The first clinic day started out with a bunch of "oh, by the way", which is something you hear frequently and never want to. Most notable among them were these two gems:
Chief complaint: "My uterus is swollen". Physical exam: Benign. Nothing unusual. Oh-by-the-way: "I can't tell if it's just my neighbors messing with me, or if I'm hearing voices talking about me all the time." Our psychiatric care megamachine monopoly will be happy to see her in December, but until then I'm managing the antipsychotic I just started her on. There is no justice in psychiatry.
Chief complaint: 5-month old well child check, with wheezing. Oh-by-the-way: Mom, literally walking out the door, says "If I had an indeterminate pregnancy test and I'm having a lot of cramping and spotting, is that bad?" I had them make up an encounter form for her, sat her down, talked about what was going on and got into the meat of it. Which meant talking about whether she intended to keep the pregnancy if she was pregnant (not sure) and what that meant, taking a urine HCG (positive) and shipping her off to see the ultrasound techs to look for an ectopic. She came back with her other child two days later and told me that she was keeping the baby. "It had a heartbeat."
On such things are futures decided, O Best Beloved.
Two new OB's, one of whom I already knew through caring for her son. One OB visit that left me frustrated. Z says I could carry on a conversation with a chair. Some of you who know me probably agree. So when I have a hard time talking to someone - as in, I feel awkward with such questions as "How are you doing?" - then I can't help but wonder if something is wrong. And this particular 18-year-old girl with her first pregnancy makes me wonder if something is wrong. So I went to talk to the psychologist, who gave me a bit of advice mostly consisting of "Get her alone."
Spent all day Monday fighting to get my 41-week pregnant patient in for induction. It probably could have waited for Tuesday, but I had a bunch of little things going on with her that combined to make me feel like the best thing to do was induce. Not that it mattered. Cervidil Monday night, contractions Tuesday early AM, pitocin augmentation Tuesday 0900, screaming and crying at 1-2 cm dilation by Tuesday at noon, and when my proctor (who wouldn't give me permission for an epidural without evidence of active labor) came to see her she demanded a C-section. Even after being offered an epidural - she was, by then, literally screaming at us: "I want it out! Now!". And so we scrubbed back for a section, because the burden of ethical decisionmaking is on the person providing the surgery (that's the new ACOG guideline) and in her case the data don't support additional risk to mom or baby for a section.
Opinions are varied about this.
This morning I am leaving for a Residency Retreat. This means that I need to find some tennis shoes and a sweatshirt, so that I don't freeze or fall and break something. It is "Survivor-themed" which should mean something to me, but I don't watch TV so all I know is that it might involve catching live pigs to eat, or getting voted out of the camp.
Then coming back to round on my OB this afternoon, and maybe write a letter I've been meaning to write, or maybe I'll put that off another day.
Medicine starts Saturday. I've got first call. I'll also be starting my moonlighting in the ER, so that we can afford for Angel to take FMLA when his daughter arrives.