Culture, body fluids and the health care system

Well - I've officially survived my first rotation of residency. Figures my last days would be on call.

My last night was an eventful one, lots of various fluids and excretions causing me to shower twice and ultimately go home in my fourth pair of scrubs in 30 hours. One delivery was fast enough that we didn't break down the bed. I sat at the end of the bed and delivered the baby, along with a gush of amniotic fluid, which soaked the bed and the parts of me sitting on it, namely my right thigh and butt. Another woman, screaming in labor (no epidural) spit and got phlegm all in my hair. A third baby was delivered with a huge gush of blood, soaking me enough to the point where the mom, looking at me perched between her legs, said, "Now I see why you wear the face guard."

I saw another patient who inquired about my age. She and her husband reminded me of my college friends and I felt we had pretty good rapport - sometimes you bond with some patients in the wee hours of morning. I told them I was 30, then, followed with my new epiphany, "I'm old enough to be a grandma in Tacoma". Both my patient and her husband found my statement hilariously true and were inspired to give each other high-fives.

One exciting thing about this call was that there was a cultural festival in Wright's Park (the park between my apartment and the hospital). Some of the OB nurses went there on their breaks. There was a brief lull after the butt-soaking delivery and Molly (the fellow I had worked with all month) and I were able to check it out and watch the stage shows until we were paged back in. I managed to bring my camera to work and snapped a picture of Molly, the part of the festival we got to see, and Molly snapped a pic of me - post shower #1, second pair of scrubs, pager as close to my ear as possible (it was loud there), and hiding my badge (that has the huge MD all over it) in my front pocket. Note the scruffy hair and glasses - a classic "on-call" fashion statement. I'm terribly disappointed I wasn't able to really attend this event - it looked to have great shows and vendors. Perhaps next year I won't be on call that weekend.

It was a good call overall - busy - and I was exhausted enough to sleep through most the day after I got home, waking enough to eat crap, watch TV and talk to someone on the phone before crashing again for the night. The following morning I was introduced to my new rotation: Community Medicine.

It's two weeks long. Each day is spent shuttling around different community resources, learning where they are, what they do, who works there and how I can use these resources for my patients. Yesterday was a couple hours at a domestic violence comprehensive help center (not a shelter, though) and the afternoon and evening were spent with a really cool naturopathic doc, basically shadowing him with is patients - one of them a seriously powerful executive who I will certainly not tell you about since it's a HIPPA violation, but she may be one of the more powerful business women in the Sea-Tac area :)

I think I may have helped that executive quit smoking which made me feel like I was doing something. That was refreshing, especially in light of a patient of mine who has been making me feel a little helpless. On scales from 1-10 - ten being the most and 1 being the least - she is 9/10 sick, 10/10 unhappy with the health care system and 8/10 sure I will do whatever she wants when she wants it. Likely she is also sad, angry and scared since she probably does not have all that long to live and admitted to me that she doesn't really want to die. I don't think there is a lot I can do for her aside from listen to her and manage her the best I can. I can't fix her illnesses, I can't get her everything she wants when she wants it, and I'm pretty sure, given the resources I have, I can't restore her faith in the health care system. I'm not saying I don't have great resources at TFM, I'm saying she may be partially right. Our system is inherently flawed. We all know it. It's like the environment: we all know it's messed up, but who is actually doing anything about it?

And on that happy note, I'm off to shadow some hospice care workers for the day...

…And to infuse some optimism at the end of the post – my gerbera daisies have not only come back from the dead – but they started blooming!

Sleepy Doogie, MD

Surprisingly, the first month almost went by without one inquiry into my age. Then, just as this rotation winds to a close, they come in droves. Apparently the nurses on labor and delivery were talking when I wasn't around, trying to guess my age. I wouldn't be surprised if there was a pool going. Then I got a Doogie Howser comment. Yep, they actually called me Doogie just before I fessed up to my fabulous three-oh status. Most of my patients and their parents have just been asking, "How old are you?" And without skipping a beat I say, "30," and move on. "No way!" they say. I understand I look younger than my age but you'd think from their reaction I looked 12 years old!

Overall things have been going well. I'm nearing half-way for my second 12-day stretch without a day off this month. I could really use a day to sleep in but I'm trying to go to bed early. My to do list is terribly long: I need to get my WA driver's license and registration, get my eyes checked, order new contacts, see the dentist, buy a new litterbox... etc, etc. Can I do all of the on Saturday, August 4th (my next day off)? I'd be excited if I got two of those things done.

My last OB overnight call is Saturday. Then Sunday I go home post-call, crash, and then Monday have a new rotation. I have two weeks of what they call "Community Medicine". I got a flavor of what the rotation will be like but will have a better idea after our orientation to it on Monday morning. Bottom line, it looks like each day, mornings and afternoons, I have a pretty tight schedule visiting community resources and clinics. I'm excited for a new rotation, but I have to be honest, I'm more excited to be able to sleep on in August 4th than anything right now!

"How tired are you?" You ask.
I'm so tired that instead of writing "spleen" on a patient note I wrote "sleep". Twice.
I'm so tired that I fell asleep peeing. In a public restroom. Don't worry, I didn't fall off the toilet.

Photo of me in the giant bed in Sedona last May. Ah... if wishes were horses...

Tacoma Pride/Narrows Bridge

So the weekend of July 14th (Happy belated Bastille day everyone) was my first golden weekend of residency. It was a beautiful weekend overall, hot, summery, sunny at just the right times.

Saturday was Tacoma's 10th annual Out in the Park - their Pride festival. I had heard it wasn't much to see, but I had heard wrong. The event was actually very well attended and had lots of good entertainment and a great variety of vendors. I think it probably matched what Motor City Pride was a few years ago - before they got their climbing wall and bigger musical acts. It paled in comparison to Boston pride. But it was nicely tucked in Wright's park and was totally doable solo (while Boston pride is a behemoth city-wide event that may swallow you whole without reinforcements).

The highlights, of course, were the drag queens. There were some great numbers, hip hop, R&B, Tina Turner with huge hair and big moves. The live musical acts were so-so. The Art Festival definitely had better music, but, admittedly, I was only there for a couple hours of the 6-hour event so may have missed some better acts. I could hear everything from my windows all day, though it was difficult to tease out what was live and what was pre-recorded for the drag shows. The had bottled water that was encased in rainbow bottles which was tons of fun. They also had a very comprehensive HIV/AIDS multimedia display, chronicling the history of HIV/AIDS via mostly photo and print. There was also a group of LGBT car collectors and aficionados who brought a few vehicles to show off their wheels.

I met a woman who is starting up a community clinic for LGBT patients. She is an N.D. (naturopathic doctor) and very cool about allopathic medicine working with naturopathic medicine. She's not anti-vaccine, or anti prescription and was really interested in having some help with her clinic. It's only been officially open a almost a month and she's still struggling. It appears she's in need for an MD to do various procedures, paps, colposcopy, and other things. If this clinic gets off the ground (and I can get approval from my program or when I get my license) I might be able to arrange some volunteering (or moonlighting) later on.

Saturday night, after pride was over, almost precisely when the music stopped, my medschool classmate, Jackie came over. We had dinner at one of the restaurants along Ruston Way and crashed to get some shut eye before the Bridge Run the next day.

The Bridge Run was to benefit the Neonatal Intensive Care Unit at Mary Bridge (the peds hospital at Tacoma General - where I work and where the premature and sick babies I deliver go right now). The run/walk was across the new Tacoma Narrows bridge.

Most everyone has heard of the Tacoma narrows bridge at one point or another. You've probably seen footage of the old bridge's collapse in physics class. The old bridge - nicknamed Galloping Gertie - would ripple and sway in the wind and ultimately fell into the 200 ft deep narrows below. A new bridge was built nearly 50 years ago and now a second bridge has just been finished. This is the one we ran. It's a spectacular suspension bridge. The event was HUGE deal drawing tens of tousands of registered run/walkers and about 60,000 people overall. Click here for a short article talking about the bridge. And click here for an awesome picture gallery that includes some great aerial shots! It appears from those pics that Darth Vader was there and I totally missed him. Ah well.

Some highlights from "The Span" were bagpipers that did the walk - all 5K, playing as far as I could tell. People in fun outfits - dressed as fairies or wearing homemade "Narrows Bridge" hats (see left). There was one old dude who was power-walking, listening to his walkman, and belting out the parts of the tunes he knew. Great fun! The race finished with a few sign-holders asking us to repent, an interesting and totally unexpected surprise. I took a lot of pictures and will upload them to snapfish and share it with many of you.

After the bridge walk Jackie and I treated ourselves to a yummy breakfast at the Old Milwaulkie Cafe (small joint, checkered table cloths, friendly wait staff, hot maple syrup, divine scrambles).

Then Jackie head back to Seattle and I crashed on my couch. All in all it was a great weekend. I hope all my golden weekends are as fun-filled!

For footage of the old bridge's collapse (and to refresh your memory because you know you've seen it) click here! Or, for a less dramatic footage but more dramatic telling, see this old 1940's newsreel - but it doesn't do the oscillations justice - click here!

Screamers

At the L&D deck we hear the calls in from the patient rooms on a speaker phone at the clerk's desk.

Beep: I need a nurse.

or

Beep: Baby boy! Room 32, 10:59 PM

The other night a great call came in. The nurse beeped in and asked for anesthesia for the patient (i.e. epidural) and in the background, practically obscuring everything the nurse said, was an impossibly long cry, complete with vibrato, like an opera singer. "Ahh[we're ready for]hhhhhhhhhhh[anesthesia]hhhhhhhhhhh[in 222]hhhhhhhhhhhhhhhh"

The transmitter clicked off. There was a pause of silence (rare in the gossipy deck area) and then a burst of laughter.

Never a dull moment.

Tacoma Horror Picture Show

This post is not for the faint of heart:

Last night's stats:
I delivered 4 babies: 3 vaginal deliveries, one c-section.
Two deliveries so fast I didn't have time to put both gloves on.
Three of the 4 got me so soaked in blood I had to change and wash up.
At one point, I didn't have time to put a mask on, blood splattered in my face around my mouth (not on my lips or in my mouth thankfully). However I had enough blood on my philtrim that I couldn't talk without risking getting blood on my lips or mouth. So I had to "mmm-mmm" to notify the attending I was going to the sink to wash.

The c-section involved an exploding placenta. At least, that's what we called it. With only mild traction on the cord avulsed and exploded blood all over the table, on me, the fellow, the attending and the scrub nurse. Most of blood splattered atop my face shield. One of the nurses in the OR came around with alcohol soaked pads and wiped our faces. We had to run out of the OR for another delivery. The fellow and I were so blood-covered we looked down and realized that no way we could even walk down the hallway looking like we did. There was a reference to Sandra Oh on Gray's Anatomy. I wasn't sure what the reference meant until I was clued into the picture you see here.

So since we took the time to remove the blood-soaked gown, face mask, cap and booties we were late the the next delivery and I just put a gown on, got one glove, and used the sleeve of the gown to cover my other hand as I delivered baby, clamped the cord and suctioned. I'm definitely getting the hand of handling slimy newborns. However, it would be more ideal practicing my new skill with both hands!

It was an exciting and exhausting night. I didn't have any time to sleep. I came home and basically crashed for a while. Woke and ate all three meals within three or four hours, and now am off to bed again.

Before rounds I was sitting with the fellow and she was playing with her earing. She brought her hand down and looked at it. "I have blood in my ear," she said. We both paused. I leaned in to examine the dried blood on her finger. Then we both cracked up. What jobs we have.

Birthin' Babies

So far so good. I'm liking OB. (Loving looking out my window too. See these recent pics.) My schedule is pretty nice, actually. True, when all is said and done, I only have 4 days off in a 6 week period. However, here's how my schedule works:

Day one: CALL
Day two: post-call
Day three: Rover (f/u lab results and do NST's, AFI's - very low key); prepare for a talk (also act as back up for labor and delivery should they need it).
Day four: give a talk in AM and have clinic all day
Lather, rinse and repeat

Call on 4th of July was fine. I delivered 5 babies on my first call and three on the 4th. Big numbers right off the bat. I'm getting the hang of it. I don't get a lot of sleep on call - I got to lie down for about an hour the last time which was nice. But overall I am pretty busy between checking on pregnant women and working up women in triage.

I wish I could report on all my fabulous adventures in my free time but there hasn't been much of it yet. I do get a golden weekend on the 14th. Ahh... what is a golden weekend you ask? Let me clarify:
Golden weekend: when you have both weekend days off. Typically that's being post-call on Friday and then free on the weekend.
Black weekend: when you work both weekends day - typically on call Saturday and post call Sunday, back to work on Monday, etc.

Me? My golden weekend is the 14th. I have the unsual misfortune of having two black weekends in the four weeks - the first and last. Which actually makes for a bit more than a 4-week rotation but them's the breaks.

Interesting deliveries I've had:

There was the lady who employed hypnosis and a doula to help her. Each time we went into he darkened room a recording of a "soothing" voice repeated over and over again how relaxed her cervix was and how happy she was. We weren't allowed to call her contractions contractions. They were called "birthing waves" and we couldn't ask her about her pain, we had to ask her about her comfort level. In addition she, her husband and doula took many minutes to deliberate together, separately, and together again on each decision about medical intervention since her labor was progressing very ,very slowly and baby was looking a little distressed on the monitors. Long story short: Near the end she was crying out that the hypnosis wasn't working and that she was miserable. She seemed just about to ask for an epidural, but then baby came along, ended up healthy, and all was dandy. Definitely an interesting experience.

Then there was the lady who, after having so many babies, delivered her baby so fast that by the time I got into the room the baby's shoulders were out and the nurses just helped the baby slip out and onto the bed. No time to even write her admission orders!

I have to say, adoption is looking very tempting... I come at the end of a call with visions of stretching vaginas in my head.

Hey - and look at the GIANT artichoke I ate for dinner!