Alpine Adventure: Day 0

In which I earn my vacation
June 26 I went for a great bike ride. When I got home I took a nap and I woke up sick. This virus really wiped me out and I took naps whenever I could, all week long, and canceled one of my clinic sessions. I needed to rest as much as I could for my week on inpatient service.

My call for our maternity care group started at 8 am on Friday morning 7/1. I needed to go to the hospital straight from work because we thought we were going to put our laboring patient on pitocin. She ended up not needing it but I stayed to manage things until her own doctor got there, and worked on catching up with notes from the week. By the time I was relieved it was midnight and as I wanted to be in for sign out on Saturday morning, I slept in the hospital.

It was a busy Saturday on service, July 2 so the intern was brand new and the second year was acting as the solo senior for the first time. Labor intensive. I got home for dinner then in the evening answered a call from a patient with contractions. She didn't sound too uncomfortable so I decided that while she was getting to the hospital I would take a shower, as I hadn't changed my clothes in 24 hours. I got out and was drying off when L&D paged that she was fully dilated. Because I was officially in charge I headed on in even though there was no way I would make it. They paged me along the way as the baby was born and the placenta followed. Happily my friend who was on as the obstetrics attending was able to supervise my resident, and it was a great experience for him to do the delivery so independently. I tidied up loose ends but then it was midnight again so I slept at the hospital, again.

Another busy day Sunday and I was paged about obstetrics again Sunday night, though I didn't have to go in. Monday was July 4 and I was still on maternity call until 8 am Tuesday, and responsible for the hospital service until 5 pm. I calculated that this put me as the responsible attending on call for maternity and/or inpatient for 105 hours straight (8 am Friday until 5 pm Tuesday). And still Wednesday through Friday I was rounding. I did a good job getting all the notes signed but it required staying up until 12 or 2 am every night. I averaged 5 hours sleep I think.

I had a nice restful weekend. Then a busy week with lots of extra time in the office so I could get some patients in before my vacation.

In the category of really, really stupid, I was again on maternity call starting Friday 7/15 and hospital attending for the weekend. A friend had asked for coverage so she could go out of town for her son's birthday and I agreed so I could trade for a weekend I wanted to be off in January. I knew it was right before I was leaving so we agreed to trade off on Sunday night. But I hadn't thought about how my family might want me around for the weekend before I left them for 9 days. Also I forgot that it was my own son's birthday on Friday. Idiot. I again had to go straight to L&D from work because I was responsible for a patient who broke her water at 22 1/2 weeks. I had already arranged for the high-risk obstetrics service to take over her care, but again I needed to go in to be present. I had a good talk with her - lovely lady who has had a really hard time, and although I'd never met her before, I was glad to be able to support her on behalf of her own doctor. Then home for cake which was delayed for me.

As I was lying down to sleep Friday night the resident called me about a woman coming in, just to let me know. He was being so responsible, knowing that we expect them to call us about all pregnant women who call, but hadn't heard the part where if they have decided to evaluate them on L&D they don't have to call us until they have done the assessment. Then an hour later I was paged by a colleague who wanted to know about a test result. Then another call to let me know the patient's water was indeed broken and she was getting admitted. Then at 3:00 a call about a decrease in the fetal heart rate, so I needed to go right in. I stayed up getting work done and watching the strip, got sign out on the hospital patients, then back to L&D. I had tried to call the patient's doctor all night without response, so I figured she must be out of town. She got to complete dilation and started pushing. At the same time, another colleague's patient was undergoing induction. Things had been going okay and at the last check she was 4 cm. We were working with Patient 1 and giving her lots of coaching, she was doing fine - then the nurses asked for us to check Patient 2 - and she was complete with visible hair. So we left Patient 1 with her nurse, zipped over to Patient 2, did a lot of careful support so she wouldn't tear. I called her doc but there was no way she could get in in time. Patient 2 pushed out a 9 lb 10.5 ounce baby in about 20 minutes with no trauma and we were able to get right back to Patient 1 for more support. Then I heard from Patient 1's doctor who had been sleeping in a tent with her kids so didn't get my pages and texts. By this point there was no reason for her to come in either. Patient 1 started having some more low heart rate and we started talking about a vacuum delivery and called the peds team. But then just when she thought she couldn't do it anymore she turned the corner and had a great delivery. Two babies in less than an hour!

During that exciting hour another patient arrived in early labor and she had a prior cesarean section so needed lots of monitoring because of the extra risks. I was able to get my adult patients managed then back up to L&D to watch Patient 3. Her doctor couldn't come in because her husband was away and she didn't have child care. At 11 pm I lay down for a nap, got update calls from the resident every hour or so, things really stalled out but my brain was so fried so I let him manage things. Then there started to be some heart rate issues so I got out of bed and went out to assess, we were finally ready to push. This was a kind of scary second stage because the heart rate kept going down and our monitors weren't working well. But happily we had yet another nice delivery and healthy baby.

Back to the call room for 5 hours of sleep before another day of medicine service. Then hometown for dinner, signed out to my friend at 8, got my bag packed, hung out with the fam, took a shower. Alarm at 3:30 and cab at 4:20, flight at 6:10 am. Now I am spending the day in Atlanta until our 5:45 pm flight to Zurich! I managed to devote 3 hours to getting work done so I am in great shape and now I can KNIT.

Projects I brought:
Beekeeper's Quilt - plan to continue a puff a day. I did two today because I didn't manage any the last two days. I still owe myself one for today.
Featherweight (wip) - Posh Yarn Bryony Lace
Oscillo (wip) - SpaceCadet Aurora
Everyday Shawl (casting on now) - SpaceCadet Oriana and Celeste - gradient mini skeins from Sept and Oct 2015
La Jefa - SpaceCadet Thebe
Tucked - (Vi)Laines BFL DK
Wide Ribbed Beanie - Swan's Island DK