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Post-call. - Nobody wears a white coat any more...
...a tribute to becoming a doctor.
ayradyss
ayradyss
Post-call.
silmaril linked this morning's entry in her Livejournal. I have new friends. Perhaps the two are related. Welcome, and buckle in. It's going to be, if nothing else, an interesting three years.

I did not actually sleep last night; I moved from room to room, baby to baby. I caught a nap at four-thirty, when the night nurses scolded me: "Go, sleep. Come back less weird." It had something to do with my decorating my nails with strips of surgical tape, I think. At four-fifty my pager went off again, and I was back on my feat, arguing with a girl much younger than her age, coaxing, commanding. You become, at some point, no longer uncomfortable when talking to a woman who is naked from the waist down, splayed and spreadeagled for the very most possible pelvic room. It is no different than talking to a woman who is clothed. She wanted to give up.
I hear that a lot, in the labor room, usually at about ten centimeters dilation, +2 station, pushing. I hear it wailed more frequently than I would have thought. It is mostly at the stage where the baby's head moves from tucked tidily behind the pubic bone to moving steadily out in front of the pubic bone (see this diagram, if you are confused), and in a first-time mother that stage can be very long. It is long, and it involves active pushing, and that, O Best Beloved, is the formula for complaints. They are almost formulaic: mothers wail with each push, a long exhalation that robs force from the effort of pushing. They give one decent push, one halfhearted effort, and one scream with each contraction. And then, between, come the pleas. "Pull it out. Take me to C-Section. I can't do this any more. I can't push."
Please believe me, O Best Beloved, and if you do not believe me then ask any of the women you might happen to hold dear about childbirth: this is marathon-quality effort. It is a cardiovascular effort the likes of which many human beings would not believe themselves capable of putting forth. Even with an epidural there is pain, and so many times the pain overwhelms the anesthesia. The average baby's head, O Best Beloved, is between 13 and 15 inches around. That's about four to five inches across, on average, and it is squeezing through some of the most delicate and sensitive territory on the female body. A first baby with an epidural can push three hours on the average, and we're asking for every last iota of effort with every push. I am not saying that these women have no right to complain and cry and whine. I am saying that it is my job to turn the energy they are pouring into their tears toward getting the baby delivered.
And so I argue, I cajole, I order. The nurses are far better at it than I, but I am listening and I am learning and I am beginning to understand the tricks of the trade. Once the baby turns the corner of the public bone the pain is not over but things move much faster. If you can get the baby there then it is merely a matter of convincing the patient that one more good push might be the last. Thus far, every woman begging for a C-section or a vacuum or forceps has delivered on her own as long as the baby looked well.
It is hard. It is emotionally exhausting to be in the room, to argue, to keep my voice calm and authoritative and soft and nurturing and soothing and encouraging all at once. It is hard to watch a woman in agony and to tell her that the only thing to do is keep pushing, through and past the pain. It is hard. It can be done. After an hour and a half, it was done, and all of her screaming and crying vanished with the wet
and warm infant on her belly. Better than an opiate.

Yesterday's totals: one urgent C-section, five vaginal deliveries, one laceration I did not have to repair. I have settled the affair of the call I did not have covered and I will pay back the karma I am due in spades. I slept from seven AM to eleven-thirty, went to noon conference, went to the resident meeting and came home. I couldn't sleep any more; I am tired but not able to stay still. My father is out in the garages (we have the single-car garage that came with the house, and a second garage that was added on later) jackhammering a hole in the wall so that we can get from one building to the next without going outside. I have scolded him into wearing earplugs and eye protection. My Angel is at the boys' night out, eating buffalo wings and perhaps going to watch a movie.
I think I will go and watch the destruction.

now feeling:: tired tired

10 whispers echo . o O ( ... ) O o . whisper a word
Comments
omarius From: omarius Date: July 22nd, 2005 12:10 am (UTC) (etched in stone)
Hi, I'm one! I got here via simaril's friend rimrunner. Your post was beautifully written and quite touching. I also have a friend--one of my wife's oldest and best--who is going to be following in your footsteps once she graduates (except via the Army). I got intrigued, read back through a couple of your entries, and decided your tales are too good to miss. Don't you dare add me, you're entirely too busy and my journal too filled with inane prattle. Best wishes!
ayradyss From: ayradyss Date: July 22nd, 2005 08:27 pm (UTC) (etched in stone)
Aww, welcome :)

Best of luck to your friend, too. My father-in-law is a recently-retired Air Force flight surgeon.
From: broken_onewon1 Date: July 22nd, 2005 12:45 am (UTC) (etched in stone)
I envey your father for getting to wield the jack hammer of destruction +4 breaking holes in walls breaking things uging powerful dangerous tools. Though I have to admit I'd have had used a 5# sledge myself, what can I say I'm a tradationalist. Liked the entry I can't get over how that baby flopped on their belly makes all the difference but it does. Hope this finds you well.
ayradyss From: ayradyss Date: July 22nd, 2005 07:58 pm (UTC) (etched in stone)
Hey :)
We used a 5# sledge on selected glass bricks and extra bits, but it's a big hole :)
dempcat From: dempcat Date: July 22nd, 2005 02:36 am (UTC) (etched in stone)
How hard is it to deliver without an epidural?
ayradyss From: ayradyss Date: July 22nd, 2005 07:57 pm (UTC) (etched in stone)
Depends on the woman.
A lot of docs I know almost prefer women on their first baby to have an epidural, because it's less stressful for them then. On the other hand, there's a real urgency to pushing without one and it can really lessen the time spent pushing.

If your pain tolerance is pretty good, and you're the determined type who wants to have the baby, and things line up well, then it's very much doable, and I've seen several recently who just pushed really well and did a fantastic job without the epidural at all.
If you're not good with pain, then it's hard. It hurts.
blueeowyn From: blueeowyn Date: July 22nd, 2005 02:21 pm (UTC) (etched in stone)
I'm here via Silmaril and Turnberryknkn.

Having grown up watching medical shows on PBS (and having a degree in ANSC), a lot of this is fascinating to me. I respect you (and all the other doctors out there who qualify) for your work, your dedication, your caring and your wonderful writing.
ayradyss From: ayradyss Date: July 25th, 2005 06:33 pm (UTC) (etched in stone)
ANSC - animal sciences? Welcome, and glad to have you!
suthnoli From: suthnoli Date: July 25th, 2005 05:23 pm (UTC) (etched in stone)
I have added you, but do not expect you to add me back. I want to read your posts and understand more about something I am ignorant of, and which you describe beautifully. But I am a 15 year old fangirl who's entries are wholly uninteresting. Not adding me back will cause no offence whatsoever. It would embarass me to think that someone so articulate was reading my ridiculous spazz and whining.
ayradyss From: ayradyss Date: July 25th, 2005 06:25 pm (UTC) (etched in stone)
Aww, thank you for the compliment. And welcome. I was a fifteen-year-old fangirl once. :)
10 whispers echo . o O ( ... ) O o . whisper a word