at 0730 with the intention of meeting fellowship director, who gives a lie to the old-dogs-new-tricks mantra, for a little chat about breast disease in pregnancy.  Nurses are buzzing - seems there's a patient going downhill on high-risk side.  Looks like my 0800 chat is going to become an 0800 section, if I let it, and I plan to.
Yesterday, she was an ordinary preeclamptic - blood pressures up, maybe some protein in the urine, labs looking okay.  This morning, she's in HELLP syndrome - her liver numbers are skyrocketing and her platelet count is plummeting.  We're down from 225,000 to 74,000 overnight already, and anesthesia refuses to stick a needle in her spine for fear she'll bleed.  The problem is that she's not even 30 weeks along yet, and while she may have gotten steroids that doesn't mean that everything will be all right.

This is the part of obstetrics that frightens me - the bit where I don't get to package up a 7- or 8-pound bundle of baby in a blanket and send it smiling home with happy parents.  It's why I'm glad there are obstetricians backing me up, and why I'm secretly glad I'll be sending scary sick mommies and babies to bigger hospitals if I have any concern at all.  But, as I'm constantly reminded, sometimes there isn't time to send them.

Walked into the OR with the attending OB, a somewhat quirky woman who was the very first to hand me a scalpel and has been my cheering squad for the last three and a half years.  We're gowning up and she looks at me.  "I don't know how you feel about this..."  It's an opening for me to let her take primary on the case, if I want.  Something inside me flares.  I can do it.  She gives me a startled look, but smiles and nods.  High Risk OB has me do them.  "She's all yours, then."  And we take our places.
Three, maybe four minutes later, we're handing over a struggling, crying infant to the NICU staff, and the attending is smiling behind her surgical mask.  "He taught you well.  Next time I see him, I'm going to have to tell him.  That was really good." 

The quads are doing well - they were in the paper the other day.  Those are my babies!  And the NICU staff just smiles.  I think my transparent enthusiasm for my work amuses them.  

Many fat and happy full-term babies have been delivered recently as well, bundled up and given to mothers.  My favorite kind are the women who deliver all-of-a-push, as if there were no pain and no effort to giving birth.  They make the rest of us poor mortals seem like struggling shadows of motherhood, but it is so glorious to be a part of it that I can't be angry with them.    That's simply the way of it. 
My clinic patients are beginning to complain to me that I am leaving them; they are threatening to follow me.  I wish that I could box some of them up and take them with me, really.  I am amazed at how attached we have become.  I thought it would be easier to leave, but even the ones who drive me a little crazy, the ones I think I have never really helped, I am sorry to see them go. 

This is somewhat stream-of-consciousness, and I apologize, O Best Beloved.  I want to tell you stories and catch your attention.  I want to rivet it.  I want you to hear about the C-section on the patient with the fantastic socks, and why she almost died, and what it was like to be in the operating room for three and a half hours, and what happened afterwards.  But I wanted to write it then, and I was too exhausted, and now it is late and if I do not sleep now I will not sleep at all.  Perhaps that will come later.  It is a good story, I think.  I will most definitely never forget her socks, or the baby, or the uterus we couldn't save.

But enough, or I'll ruin the story by talking about telling it.  We leave for Papua New Guinea on May 30th.  We'll likely have Internet access while we're there - we'll be taking a very tiny computer with us and blogging from the Highlands at  http://png-09.blogspot.com/.  You're welcome to follow along - I'd like to spend a little time in mental preparation, so there may be posts incoming eventually.  We're going as part of a medical missions trip (and my Angel has already been asked to do networking support while he's out there); I think it's a good time to do some spiritual soul searching - something I've kept out of this blog - and I'm hoping for Angel to contribute as well.  We'll see what happens.