February 28, 2008

• Pregnant Fight Club

  So most of my mornings on OB are spent punching fat women in the stomach.

  No, really. Because one of the parts of the physical exam post partum is checking to make sure the uterus is firm. Except, most of these women (though not all) were quite hefty BEFORE they became pregnant, and while the uterus is hard to palpate in a skinny woman, what with having to press down fairly hard, it is almost ludicrously difficult to find in a fat woman, because there are so many more layers to try and feel through before you find this tiny little organ. So i have to apply quite a lot of pressure before i can feel it.

  Around 7:30 the circumcisions for the day are carried out. One med student from our team of five needs to remain each day to observe and/or assist. Tomorrow is my day. I apologize in advance, little fellas.

  After that is usually about five minutes to scarf down the quality hospital 50 cents scrambled eggs for breakfast, and then to morning signout, where we learn about all the patients for the day. Half of our team stays on the floor to participate in c-sections and vaginal births, and the other half (again me, today) goes to the maternal fetal medicine clinic, a clinic for high risk pregnancies.

  Now high risk can mean a lot of things, from twins, to pregnant with previous cesaeran deliveires, to HIV positive status, to down syndrome risk. It’s kinda like a box of chocolates. You never know what you are gonna get, but it will probably be filled with something you werent expecting.

  Few interesting patients today, though I will not bore you with too many of the technical details. The first was a woman with toxoplasmosis, an infection that is VERY difficult to get unless you are immune compromised. Since i am pretty sure the only person interested in infectious disease here is me, those of you who are interested can click the word to get the wiki definition

  Next was a 15 year old primigravida (first time pregnant) who had a higher than normal risk for downs syndrome. She was there with her bf, and i gotta say this one was kind of tough for me. Here is someone who probably has just barely learned about sexual reproduction in school (when do they teach that now, anyway?) and we had to give her a crash course in what the meaning of downs syndrome is, genetics and inheritance, and medical/surgical options for continuing or ending the pregnancy. It would be a lot for ANYONE to take in, even more so if you are socioeconomically hard up. At least she had a support group, as her mother came back with her to get the information brochures. These patients are difficult for me because on the one hand, i sympathize with how your circumstances can lead you to difficult choices and life is not handed to everyone on a silver platter. Yet on the other, if you are going to have sex, at least use some form of contraception. you play with fire, you are liable to get burned. My inability to resolve this sympathy/disappointment issue is a large part of what made me dislike ER, where the majority of the population comes off as uneducated, even when they are NOT. Yes people act stupid, but when you see it day after day, man.

  More disappointments as an HIV/diabetic woman comes in angry with the fact that her baby is at high risk, yet doing nothing we have told her to help control her diabetes nor taking any medicine for her HIV status. While i have no doubt this mother will love her child, should people this irresponsible for themselves be allowed to raise another human? oh those ethical dilemmas are the bread and butter of medicine

  After a brief lunch (2.00 tuna sandwich from the cafeteria) it was time for the weekly rounds on the NICU. In a juxtaposition so awful and hilarious at the same time was a 12 pound baby born to a mother with diabetes and some mild respiratory issues and a baby who could not have been more than 2 pounds in an incubator right next to him. The smaller baby has a less than 1 in 10 percent chance of surviving and even if he does, it will not be without some serious defects. His entire body stretched the length of your two hands placed next to each other. Beside the other child, the small frail infant made his roomate look like worlds most giant baby. Both premies, but that is the difference between 23 weeks and 32. 9 weeks makes a huge difference at that stage of your life

  Finally as i was sitting at the computer on the floor, looking up some labs, a hospital staff member walked by and with no reason, sung “i’ve got a golden ticket”

  And that was it. just that one line, no followup or pause, just a single line from willy wonka right as he walked by me. All i could think of for the rest of sign out that day was run home charlie bucket run home!

  and that was my day from 6am to 6pm. One more week left on OB and then its 2 weeks of gyne.

  P.S. I still detest/loathe/abhor/despise/hate with the passion of a thousand suns the term “baby daddy”

  ***yes i know i have yet to post pics of the eclipse, i will get around to it. It is a very busy week for me right now

  • 8:35 pm
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