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Hi, I'm Dr. B. - Nobody wears a white coat any more... — LiveJournal
...a tribute to becoming a doctor.
Hi, I'm Dr. B.
OB call is 7 AM to 7 AM. It is 2120 and I am sprawled on a bed in the call room, trying to remember how to breathe. I have been seeing patients in triage, catching babies, feeling my adrenaline surge and rush and keep me going one patient at a time.
Dr. S, the MFM doctor on call, found me trying to finish a chart in Special Care after I sent its owner home. "Do one thing at a time," she said to me, with the smile I was soon to learn was her characteristic expression. "You'll get through it." I enthused at her about my plans for after residency, how I wanted to learn to do ultrasounds. "You'll have time," came her answer. "There's three years yet."
It's somewhere between amusement and bemusement, the expression that crosses people's faces. "I'm one of the new interns." Welcome, comes the answer. I hope it's a good time. And it is, so far, this hospital where the OB nurses run the service with iron fists, where a little humility can go a long way.

It carried me into the birthing suites four times today, and put my hands on the crown of a delivering infant more than once. One baby sent everyone's heart racing as her heart rate came casually sauntering down into the 90's (normal, O Best Beloved, is 120-160) and sat there, refusing to rise no matter what we did to her scalp. I stepped aside then - in an emergency, yield learning to experience - and Dr. D put a vacuum on and pulled out a little girl clutching tight hold of her umbilical cord, as if to make sure that the double loop around her arm would stay put. She perked up immediately, but our heart rates didn't recover quite as quickly.
Any number of patients through triage, calls to OB doctors, sterile speculums and cervical checks and nitrazine paper and a lot of "what does that mean?" to which the answer was, more often than not, You've bought yourself a delivery room. I learned about infant heart murmurs. I learned about doing one thing at a time, a little later than I ought to have, and I ran from L&D to Mother-Baby more times than were strictly necessary. But I'm learning, and part of learning is making mistakes.

One residency patient, and the proctor let me deliver her. He coached, calmly, soft voice, suggestions rather than orders, and I slid an 8#11oz girl out of her mother with barely a skid mark. I think, O Best Beloved, I almost dropped her. Babies are warm and wet and wriggly and slippery and the sheer shock of doing the delivery made me go a little limp. But I didn't drop her, and she screamed, and she was beautiful. Lots of hair.

One phone call about which I am still laughing. You must understand and imagine this physician's strong Chinese accent. He is a little man, speaks loudly and quickly, and the nurse had just let him know that she hadn't checked the patient but that L was doing well, 4 cm at last check, feeling no need to push. He informed her that he'd be in-house after he finished the last two holes of his golf game. I suggested that we check her - two hours after an epidural, a lot can change. She checked, arched her brows. "Hm. She's nine, bulging bag of water." I picked up the phone and called. Doctor, I wanted to let you know about L. She's nine now, bulging bag. Imagine the accent. "Nine?" Nine. "Nine?" Nine. The nurses are starting to laugh. "Nine?" Nine. I'm struggling to figure out how to say "Nine" in another way. "I be right there," he says. Okay. "ThankyouBye." Click. I turn to the nursing. He's on his way.

One urgent C-section, and I was complimented on my fundal pressure as we delivered a baby through a tiny hole in a belly hung heavy with fat. Under his breath, the surgeon explained the difficulties inherent in delivering C-section babies to obese mothers. He was not necessarily complimentary. Some doctors are more tactful than others, but in this case, at least the mother didn't hear him. The anaesthesiologist who was outright rude to the nurses and the patient needing an epidural bolus, on the other hand, made no effort to keep his voice down. Later, after the patient's family commented on his complete lack of charm and likability, he was noted to me to be "a grade-one dirtbag who hates women" and only does OB because his group makes him.

I much preferred the anaesthesiologist I have not officially met; he stood at the head of the delivery table in the OR suite as Dr. S smiled her characteristic smile and vaginally delivered vertex 26 1/2-week twins as if she were baking cookies. I had just come out of a delivery that called its physician away from the golf course when the nurse (always be good to nurses, O Best Beloved, and this is why) mentioned to me that if I hurried, they'd just taken a twin delivery back to the OR, and it might not go sectioned. Mom had come in at 4 cm dilation via transport. Family had left for dinner. She went to 10 cm and the babies started coming. By the time the family (including the father) were back from dinner, two 2-pound babies were doing well in the NICU, and Dr. S was complimenting my starting knowledge base of ultrasound. I'd held the probe and looked at the uterus and correctly identified what I was seeing (thanks so much, $residency_elsewhere) and she was most delighted. This anaesthesiologist coached the mother and kept a gentle voice and exclaimed delight as each twin delivered.
They were tiny, O Best Beloved, tiny and fragile, dusky creatures the size of my two cupped hands, arms and legs in flexion as if they were tiny hedgehogs rolling up against a hostile world. Two boys, ribs flat protrusions in thin chest walls, abdomens slim and curved, pencil-thin arms and legs, sex waving wildly as they kicked in protest and curled up again, mouths open in silent screams of defiance. There were tiny coughs and ribbon wails, the sounds of air in lungs not meant to expand so soon. I walked over to the warmers and watched - blow-by oxygen to stimulate them; a tiny breathing tube no bigger than a straw to do the work of weak and unripe muscles - and I watched as they uncurled, slitted open infant eyes, were wrapped in blankets and covered by knitted hats to keep them warm. They were the size of dreams.

Everything has been happy thus far on call, O Best Beloved. The weekend food is awful, but I was expecting that. I have been helped in so many ways by the nurses, the doctors, my in-house backup (who, I think, was a little surprised when I vented at him about getting behind and then declined help, but I need to learn), and our upper-level resident who called me once he woke up from his nap just to check in. And now it is 2200 and I think that if I do not sleep now I will not sleep tonight. Babies are inconsiderate like that.
And so.

Tags: , ,
now feeling:: exhausted exhausted

9 whispers echo . o O ( ... ) O o . whisper a word
kesil From: kesil Date: July 3rd, 2005 03:24 am (UTC) (etched in stone)
There's a rumor going around that the NICU is the place to be this week.
ayradyss From: ayradyss Date: July 3rd, 2005 03:25 am (UTC) (etched in stone)
Might have something to do with the multiples :)
kesil From: kesil Date: July 3rd, 2005 03:27 am (UTC) (etched in stone)
2, 4...I keep waiting for six.
coanteen From: coanteen Date: July 3rd, 2005 04:04 am (UTC) (etched in stone)
"He was not necessarily complimentary"

is anyone ever, about obesity? orthos. orthos are the worst, i think.
smallstar From: smallstar Date: July 4th, 2005 03:51 pm (UTC) (etched in stone)
I've found anaestheists to be the most frequently vocal about it, though I suppose the orthopods are usually more blunt. :p
coanteen From: coanteen Date: July 4th, 2005 05:07 pm (UTC) (etched in stone)
well, the anaesthetists complain because they're harder to intubate or put spinals in or whatnot.

the orthos will be like, "why should we even bother operating on her knee? as fat as she is, she'll just ruin it again."
reynardo From: reynardo Date: July 3rd, 2005 08:18 am (UTC) (etched in stone)
Of all the places to be, this will have, I think, the biggest ups and downs. But the joy, the utter joy of seeing another new life come into the world - and knowing you were a help where needed and a watchful eye when that was all that was required - I wish you so much joyful work there.
lorriejharris From: lorriejharris Date: July 3rd, 2005 02:30 pm (UTC) (etched in stone)
Very touching and moving entry, Aradyss. I hope you consider professional publication someday.
trinapink From: trinapink Date: July 3rd, 2005 04:06 pm (UTC) (etched in stone)
"They were the size of dreams."

What a great statement! This is profound and lovely and exactly the right statement.
9 whispers echo . o O ( ... ) O o . whisper a word