Thursday, December 31, 2009

2009 in review

Only a few hours left in the year. Time to reflect, meditate, grow.

Has not been a good year. I tried to write my annual Christmas letter...it was a real downer so I didn't print it out to include in the cards I sent out.

I am grateful for a wonderful husband. He and I are opposites in personality, but we mesh well together. He has truly lived up to his vows 11 years ago and I love him all the more for that. He is my best friend and we make the other better.

I love my two kids. I am blessed with healthy kids. They are great fun to be with. Parenting truly is my hardest and most important job.

I have terrific friends. Went out last night karokeing with several. They are great for venting upon and making me laugh when I need it.

I do love my job. I can't imagine doing anything in medicine other than OB-Gyn. It's just who I am. I am grateful that the hospital supports the clinic so I can focus on the medicine part.

I have a roof over my head, food in my pantry, the ability to walk without crutches, and dogs running underfoot. I need to stop being such an Eeyore and focus on what's right, instead of what's not.

May all of you have a healthy and happy 2010.

Wednesday, December 30, 2009

Brag

So I'm out with the girl, shopping for her brother's birthday presents. We stop to eat at a small Indian joint, where she is truly a pleasure to be with. We chatted and ate. Good food, good company. It's a nice way to spend a day. Plus she's the only one who will eat Indian food with me, so we find excuses for "girls' dates" frequently.

Afterwards, the waitress came up to us and complimented her on how well-behaved and mature she acted. The waitress was surprised to hear that she was 9, she thought DD was a 12 year old.

Dear Son

If Mom is in bed with her eyes closed, there is NO need to poke her and ask "Mom are you sleeping?"

Love,
Mom

Monday, December 28, 2009

Luck

There's a lot of it in medicine. I'm a relatively young doc, but even I'm starting to have quite the collection of cases that make you shake your head in amazement. And in rural BFE, support staff may or may not be available (we just got an interventional radiologist a couple of months ago) so it's on us. And if the patient isn't stable, I'm not shipping out...

I had the rep as a resident as a "shit-magnet". One day, as we were scrubbing into a true crash section, the attending looked at me and said "Jonesy, you really ARE a shit magnet!!!"

Some people walk out of the hospital when they should not have. I have had cases where 19 units of PRBCs ended up being transfused after a standard vaginal delivery. Aortic dissections in pregnancy are NOT a good thing...the CV surgeon looked panicked when he realized about the viable fetus. Hell, on that one I pointed out I can get the kid out in 30 seconds, it was his part that could kill her.

Blown ectopics with liters of blood in the belly. "Where is the tube?" is going through my mind as I'm pulling out clot after clot to try to see down in the pelvis.

A vaginal laceration can be deadly...or at least close. Had one in residency where the woman's partner was wearing a chunky ring that gave her quite the tear...had to repair it in the OR at 3 am. The attending was less than happy to be called in for that. Vaginal mucosa has an abundant blood supply and she ended up needing several units of blood. The attending that was called in then related another story about when he was a resident and had a similar case.

Term demises. Really hate them. Nothing good about them. And most of the time there is no explaination.

Many times, skill creates luck, but there have been many a time where just sheer good luck has prevailed for me. OB is lucky, our patients are young and can withstand a bigger insult than an older, less healthy patient. Sometime, though, my luck will run out. Law of averages.

Friday, December 25, 2009

Christmas morning...

7:01 A.M. I am greeted with a slurp from a dog, a girl telling me that it's after 7:00 just like I told them and a little boy singing "It's Christmas, it's Christmas, it's time to open presents!" over and over again until I start moving.

7:10 A.M. Fist cup of coffee is being drunk.

7:11 A.M. Presents start being opened.

7:47 A.M. Presents are all opened.

8:30 A.M. Homemade donuts are being devoured.

8:45 A.M. Laughter from the note Santa left:

Dear Kids,

Thank-you very much for leaving out the plate of goodies. The gingerbread men looked very tasty. Unfortunately, I wasn't able to eat one of them myself. Mrs. Claus has been telling me that I'm becoming just a bit too much of a jolly old elf myself, so I'm afraid it's just carrots and skim milk for me.

Dasher and Dancer, however, are very partial to gingerbread men and they tell me that they were delicious. Rudolf wanted one too, but they make him gassy and I've still got to ride behind him for the rest of the night, if you take my meaning. Tell your mother that the reindeer said "thank-you" for baking the cookies.

Yes, we're a bit warped.

Thursday, December 24, 2009

Musings

9+ hours is a loooooonnnnnngggggg time to be in the OR. Mom seems to be OK, but talking to her is frustrating - she's very hard of hearing, and misunderstands phone conversations constantly. Plus she's still on a Dilaudid PCA, so she's loopy too.

Did you know Santa has a cell phone? It's how I threatened my kids into behaving today. ;)

Who in the HELL wants their hip replaced today? Yes, it was on the OR schedule! I saw it when I went in to do an ectopic from the ER.

Couldn't get everyone discharged today, so I'll have to round tomorrow. Grumble.

Merry Christmas!

Tuesday, December 22, 2009

Waiting

Mom's surgery was scheduled at 2 pm today...and she was wheeled back at 2:10. She's still in the OR, which is one long fricken time. Hope the surgeon has a foley in him! ;)

DH is up in Michigan, texting me updates. Last one was about an hour ago.

At least this call night is being kind to me...(tempting the call gods, but, oh,well).

How NOT to start off your Monday...

1. Run late because you kept hitting snooze.

2. Get rear-ended on the way into the hospital to round.

3. By the CEO of the hospital.

2009 can't end fast enough. :) I'm fine and so is my car.

Saturday, December 19, 2009

Kids and their funny statements, part umpteenth

So my 5 year old boy was sitting in my lap the other night when he let one rip. Loud and stinky.

I looked at him and asked him "What do you say?"

And he looked at me with these big blue eyes wide open and said "I didn't do it! Mr. Bear did it!"

"Mr. Bear is upstairs in your room."

"Mr. Bear farts really loudly."

I couldn't help laughing.

Friday, December 18, 2009

More crappiness

So Mom was scheduled for surgery earlier this month. It got postponed due to scheduling issues with the surgeon until today. Fine, whatever. I can understand.

So she does the Mag Citrate prep yesterday for surgery today. She is scheduled to be the 1 pm case. I manage to get coverage and my sister, BIL, DH, and me are all there for the surgery...at 12:30 I remark that since she's not in pre-op yet, there's no way it's running on time. At 2:30, we ask why she isn't in pre-op yet and are told that her case is now scheduled for 4:50 pm. At 3:15, we find out the surgeon has canceled it due to the previous case is still going on and he doesn't know how much longer it will take. It is rescheduled for next week Tuesday...I'm on call and doubt that I can arrange coverage on such short notice. DH is on winter break and will be there, but the rest of us have to work.

She will be in-house over the holiday...assuming it goes THIS time. I am on call for Christmas weekend.

AURGH!!!!!!!

Monday, December 14, 2009

Kids say the darndest things, part 2

So we live in rural America, in a super-conservative area. I am a social liberal. I can cloak well, as can DH.

So today, we get a Christmas card machine-signed by the Obamas. We show this to our 9 year old and boy, oh, boy is she IMPRESSED. As in her jaw is wide open and she thinks that we are the bomb to get a card from the White House. I point out that we are probably the only people in the county to get one of these. DH starts laughing. The girl asks "Why?"

I'm trying to explain liberal versus conservative political philosophies and failing miserably.

So she asks "Because people around here don't believe in democracy?"

Oh, kids sometimes nail it without even meaning to do so.

Saturday, December 12, 2009

IUFD

I hate them, hate them, hate them, hate them, hate them, hate them.

They represent the worst thing about OB.

Thursday, December 10, 2009

Bad day

Lets see..

A patient altered a script for post-op pain meds from a quantity of 30 to 80. Pharmacy called me and verified what I wrote. We use carbon copy scripts, so I have a copy of what I wrote in the chart. The police are now involved. She getting dismissed from my practice.

One NP in the office is pissed at me because I snapped at her when she walked into a room when I had the door shut and I was talking privately to my boss.

Another fetal demise.

My stupid knee hurts because I slipped on the ice. No, I am not going to tell ortho.

Wednesday, December 9, 2009

Good day

All patients today in the OR were thin and insured. My iPod was playing ABBA. All had real pathology that hopefully surgery will cure. Got out a 10 cm myoma through a 6 cm mini-lap incision. My longest case took 45 minutes.

And the PITA patient who (finally) was REALLY in labor last night, who had a quick and easy vag delivery told me this morning "That was easier than my first delivery when I was induced!"

And I'm now off call. Beer is opened. ;)

Monday, December 7, 2009

I am evil

So last week, 3 nurses at our clinic announced they were pregnant. All due at about the same time, which will make scheduling interesting this summer. Our office manager doesn't want to hear about pregnancy right now...
which is why I walked into her office today to tell her I was pregnant. She swatted me!

Evil laugh.

Sunday, December 6, 2009

Kids say the damnedest things

At Oh-too-damn-early-in-the-morning the other day:

Poke. Poke. Poke.

One eye opens to see the boy. I grunt at him.

"My penis is stupid."

Both eyes open at this. "Huh?"

"My penis is stupid."

"Why?"

"It's sticking up and I don't want it to."

"Talk to your father."

Wednesday, December 2, 2009

Quote of the day

From my favorite anesthesiologist, who was in my room today. We were talking about med staff last night, and I mentioned that I lucked out and got called out.

"Yeah, I go to my 50% yearly."
"Me too" I replied. "Too many whiny doctors to deal with there."
"Most of them need to be on meds."

Couldn't disagree.

Tuesday, December 1, 2009

Whine

Quarterly med staff is tonight. Crap, I don't want to go.

Monday, November 30, 2009

Spelling fail

On a new patient's paperwork, where we ask about previous surgeries: Sea-section.

I got the giggles reading it.

Saturday, November 28, 2009

I attract the STOOPID

All of these are actual phone calls today.

Case 1. a lady who I examined in the office on Wednesday for abnormal bleeding. I'm starting the work-up for a potential hysterectomy. Called yesterday complaining of "Bleeding to death." Told at that time to go to ER. Called again today (interrupting dinner) with same complaint. Did not go to ER yesterday. Also tells me she's pale and dizzy.

Talked to ER just now. Her hemoglobin is 13. I guess it's a slow bleed. ;)

Case 2. First trimester gal with n/v. Called in some phenergan suppositories. SHE CALLED BACK TO DOUBLECHECK IF IT WAS OK TO TAKE IN PREGNANCY!!!!!!!! No, I'm just going to call in something that will cause your child to have 3 eyes and 1 ear. I mean, WTF?

Case 3. Lady just d/c'd from hospital yesterday by her internist. Having similar issues as to what put her into the hospital. I specifically asked if she had any GYN problems. Nope. Please call your family doc, since I can't help you.

Monday 5 pm can't come soon enough.

Thanksgiving

My favorite holiday. A reminder to step back and be thankful is something that we all need.

I'm hosting the 4th annual Unthanksgiving Feast today. I always do it on the Saturday. It's just easier. This year, we'll have 10 people here.

There is a lot to be thankful for. The ability to walk (amazing what several consecutive days of rest can do). Food on our plates and a roof over our head. Friends who take a week's vacation to care for you. Healthy kids. Unconditional love from dogs. A husband who lives his wedding vows fully and without complaint.

I should go stick the turkey in the oven soon.

Good timing

My "drive-through" (a patient who arrives on L&D complete and ready to push) arrived at a time when I could get home and get the turkey in the sink of water to finish thawing.

I actually like drive-throughs...yes, it is disruptive during office hours, but it goes so quickly, I usually end up being only 10-15 minutes behind. And in the middle of the night, I LOVE fast deliveries.

Nurses like drive-throughs too - less charting! My assessment and plan on the written H&P: Labor. Delivery. Gotta love going through the paperwork after the actual event.

Wednesday, November 25, 2009

Can't do it all

And I finally admitted it.

I called my PCP and got my meltdown out of the way. I left with a script for an SSRI.

I started it this week...hopefully it will help. I was talking to one of my favorite L&D nurses and evidently there had been a betting pool on how long it would take me to admit that I'm really stressed. Thanks guys!

On the upside, when I lay on my back all day, my knee doesn't hurt. ;) I'm on call again this weekend and hosting turkey day...how much do you want to bet that I end up needing to leave my own party?

Hair pulling

Are the new guidelines published by the task force. We now have multiple competing guidelines on mamms, worried patients, an avalanche of papers to read before I decide to change my practice (I am a thinking doctor, after all).

And buried deeply in the back of a practicing docs head...the knowledge that a missed breast cancer is a leading cause for lawsuits.

It adds up to one big, hot mess.

OTOH, I'm glad the pap smear guidelines got publicized. It makes sense not to do paps on teens. For years, I've been trying to avoid doing them. We know that the natural course of HPV is clearance in these young girls. Now if I can only convince people that they need a pap every 2 years. I've had an easy time with post-hysterectomy patients, they are thrilled to know that they don't need a pap.

I have to say, I'm sick of talking about it already. Reminds me of the HRT debacle back in 7/02, when those studies were published.

Tuesday, November 24, 2009

Have to brag

About my daughter, the 4th grader. Honors report card, reading at the 9-10 grade level, and well behaved in class. Her teachers report that she is one of their favorite kids.

And our boy is a great kid too, very sweet and loving. He's very silly and can always get us to laugh. We're lucky to have two great kids.

Monday, November 23, 2009

No control

That's the essence of OB call, like Grumpy said. It really sucks.

Take this weekend. I had a huge FAIL on the rest and elevate your leg. Why? Multiple spontaneous labors leading to deliveries and then an ER hit last night at 8 pm, who ended up in the OR. I got home at midnight.

And I have office starting at 8 am.

Sunday, November 22, 2009

Two steps forward...

And three steps back. Gordon put me back on crutches. I have to admit, I can really fly using those things, so I'm faster with them. But I'm frustrated at my lack of progress. I gave him an earful due to the frustration, which is out of character for me. He's so damn cheerful, I don't think it phased him. My knee is still tender and swollen...he measured it Friday and it's actually larger than when I started.

He told me I need to stay off my leg. And then I broke loose, telling him about mom moving in and needing to caretake her. I have too many people to take care of to be down. The original plan was get surgery in October, recover, and then have mom move in after the holidays, but she's unable to be alone now so plans changed. He just shook his head and told me to rest as much as I can.

So I'm trying to rest this weekend. And babies being babies, are not allowing me to do that. Spontaneous labor is awesome compared to induced labor, but it causes havoc in my schedule. At least they were both delivered before 9 pm yesterday. ;)

Dammit, now I have to round today since they came in last night. :(

Wednesday, November 18, 2009

Every time

I write about how much I love the OR, I must piss off the OR gods.

Multiple vag hysts today. I hate vag hysts. A latex-allergy case in the middle, so all of the previous cases also have to be latex-free. I hate latex-free cases.

grumble.

Nice delivery

My two favorite places at work are the OR and L&D rooms.

So I had primip last night, being induced (yes, I know. Overdue by a couple of days and I had a moment of weakness to whining in the office. I'm not perfect.) No health issues. Happy couple. Happy baby during labor. Checked her after office hours and before I went to PT. She was 7 cm. Told the nurse about my appointment and that to call me only if the head was out. ;) If she was complete, I didn't want to know.

So I go to PT and get tortured. As I'm sitting there at the end with the ice and electric stimulation, I call. She hasn't checked her but told me "She started having earlies about 15 minutes ago."

SWEET!

Finish PT, wander back to the hospital. Head is at +4 station. Pt pushes for only 20 minutes with a happy vigorous baby. Daddy is sobbing. She kangarooed while I got the placenta out and stitched her up.

Nice delivery.

Monday, November 16, 2009

Still slow

So Mom moved in. And thus far, she is still alive and I am still sober. We'll see how long that lasts.

But she had a list of things that she needed/wanted from the store. So off to Walmart I went. And no, I was wearing jeans and a sweatshirt, definitely not People of Walmart worthy. ;)

I'm thinking I'm not going to be doing any more shopping in the near future. It hurts walking through a big store like that!

Saturday, November 14, 2009

2 hours

And counting until DH comes back her with my mother.

And let the fun begin.

Held back!

I was supposed to graduate from PT this week - yesterday was visit #12. And my ROM is back, which is nice. Most of the swelling is gone, but there is still a difference between knees.

But my right leg is still pretty weak. It's amazing how you can compensate (and not even realize it). I still hate stairs. My biceps and upper back are getting awesome because I've been using them to go up and down flights of stairs. Balance and proprioception is off if I'm forced to close my eyes. If I'm walking without crutches, I'm staring at the ground to doublecheck position of that leg. Gordon called me out on cheating during squats - all of my weight was on my left leg...I didn't even realize it.

And objectively, that right leg is a total loser! During the strength testing, he could move my leg any way he wanted to move it. I couldn't hold it in position to save my life. Left leg is just fine and stayed put.

Friday, November 13, 2009

The end of the world

I thought I recognized a patient on the People of Walmart site. It's the right state and it looks JUST LIKE HER.

Thanks, Grumpy.

Thursday, November 12, 2009

Mothers drive you insane

And that's my plan for when my kids get older. ;0

She's doing better. On Vanco for presumed infection. Got 3 units of PRBCs thus far, last hgb was 7.9. Her white count is up to 1.1.

And I browbeat her into moving in with us. More accurately, I told her that and she finally stopped arguing.

It will be easier to keep an eye on her here.

Monday, November 9, 2009

Readmitted

I'm starting to dread these phone calls at night.

Grrr.....will go up to Mecca after operating on Wednesday and say "WHAT THE HOLY HELL WOMAN?!?!?!?!?!?!?! IF YOU HAVE BEEN PASSING OUT FOR OVER A WEEK, WHY THE HELL DIDN'T YOU TELL SOMEONE?!?!?!?!?!?!?!?"

Another neutropenic fever.

I am aging too rapidly here.

And yet another PSA

Kicking your doctor in the delivery room is NOT appreciated.

Thank-you.

I was proud of myself - I didn't cuss outloud, although I really, really wanted to. She got my bad knee!!!

Saturday, November 7, 2009

I want to claim credit

We do a lot of practical jokes on L&D. Docs, nurses, techs, the vast majority of us love to pull pranks. And we do them frequently. Birthday folks have to be especially wary (hence the reason they still after 4 years, don't know my DOB). We have a rubber snake that is making its way around. If we have a willing patient, nurses have been known to convince her to place it between her legs and then send the doc in for a cervical check. Lockers have been known to be stuffed full of popcorn.

So last Halloween, another doc had a labelmaker out. He made nametags saying "Boo" for all of the nurses. Bea was working that day, and he had made one for her too. He even offered to affix it to her nametag. She looked at her name badge and read "Boo Bea" from it and turned bright red.

I so wish I had thought of it first!

Friday, November 6, 2009

Slow Learner

That would me.

I had told DH last night, since he had an early morning meeting, that I could easily get the kids off to school since I had no office and only a PT appointment at 9. Other than that, a wide open calendar until my hair appointment in the late afternoon.

Remember the previous post about the GDER? It ended up being a torsed ovary in a pregnant gal. Initially thought to be an appy by the ER doc, but since she was pregnant, I got to admit her and promptly consult general surgery.

I quick get the kids hustling to get dropped off at school (forgetting my cell at home in the process and needing to go back to get it). I gimped onto L&D, where the surgeon has beaten me into evaluate her. Quick dictate the H&P.

Eric (the surgeon) looks at my crutches and starts in on me. First words out of his mouth : "I heard from Jeff (the orthopod) that you aren't supposed to be working!"

L&D nurses lean in to hear my reply. I admit that I am not the best patient, but that I need to take of my patients. Eric arches his eyebrow, but doesn't say anything.

Eric and I then go into the patient's room. By this time, I've left the crutches at the nurses station, since there's not much room in triage. And Eric looks at me, big ole gleam in his eye and tells the patient "Dr. ER's Mom really likes when patients do what their doctor says. Compliant patients heal better." The nurse in the room bursts out laughing. I'm giving him the strongest stink-eye that I can give.

He ended up taking her down to the OR, agreeing with the ER doc that it was an appy. I offered to assist, but he said he would call me if it was a GYN issue. So, I looked for my phone (DAMMIT! Left it in the car!!!!) and told him that I would stay on L&D and round. By this time, it's 10 minutes before my PT appointment, so I call and cancel, apologizing up the wazoo.

15 minutes later, I'm in the OR dealing with a torsed ovary.

AURGH!

They should know better...

Than to fight when I am on the phone talking to the GDER.

Grumble...

Poor ER doc heard an earful while I yelled at the kids to quiet down.

Thursday, November 5, 2009

And it is a grind

Horrific call the other night. Even though the full moon had passed uneventfully for my cross-coverage, my call brought out the stoopid. Correction. The STOOPID. When we got out of bed (please note I did NOT say woke up, because by that time, we had had zero sleep), hubby was cursing the call gods and my cell phone. He wasn't the only one.

I spent the day operating and trying to remember why I agreed to do these surgeries. Now, I'm a good surgeon and I know my limits. I am happy to refer on if I don't think I can technically do a case. So I'm doing a hysterectomy yesterday and every other sentence coming out of my mouth was "Need to work on patient selection." or "Why did I agree to do this one?" Also said frequently by the scrub nurse "I need more suture thrown!"

But it is a great feeling when you get that last piece of the puzzle and the case gives way, surrendering to your skills/tenacity/patience (take your pick). We were finally able to remove the uterus and my assist and I high-fived each other. Anesthesia was just happy the blood letting was completed. Big fibroidy uteruses usually have large, multiple blood supplies and this one was no exception. I'm guessing the uterus weighed 2-3 pounds, when they normally weigh around 1-2 ounces.

The remainder of the case, you go on semi-cruise control. Pedicles hemostatic. Check. Lap count correct. Check. Close peritoneum. Check. Close fascia. Check. Reapproximate sub-q tissue. Check. Close skin. Check. There is always a point in a surgical case where it's almost automated.

Oh, and I went without crutches for the first time. Let's just say that was a huge mistake and I took a couple of my hoarded pain pills after I got home. I have about 8 left...I am rationing them for the truly bad days. I refuse to be the PITA patient and ask for more.

Tuesday, November 3, 2009

Back to the grind

You know, most people are basically decent. So they won't ever catch themselves being made fun of in the blogosphere of grumpy docs, nurses, profs, salesclerks, etc.

But then there are the special ones.

The wholly self-absorbed assholes.

I caught wind of a few of these the past week. I have been canceling office hours the last few weeks because I was physically unable to work. And most folks have been very understanding. But the few that haven't been have truly exposed themselves to be snail slime.

Case 1. New patient, transferring to me from another doc from the next town over. Transferring because previous doc "Isn't taking me seriously." Whatever. So my nurse is stuck calling (3 days ahead of time) to cancel and reschedule. And the patient can only do certain days at certain times. Which means it will be a few weeks since other people were previously scheduled for those days/times. Per my kick-ass nurse a direct quote "Well, hopefully she'll be at THAT appointment! I've been in pain since August!" Bite me.

Case 2. A PITA who followed me from my previous practice. Called the day before my surgery to ask for a refill on a medicine. My cross-coverage didn't want to fill. Fine, it's not life-or-death urgent. Demands to speak to me that day (um, no way in hell). I had left the office by then. She called again Monday, asking for a refill, which I then OK'ed THAT VERY DAY SHE CALLED. And then she bitched to my nurse that "I had to WAIT for you to deal with my problem!" Jen tried to explain the concept of sick doctor, but it's all me,me,me to this woman. "It took her FOREVER to agree to the refill." Fuck you.

And then there are the folks who arch an eyebrow as they watch me hobble into the room, ask what's wrong and I explain that I had knee surgery. And these folks tell me "You came back too soon! Why are you working?" I had one patient literally smack me upside the head and tell me I was stupid. Another patient made up some story about how I was busy saving the lives of these triplets and that's how the doc who delivered her child ended up on crutches. I think the story involves me as a superhero flying into something.

GO VOTE!!!!

Thank-you.

Sunday, November 1, 2009

A Public Thank-you

To my Dearest Husband, who has been taking care of me for the last few weeks.

I owe ya one.

I love you with all of my heart and I truly appreciate the work you've had to do the last 3 weeks. Thank-you.

Saturday, October 31, 2009

Difference between me and hubby:

Me buying Halloween candy : I buy the stuff I DON'T like, so that I'm not tempted to eat out of the bowl while passing out the candy.

Hubby : Buys the good stuff. Great, now I have to exercise a lot of restraint while handing out the candy.

It was hard last night passing out the good stuff. I only ate 6 pieces.

Thursday, October 29, 2009

Woot!

Forgot I traded call (tonight for tomorrow night). Second Percocet, here you come!

I just need to stay off of the stupid knee.

You make plans...

And higher powers laugh.

So I cut my office hours today. I expected to round on my in-house patients and go home.

But noooooooooo... GDER (God-damned ER) calls me in for an unstable ectopic and then an unstable incomplete miscarriage.

Spent the afternoon in the fucking OR. Which most of the time wouldn't be a problem, but my knee is swollen and throbbing after PT.

Wednesday, October 28, 2009

Good patient quotes

So I'm with a patient who is pushing. One of her labor support persons was a woman I delivered a few months back. Now Megan (not her real name) was doing a great job pushing, and I'm saying my usual spiel of "Good job! You can do it" cheerleading her along.

Her friend chirps in "You're doing great!"

Megan replies " I hate you both. I know that she won't come out!"

Me, "No, really, you're doing great!"

Her friend "I thought you were lying when you told me that too. I woulda kicked you, except I couldn't move my legs."


*********************************
Another patient, sans epidural. She's just starting to push when she tells me "I can't."

Me : " No such word as can't in this room."

Patient gives me the dirtiest look possible, then slowly, for emphasis says "I CANNOT do this."

Her mom and I just started laughing.

So I guess I'm a sadist too. ;)

Tuesday, October 27, 2009

Physical Therapists

Are sadists. I'm convinced. I look at Gordon when he tells me to do some exercise and ask "Are you INSANE?" There's no way my knee will bend that far. And my poor quads are spasming away from the effort.

But somehow, he makes it so. And it seems to be helping, as I can now bend my knee more than 90 degrees.

The real test will be tomorrow - my first official day back in the OR. I don't trust my leg right now. But I need to get back full force.

I don't do this patient thing very well.

Saturday, October 24, 2009

They were right

I give in, I admit I was wrong. I should have waited another 1-2 weeks before going back.

Just have to get through until Monday evening when my cross-coverage is back in town.

My office manager was going to throttle me on Thursday. I should not have been seeing patients. But I canceled most of my office hours next week.

Crossing fingers about this weekend...

Wednesday, October 21, 2009

Ohhh....

My shoulders and upper back are getting the work-out from the crutches. To go long distances quickly, I don't weight bear, but instead swing along on the crutches. I'm paying for that.

Had my first surgery today. Got a lot of ribbing from everyone. When they saw me swing in on the crutches, they understood why I asked for a specific assist...he's fast and good and that allows me to scrub out fast and sit down. Plus he's a joker and it's fun to spar in the OR with him. He's like the obnoxious older brother who is always teasing you. Today he was alternating between calling me "Doc" (his usual name for me) and "Gimpy".

Leg is much more swollen and painful today. Yesterday was not the best way to ease back into work. Operating today wasn't a good idea either, but I had to add in this case.

Tonight is shaping up as outpatient hell. At least so far, I don't have to go in, although I may want to rethink typing that. If you are pregnant and have been bleeding FOR DAYS, why pick nighttime to go in? And why do you think that I will bump up your section if you go in AGAIN (5th time since Saturday and 10th time this month) for "Abdominal pain?" And why, if your doctor works out of hospital B exclusively AND YOU KNOW THIS do you come to our hospital for evaluation? I'm covering call for the doc o'month until he comes back into town. I hate no doc call.

And so life goes on...

So how DID it go?

Got called when as I was rinsing the shampoo out yesterday for a drive-through (aka someone who walks in complete and ready to push).

Delivered her, looked at my list. I had 5 to round upon. As I'm sitting at the nurse's station, someone comes up and says "I think my water broke." I look up and recognize her as one of mine.

"Please put her in a room where I don't have to walk far."

She was right and dilated to 6. We kept her.

Then I had an induction due to postdates from the other practice (he's out of town).

Then an observation from yesterday...her urine labs came back. Another induction for pre-eclampsia at term.

Then the office called. I had them bring in someone...IUGR, oligo, hypertension, preterm. She's getting steroids and mag until I deliver her today.

Then the psych ward called with a GYN consult. Ohdeargodshootmenow!

And I stuck myself with a FSE while removing it from the head after delivery. Cut deep enough to draw blood. Sonofabitch, got to report it and get labs drawn.

Got home around 8:30 pm.

I missed this?!?!??!?!?!?!?!?!?!?!

Tuesday, October 20, 2009

Here it goes

My first day back on call starts in an hour.

I drove for the first time yesterday. Since my right knee was the one operated upon, it wasn't easy. But I had to do it in order to confirm that I could...can't be on call if I can't drive. So I went to the office to sign the kajillion charts that had piled up. While I was there, my friend the risk manager called (she really is one of my best friends). She had a cow...until I told her that I wasn't seeing patients, I was just doing paperwork.

My nurse Jen had a cow when she heard I drove (lots of cows around here). She took last week off and nursed me. I tried to explain that I needed to prove I could drive. She yelled at me anyways.

Off to shower and get dressed...

Monday, October 19, 2009

Something funny

So last month, I spent a weekend in New York City.

Before going, I had told my mother that I was going with the girl. Her response:
"You're too naive to go to a big city."

Dear god mom, do you KNOW what I deal with on a daily basis?

Sunday, October 18, 2009

You know you work at a clinic when...

(apologies to Jeff Foxworthy)

1. You read the newspaper to see which patient has been arrested recently.
2. Your speed-dial includes 911.
3. Your patient has no idea who the baby daddy is.
4. You see at least 1-2 patients per day who come courtesy of the county jail.
5. When you talk to your office manager about your recent surgery and you mention your prescriptions, the first words out of her mouth are "Do you know the street value of those?" And your answer is "Yes."
6. You have bullet-proof glass in the lobby's window.
7. You know the CPS workers very well.
8. You can't get ahold of your patient who tested positive for an STD - no phone and last known address is the local shelter.
9. You have "Shower upon admission" pre-printed on your L&D admit orders.
10. You know cocaine does better inductions of labor than pitocin.
11. Nothing surprises you anymore.

Wednesday, October 14, 2009

Update

The disadvantage of being in BFE: everyone knows your business. And since I have an unusual last name, it's pretty easy to guess when I am the patient (like last night in vascular lab).

I am hospital-employed, solo practice in a clinic setting. So the hospital has a vested interest in knowing how I am feeling and whether or not I am healthy.

Risk management stopped by earlier. I have been informed that I am NOT going to work while still on crutches.

"But, but, but...."

"No. The liability is too much for OB." (she's probably right). "It's the hospital's problem how to cover your call."

"And besides, do YOU want to screw up your knee even more?"

I gave up, knowing that I would never win against her. Plus she was right (but I won't admit it).

Tuesday, October 13, 2009

The saga continues

So my knee is swelling up and my ROM is minimal at best. My leg fricken hurts and I don't/can't be on narcotics when I'm on call on Friday. Went back in today to see PT and ortho. Was placed back onto crutches. Here's hoping no crash sections happen when I'm on call this weekend.

LE dopplers are negative for DVT, which is good.

Got to see video of my scope - he was really impressed with the derangement. Dr X said that he taped it to show residents, since it is such a "nice" example of plica with impingement of the joint.

If you're going to have problems, do it well. At least it wasn't all in my head.

Sunday, October 11, 2009

Old stories

This happened when I was a lowly 3rd year medical student, doing my infernal medicine rotation (2 VEEEERRRRRYYYYY long months).

So on your team was 2-3 med students, 2-3 interns, 1 resident and the attending. There were 4 teams, so we took call Q4. When it was your call day, you would take "The call pager", which was the code blue pager. If it went off, you went running to the room it was announcing.

We had weekly lectures. Med students were in one conference room, interns and residents in another. Now these room were blocks apart, since this was a HUGE hospital - think several city blocks long.

So Allison and I were at the students' lecture when the pager started to squawk "Code Blue, Room 303. Code Blue, Room 303." We both just looked at each other and the rest of the med students were saying "GO!"

Remember when I said this was a huge hospital. OUR lecture room was a couple of steps from the wing where Room 303 was. The residents were a good half mile away in their lecture. But being the good students, we arrive to room 303.

The PM&R doctor was there. He saw the 2 of us walk in and you could see the relief hit his face - "Thank-goodness you're here."

Then I piped up "I'm a med student." The panic returned to his face.

Allison and I at least figured out the "A" of the "ABCs" when the real rescuers arrived.

I ended up doing nothing much except staying out of people's way. 3rd year students are great at getting in the way.

Saturday, October 10, 2009

More...

Oral phenergan plus Percocet = one knocked out doctor. But at least nothing's coming back up. DH is starting to hound me about drinking, since I haven't been doing much of that (it keeps coming back up!).

I honestly do not understand the appeal of narcotics. Yes, they take away the pain, but dear god, I'm dizzy, light-headed and loopy on it. Plus I'm sure it's adding to my nausea woes. I'm weaning myself starting today, I hope. It still hurts more than I would like.

Took off the wrap this morning - he had my leg wrapped from upper thigh to mid-foot with an ace wrap. Incisions look fine, knee is very swollen.

Going back to bed now.

Friday, October 9, 2009

Finally woke up

I must be a lightweight, since I stopped anesthesia from giving me more than 1/3 of the dose of Versed - I felt like I was on a Tilt-a-Whirl. It was a new experience being on the stretcher instead of pushing it. Everyone knew me (of course). I felt bad that it took 2 different anesthesiologists to get my IV started - I had warned them I that am a difficult stick.

I do remember LeAnn wheeling me into the OR and then scootching over to the table. The very narrow table. The lights are very bright from that perspective. I don't remember anything else until I was being moved to phase 2 recovery, where I slept some more. I think ortho tried to talk to me then, but I'm not really sure.

I spent the rest of the night on our couch. I'd wake up for 5 minutes and then doze off again, occasionally vomiting into a bucket. Poor DH has been taking care of me and cleaning up my mess. At least so far, I've hit the bucket every time. :(

This morning, I'm trying some coffee because I do NOT want that caffeine withdrawal headache again! I've been sipping at it for about 1 1/2 hours now and so far it's staying down. I still feel queasy, so I'm leery of taking any pain meds for fear that I'll throw them right back up. I might call and ask for Phenergan to be called in for me, since I need to schedule my post-op check.

I can very carefully weight bear on the leg, which is nice since me on crutches is amusing to all who see me. Thank God there is no video available of that, I'm sure my DH would send it in to Failblog.

Evidently, Dr X told DH that my knee was pretty significantly messed up - that it was one of the worst ones he has seen in a relatively young patient. I should have done this sooner.

Thursday, October 8, 2009

Other side

So I'm NPO since midnight. I'm hungry. I'm uncaffeinated. My head is starting to hurt from caffeine withdrawal. I hate the idea of giving up control, and that's EXACTLY what I'm going to do in a few hours.

I haven't been able to take NSAIDs for the last week...I sorta yelled at my surgeon yesterday for that (ran into him in the hospital cafeteria). I was whining about the no NSAIDs today when I rounded and no one was very sympathetic to me on L&D. The tech told me to suck it up and that charge nurse reminded me that I didn't want to bleed to death.

I felt the love, let me tell you.

Here's hoping this surgery works.

Wednesday, October 7, 2009

The power of the cell (phone)

So mine died yesterday. I could hear it ring, but could not answer it. This is a problem when you are on call.

Awaiting a new one while borrowing one from the hospital's IT department.

Not a single page last night after 6 pm.

So IT asked if I wanted my hospital email on the phone. Oh HELL no! Why on earth would I want another way for people to pester me constantly?

Monday, October 5, 2009

I doubt it's GYN-related

Since your previous doc did a total hyst with BSO.

I did a laparoscopy 4 months ago and found a big fat NOTHING. Not even adhesions.

And we (my nurse and myself) have a question - how can you FEEL pain on Flexeril, Methadone, Oxycontin, Ativan, and Zanaflex?

Go back to your PCP. Take some Advil. But no pain meds from me!

Joke

How do you tell the difference between swine flu and bird flu?


For the bird flu, you get tweet-ment. For swine flu, you get oink-ment.

Made me giggle this morning.

Sunday, October 4, 2009

Bad Momma

So I'm reading this music blog about how punk is dead. And they link to a Green Day video.

I now have a 5 year old singing Green Day in the next room. "Do you know your enemy? Oh lay oh lay. Violence is an energy, Oh lay, Oh lay."

My 9 year old loves listening to American Idiot. And she can sing along to it.

Saturday, October 3, 2009

More thoughts

I'm a small town OB. I literally cannot go out in public without seeing a patient or two. My kids are getting used to it. My husband laughs because if I see an obnoxious patient, I will use him as a shield so that she can't see me.

Going to a birthday party today for a friend's child. I delivered her...which is how we met. That's part and parcel of small town. There is a limited pool of people to be friends with...and there's a limited pool of docs. By necessity, we are friends with some of our patients. We work with our patients (I have delivered L&D nurses and have several of the unit clerks as patients).

It's hard, being both a friend and a doctor. I really hate operating on friends, although I have done it. I did one case last month on a friend and it went perfectly, although the night before I was nervous.

Tuesday, September 29, 2009

Stupid me

I decided that seeing patients at 6 am one day a week was a good idea.

Working patients (i.e. my insured patients who followed me to the clinic from private practice) love it.

I am not a morning person. Neither is my nurse. Every week, I bitch and moan on Tuesday morning.

Monday, September 28, 2009

Readings

So every doc tried to keep up in journals. It's an impossible task.

I skim the Green and Gray journals, but I read the "Throw-aways" cover to cover. Why? Because they are practical and summarize the research for me. Plus the malpractice columns are always interesting reads.

So today I was reading one of the throw-aways (The Female Patient, if you care to know) and there was an opinion piece on elective deliveries. Good research shows that delivering prior to 39 completed weeks increases the chances of neonatal complications. This is well known and trumpeted through OB-dom. Many OBs choose to ignore the evidence, but it is true. It's why I don't do it electively.

I honestly think the idea of elective induction being out in the community is dangerous. Women just think "oh, I'm going to get to have my baby when I chose." But I hate the idea! Sometimes, I wish patients didn't know that we can do it. The problem is, they DO know. And there is pressure.

Saturday, September 26, 2009

Preventing c-sections

Earlier in comments, someone criticized a labor with interventions. First off, I agree on trying to minimize the medicalization of pregnancy and labor. Mother nature is smarter than me and my pediatric colleagues. I try not to do elective inductions and my patients are told this AT THE FIRST APPOINTMENT. Labor works better if it comes on spontaneously. Plus the risk is lower that the baby will need my colleagues in peds.

Now, there are indications for inductions. And I have no hesitation to do them if I feel the benefits of delivery are more than the benefits of continuing the pregnancy.

I've looked at this month's stats thus far. Note that I do not do VBACs due to medmal insurance coverage. Rural areas have a more difficult time with the "suggestions" for dealing with one in labor, so I can't comply with the requirements the insurance company has. So anyone with a previous c/s gets an elective repeat c/section sometime in their 39th week. I don't want to add to risk, I work hard to prevent the c/s in the first place. I offer versions for those with breech/transverse fetuses.

For women with a planned vaginal delivery, 1 section out of 23...a 95% rate of delivering vaginally. My overall vag delivery rate (including those with planned c/sections for repeat, previa, malposition) is 81% (22/27). Most people were spontanteous labor. Several were inductions at 42 weeks, one induction for GDM, one induction for fetal anomaly with me wanting her to deliver during the week when peds would be available, two inductions for IUGR (the one failed delivery).

I have been trained to do c/sections...and they can be life-saving. But a large part of my time on L&D is being an overpriced cheerleader: "You can do this! Push! I can see head!" My value is knowing when to intervene and when to hold back. It's an art...one where I'll always be learning. Should I have called the section sooner? Did I call the section too soon? Should I have tried an operative vaginal delivery first (I admit, I do do nice vacuums)? Why do I have a bad feeling in my gut...there's nothing objectively wrong.

I readily admit, most of the time I'm kinda superfluous to the process of delivery. But those times when I'm not...that's when I earn my gray hair.

Thursday, September 24, 2009

Sunday, September 20, 2009

He's There...


Guess what I did this weekend?

I've seen Phantom several times before, all in the touring show (twice in college and once in residency). But this time, the Girl and I roadtripped to NYC and saw it on Broadway. (yes, the neon lights were bright)

Wow. Just WOW!

I've never before been to Broadway itself, despite my love of musicals. I had forgotten how romantic and seductive Phantom is in person. Yes, there is cheese galore, but I love it anyway.

And the guy playing Raoul is HAWT!

I didn't stop smiling all weekend. DD and I went to Times Square, Broadway, Central Park, and the Titanic exhibit (which was amazing, if you're in NYC go to it!). We spent Friday and today traveling, so we packed a LOT into a few short hours on Saturday.

Is it wrong to order a BLT on challah bread at a Jewish deli?

I need another vacation, a real one, not one spent at Mecca's hospital with my mother. This will do for now...I'm far more saner today that I was this time last week.

Thursday, September 17, 2009

Lucky 13

That's how many I've delivered since Friday. And there's an induction today.

Thank god I'm off this upcoming weekend!

Monday, September 14, 2009

Ahh, residents

So as part of my job, I have family practice residents in my clinic learning office GYN.

I had a patient come in recently for her postpartum check. She is a lesbian in a relationship with a great gal.

My resident was insisting that she needed birth control. I looked at the patient, smiled and winked. He just kept going deeper to my and the patient's amusement.

We finally reminded him that her partner is female...pregnancy for them requires some extra interventions.

You know it's a bad weekend...

When you have to bring in food for the nurses as an appeasement.

Every single patient on L&D was mine.
:(

Saturday, September 12, 2009

Friday night call

10 pm...delivery.

Check on the other 2 laboring. They're both fine. Head for call room at 11 pm to nap before delivering the next one.

Between 11 and 1 get 15 pages...mostly dumbass stuff. I actually asked one patient "Why ARE you calling me at midnight for this? This is for emergencies only!" She wanted to know what OTC meds she could take while pregnant. She obviously didn't read/lost the handout we give on that at the first appointment.

1 am...called for repetitive decels. Get the baby looking better than head back to sleep.

4:30 am called for delivery of baby.

6 am get back to bed after delivery.

8:43 am dumb husband calls to ask what I am doing. I might have been a little snippy to him.

10 am finish rounding. Break 3 girl's water to place internal since she isn't making much change.

Anyone would to take bets on zippering her this afternoon?

Friday, September 11, 2009

Cow story

So I'm in BFE. I can buy a cow and get it butchered pretty easily. In fact, my supplier is an L&D nurse. Many women around here work for the hospital to get insurance coverage for their farmer spouses, but I digress.

So I came home and said at the dinner table "I bought a cow."

DD's response : "It's going to live in our yard?"

"No. In our freezer." DH shot me the look.

Had DH pick up the order today. We now have about 400 pounds of beef at our home. Ummm...t-bones.

Help me


Because DD has decided that THIS is the instrument she wants to learn to play.

The violin.

Shoot me now. Please?

Wednesday, September 9, 2009

Trust

OK, we spent 45 minutes in the office discussing various options to treat your problem...both surgical and nonsurgical ( and yes, I documented and billed for that time, since BCBS will pay). And yes, I answered all of your questions there. I also remember my surgery scheduler calling you a PITA for all of your questions about stupid things.

Do NOT in the pre-op area quiz me on every detail on how I do the decided upon surgery including what SUTURE I use!

AURGH!!!!!!!!!!!

Tuesday, September 8, 2009

Stupid people, part one millionth

If you are in your first trimester of pregnancy and you fall on your back on SATURDAY...waiting until TUESDAY to get checked out is pretty stupid.

Yes, this was just a call a few minutes ago from L&D.

AURGH!!!!

Friday, September 4, 2009

Costs of obesity this week

3 D&Cs for AUB with thickened endometrial lining on ultrasound. Unable to get biopsies in the office for any of them. BMIs of all 3 are north of 50. I'm charging the insurance companies extra for the degree of difficulty - one of them I had 4 people scrubbed in with me to hold back assorted tissue. Plus you have the whole anesthesia charges. None of my normal vaginal instruments are long enough to work, so I'm Macgyvering solutions. Retractors aren't long enough, so I'm improvising there as well. My overhead lights can not be positioned so that I can see - I'm placing the hysteroscope's light source in the vagina...worked pretty well.

Induction for chronic hypertension, which would likely go away if about 100 pounds were lost.

Long discussion with a patient emphasizing her risk of post-op complications...I'm going to try and do a laparoscopic hysterectomy on her. Talked about wound infections, conversion to open procedure, blood clots. Told her it would be difficult. Her response "Is it because I'm a big girl?" Um, your BMI is higher than my age, so yeah, you're a big girl. And yes, that makes everything far more risky and complicated.

Post-op cellulitis in a c/s from last week.

Yeast infections galore.

Wednesday, September 2, 2009

Update

The meeting went as expected. Blah, blah, blah went a lot of whiny doctors. My new iPod has games on it too, which was handy since my phone's battery died.

As I was walking out of the Surgery Dept's meeting, I was with a couple other surgeons. We were commenting on another surgeon's perpetual whining and nitpicking, which was on full display at the departmental meeting.

Said the one of the others "Tom is so busy looking at the tree he doesn't realize he's in the wrong fucking FOREST!"

And so it goes.

Tuesday, September 1, 2009

Whine

The stupid quarterly med staff meeting is tonight.

I hate those damn things.

I sit in the back and play games on my phone. Much better use of my time.

Monday, August 31, 2009

Pharm rep today

So I tend not to like drug reps. Avoid them like the plague.

Get called back to the drug room today (need to witness you signature -- BULLSHIT!). Some rep I don't know is rattling about the newest variation on birth control pills. I don't give a shit. 90% of what I prescribe is Sprintec cuz that's the cheapo pill on Evil Empire's $10/month list. I'm not even sure what Sprintec is generic for... Off topic, another 5% is Apri (generic for Desogen) and the rest is Micronor or Alesse.

So anyways, she prattles on about some note she left on my desk last week. What note...playing dumb will get me far here. So she asks about setting up a dinner meeting with me to discuss Paragard IUDs...I shut that down quickly by saying that I don't take away free time from my family for anything like that.

And yes, that note had been seen last week. And appropriately filed...in the trash can.

Sunday, August 30, 2009

"That must be a great place to work!"

When I tell people what I do for a living, that's what they say.

"It must be such a happy place!"
"You are so lucky!"

The nurses and I were talking about this yesterday. L&D is the happiest place in the hospital...until it's not.

Do we talk about the term stillbirths? Or the nightmarish scenarios of losing a mom? Tell them about coding a newborn? I used to have nightmares about some of the deformities I had seen...I don't anymore. Delivered one recently that had multiple anomalies...my resident had to leave the room, it upset her so much. My practice has lost 6 babies so far this year, either as stillbirths or shortly after delivery. Do we talk about the crackheads on their umpteenth baby who refuse to get sterilized?

We don't. We just nod and say "Yes, it's great."

Until it's not.

Saturday, August 29, 2009

Smile!

My new range has been delivered and installed.

5 burners, baby!

The blueberry pie that caused the previous oven's downfall has been baked and is cooling as I type.

Whipping cream is in the fridge, ready to be whipped.

All is right with my kitchen...

Chocolate chip cookies are on the agenda for tomorrow.

Friday, August 28, 2009

Always be prepared

Operating is easy...if you are well prepared in advance. The MOST important part of the surgery involves not the OR but the stuff that happens in my office.

The history taking. Physical exam. Labs and imaging. Discussing options including nonsurgical management. Surgery is more than "Me operate and fix problem." Despite what the internists think, we do sometimes need to use our brain. Sometimes I have to talk someone OUT of having surgery if I think I can't help.

Take today - I knew that it would be a difficult case and booked the OR accordingly. Asked for the most experienced assist. Contemplated where to enter the abdomen. Put my bovie far away from my hands. Had in the room (but unopened) possible needed instruments and other things. One of the general surgeons was laughing at me - he knew of the patient and thought I was a might touched to consider operating on her.

Good prep work creates good luck, and the case went smoothly. Hopefully, she'll feel better.

Friday, August 21, 2009

Girlfriends

Are a beautiful necessity of life. I'm lucky to have collected quite a few. But up until the last few months, they have not lived here...I have friends from college, med school, working all around the country. But I've been too busy to find someone local. I know that my friends are willing to stop on a dime to help me. But they were all several hundreds of miles away.

Until my buddy/coworker/patient stepped in and made me her project. I think she was afraid I'd skip town due to lack of roots. But I'm now in a community of women who are an amazing bunch. We're all in different stages of life, but somehow we click. And I needed that.

Knitting the strands of life ever closer...

Yet another PSA

This one is on tampon use.

Remove the old one before inserting the new one.

And please remove the last one when your cycle ends.

Thank-you.

Thursday, August 20, 2009

End of an era

So R went to his first day of school yesterday. I'm officially out of the baby/toddler stage. Even pre-school is a memory.

The problem with being an OB is we get to see all of these darling little babies at appointments. My husband hates it, because I'll get whiny when I see all of these cuties flirting with me.

But I'm in my late 30s...time to kill those thoughts.

Wednesday, August 19, 2009

Good for a laugh

So in one of my deliveries from last night, the patient was a little (OK, a lot) out of control. A screamer with a potty mouth and pleasant personality to boot.

So she's pushing...and screaming...and screaming...and screaming.

Last night was the tour for the expectant mothers. They walked through during all of this. Evidently all of their eyes bulged out in fear.

The unit clerk told them : Don't worry. It's usually not like this.

I doubled over laughing when I heard that.

WOOT!

All delivered. All vaginal.

Crap, only a couple of hours before my OR starts.

Thank goodness I got about a 2 hour nap between the last 2.

Tuesday, August 18, 2009

It will be a crappy night

Got several laboring, all with either protracted or arrested dilation. Pit has been liberally ordered.

Knife is going to be sharpened...

Monday, August 17, 2009

For Dr. Grumpy

IF (and that's a big IF) you go school shopping, go at 9 am on Saturday to your favorite store.

Crazy people are still in bed then. Your cart is safe.

Cashiers are perfectly happy to accept Visa to pay for hundreds of dollars worth of crayons and glue.

FYI, 5 year old DS came downstairs this morning, wearing his brand-new Bakugan backpack...excited for school. Except it doesn't start until Wednesday. He was bummed when I told him that.

Sunday, August 16, 2009

My appliances hate me

In the last year, I have had to repair/replace the: washer/dryer, water heater, furnace, dishwasher, and sump pump.

Now add oven.

AURGH!

I'm hoping I can freeze this uncooked blueberry pie I fixed today.

More on small town living

So the big county fair is this weekend. We went last night for the big fireworks display. Ran into one of my dearest friends while wandering the concourse. She had already staked out an awesome spot and invited my gang to sit with her and her extended family. We accepted.

Ate good bad food - DD and I had ribs from someone who had a ton of trophies from various competitions. They were good. Kids (mine and hers) rode the rides on the midway. Why does lemonade from a carnival taste better than what I make?

My friend and I wandered away from the group after we had settled back to our seats - a terrible mothering tragedy, the balloons sailed away after multiple kids let go. So we were on a mission to get more balloons. Every minute, I ran into someone I knew - patients, my hairdresser, nurses, office folks at the clinic. I'm admiring babies ad nauseum. And that's just how a small town is. You are never alone.

Oh, and I never saw the fireworks. I got called to L&D 5 minutes before they started. :( Someone arrived complete and ready to push. Second year in a row that has happened to me!

Saturday, August 15, 2009

The joys of small-town living

Our "newspaper" has a great daily column of all of the police-calls/fire-calls/divorces/marriage licenses/court sentencing. I read it daily for the entertainment value - whoever writes it deserves to be making millions. The turn of phrase he employs is hysterical. I also check to see how many people I know. The most ever in a day was 4 people - one in the marriage license section and the rest were in the court sentencing section.

Today's lead-off bit : Police assisting in corralling donkeys along a nearby rural road.

Take that New York Times!

Finally agreed

To get the stupid knee surgery. I don't want to have it done. Truth is, I'm chicken. Yes, I am aware of the irony. I don't like the idea of the loss of control. Docs are control-freaks.

But the steroid shot worked for all of a week before I started hobbling again. I'm at the point where I can barely stand for anything. If I limp, my knee feels better but my hip starts hurting. If I walk without a limp, the pain is so intense I'd volunteer for an AKA. Laparoscopies are killing me with all of the foot controls for the instruments.

Ortho was just laughing at me. In the "I TOLD you this is where you would end up" sort of way. It's not easy, trying to schedule stuff when you are a doctor. I had looked at my OR schedule a few days ago and knew that I had surgeries booked out until October...so I scheduled for late October. Now the secretaries have the fun task of rescheduling that week of office. I hate doing that to them. I'm only taking a week...ortho thinks I'm insane. But coverage is an issue. I hate to dump on others.

Thursday, August 13, 2009

Thoughts on being a doctor

So Duncan recently commented along the lines "But you're a doctor."

Yes. I am. And a damn good one.

But I am so many other things than just a doctor. I'm a wife, mother, daughter, sister, friend, dog-lover, pianist, cross-stitcher, trivial pursuit player, avid reader, gardener. I love to cook and make (without help) huge holiday meals for 15+ people. I am a lousy hausfrau, but hubby overlooks that.

I don't look the part of a doctor. I don't own a white coat. I drive a beat-up sedan that has seen better days. I round in jeans and t-shirts. Most of my co-workers have never seen me wear a dress. My purse cost $10 at the mall. I finally bought a new winter coat last year - after my old one bit the dust (I had that one for 18 years). I drink cheap wine and expensive beer.

I cuss like a sailor. But not in front of my kids or my mother-in-law. I give hugs after every delivery and many office visits. I ask my waitress how she's doing (since she is my patient)...and ask about her kids by name.

And I am just as much of a doctor as the stuffy old guys in a white coat.

I am secure enough now in myself to be true to my authentic self. I won't conform to what you think I should be. And I hope to pass that onto my kids.

Old dog, new tricks...

So the funeral is later today. I'm getting ready to leave to drive to it in a few minutes.

I rounded, wearing what I'm going to wear to the funeral. Navy dress, heels (ugh), full make-up, and jewelry.

L&D nurses didn't recognize me.

I think I wear scrubs too often.

Wednesday, August 12, 2009

FYI

As much as I bitch and moan about the great unwashed folks, you REALLY do NOT need to put glitter on your hooha before your annual pap smear.

It sparkled when I turned on my lamp, like a disco ball.

I drew blood from my tongue to keep from laughing. I swear, I should win an Oscar for the acting I do at work, keeping a straight face.

Monday, August 10, 2009

You gotta laugh

I've been too damn depressing that last few days. So in order to change things up, here's a new high (?low?) in patient complaints.

I work in a free clinic. We have an STD clinic twice a month, where folks can get checked out. Men and women.

Chief complaint a few weeks back:



Wait for it......



This is going to be good....



It still makes me snicker...



"There are dots on my ding-dong."

Sunday, August 9, 2009

4 years

Since my father slipped away. He lived 9 months after his diagnosis with stage 4 small cell of the lung. DONT'T SMOKE!!!!!

Egads, I'm getting morbid lately. Life is seeming to be so grossly unfair! The sad thing is, as much as work is sucking and blowing lately, it's at least a relief from the disaster known as my family.

Mom got readmitted Friday night. I had driven home to Michigan. Arrived late Friday afternoon to her house. By 10 pm, we were in the ER. She then got transferred to Mecca. I drove the 3+ hours to get there and spent the rest of my weekend there.

Emily's family lives in Meccatown, so we were together. No one was particularly happy. I imposed upon them (I'm SO SORRY!) so I could sleep last night in a bed and shower this morning. Funeral arrangements are still pending...my cousin is trying to decide between lots of options. I don't know how she does it - just the grace and composure. I would have totally have lost it by now if I was her. I need to aim to be like her. I am in awe.

Please, kiss your kids.

Friday, August 7, 2009

Sad news

We're awaiting funeral arrangements for my cousin's 14 year old daughter.

I just delivered a 14 year old a few days ago. Life seems grossly unfair right now. During the delivery, I was having thoughts of Emily and how different life is for these 2 girls the same age.

Thursday, August 6, 2009

Reproduction don't need no BRAINS!

So we got this patient who is expecting. Big surprise, I'm an OB. But she's not, shall we say, the sharpest knife in the drawer. She's playing 2-card pick-up.

She also has hygiene issues. Or did...until my NP told her that she needed to shower every day (why this needs to come out of our mouths at all is another thing) to keep the baby clean.

And by golly, she's been doing it! To keep the baby clean! Now, she's not due for a few more months, but that's one less "Shower upon admission" order I need to write.

And I sadly, write a fair number of those.

Wednesday, August 5, 2009

Blah

I'm just feeling blah. BLAH.
blah, blah, blah.

I'm sick of whiny patients. I'm sick of other docs being idiots. I'm sick of my cell phone ringing at all hours. I'm sick of limping because of my stupid knee.

Blah.

I feel like Eeyore.

Friday, July 31, 2009

11

Years and counting. I still can't believe you put up with me, sweetie. I love you.

---Me

Homeward bound

I'm finally starting to feel like this small town is my home. I've been here 3 years now, delivered around 700 babies in that time, and am finally starting to figure out the relationships between the various families in the area. Knowing a person's last name around here is a strong clue as to which little village she resides in. And I'm finally starting to just know those things. I'm using the local slang for the names of these "towns".

I came here as an outsider...not related to anyone within several hours drive. I'm learning the rhythm of this particular small town. Who is related to whom and how (my head will still occasionally hurt trying to follow the pattern).

My son doesn't remember the house we lived in during residency hell. My daughter vaguely recalls it. They will grow up thinking of this as their hometown, not Michigan. DH and I know all of the back roads of Muskegon county...I don't know them that well around here. Yet.

But for them, this is where their thoughts will escape to, to quote Simon and Garfunkel.

Thursday, July 30, 2009

Quote of the Day

From a mom, bringing in her daughter to me for birth control:

"Her dumb-ass father let her be alone with a boy!"

Tuesday, July 28, 2009

D-Day

As in decision. Tomorrow Mom has an appointment at Mecca. I can't go, thanks to my cross-coverage being in Wyoming. grrrrrrrrr. And Mom told me of the appointment last week. I reminded her that Wednesdays are my OR day and that day is therefore difficult to reschedule. Plus I need more lead time than that, my schedule isn't nearly as flexible as my stay-at-home sister. It takes effort for me to get a day off! But that's a whole 'nuther rant.

So I'm sending ER's Dad up to Mecca to scout. He and I have had quite a few long discussions, so he knows my position well. If I know my sister, she'll want every thing possible to be done and I'm against that. We had this argument with our dad...

My nurse volunteered to babysit the rugrats (she works 4 10 hour days so that she has my OR day off). I'm very lucky to have her. My kids think of her as another aunt.

Last week, Mom got irradiated from head to toe - CXR, CT of abdomen/pelvis. She's hopeful that the chemo did something so that the tumor will be resectable. I'm more skeptical...out of 9 doses, she received a total of 2. She had severe marrow suppression, which was why many of the doses were canceled. We'll see.

I'm no longer allowed to ask "What else can go wrong?"

Tomorrow is going to suck. I looked at the charts for the surgeries, nothing easy, no chip-shots tomorrow.

Monday, July 27, 2009

ER's Mom in the ER

I have passed a parenting milestone, of sorts. The first broken bone.

Poor little man, howling loudly. My last name is very unusual, so as soon as I signed him in, the question was asked :Are you Dr. Last Name?

sigh. Yes.

I don't like pulling strings, but this time was nice in that we were whisked back quickly. Of course the 250+ decibel, inconsolable crying probably helped too. I noticed the door to the bay we were in was shut also. The boy's lungs were displaying their considerable power. ;)

I'm thinking we just hit our deductible, between the XRays, ER visit, and casting. Plus the f/u appointment today with the peds doc. Who was laughing at me.

The boy now has another doctor to add to the list of ones he doesn't like. The ER doc for trying to examine his arm, his peds doc for giving him shots...at least he still likes me. ;)

168

And counting...hours until I'm off call.

I've gotten only call tonight :Asking about the forms for free electricity that need to be filled out.

I refused that call from the call center. I was enroute to home, far away from the office and the chart. What part of EMERGENCY is not being comprehended here?

Had a call last night. "I think I'm in labor."

Me : Why?

Patient: I'm having these pains.

Me : How long?

Patient: Over a month now.

Me : You're not in labor.

Patient : But it hurts!

Me : You are not in labor. We can see you tomorrow if you're still hurting, but labor generally doesn't last a month.


*facepalm*

Saturday, July 25, 2009

Happy 0th Birthday

Little Jeremy! I get to go and buy all sorts of cute baby clothes for my new nephew!

A new one

Delivered a boy via c/section this week. I had to do a footling breech extraction, since the kid was in transverse position.

Kid comes out showing some self-lovin', if you know what I mean. He was really grabbing and pulling! The scrub nurse and I just burst out laughing.

Dad's comment : I guess he's starting young.

Friday, July 24, 2009

Bring on the stupid

Sigh. It's not even 8 pm on Friday.

Phone calls since 5 pm:
1. I've been having pains by my ovaries for weeks.
-----Call the office on Monday
2. I'm contracting a lot
-----How often?
Usually every hour.
-----When they are 5 minutes apart, go to L&D. Just like I've been saying in the office for a few weeks now.
3. I'm having stomach pain.
------What kind of pain?
I don't know, in my stomach.

It's going to be a long 10 days until my cross-coverage is back from his vacation. Dingbats 1 & 3 were from his practice.

Why OBs can't keep to a schedule:

Monday - multiple people walk in to the hospital in labor.

Tuesday - crash c-section in the middle of the day

Wednesday - my induction scheduled for Friday shows up (cool! don't have anything on Friday now!)

Friday - woke up thinking I could wander in at any point, since I don't have office hours today but nooooooooooo. Cross-coverage texts me : primp at 7 cm.

dammit.

I counted - only 5 left due for this month.

Wednesday, July 22, 2009

Now I remember why residency sucked

Because earlier this week I had a resident-like call : 6 deliveries, 7 babies, 21 hours. One set of twins mixed in for funsies. L&D was distinctly unhappy with me. When I rounded today, I jokingly suggested going to the local chocolate shop so I could bring a peace offering. The tech and charge nurse put in orders!

And it blew chunks. As well as a huge hole in both Monday and Tuesday's schedule since Monday pm was spent babycatching and by the time Tuesday rolled around, I needed to cancel since I was still catching them.

Sunday, July 19, 2009

Two more hours...

Until DD and I go on a girls' date to see Harry Potter 6!

And pig out on popcorn!

Sad thing is, the last movie I saw in the theater was Harry Potter 5.

I think I am officially lame. :)

Saturday, July 18, 2009

Bad Sign

Your doctor - upon signing out to her cross-coverage for the weekend - mentions your name and that you are a frequent flyer.

And the cross-covering doc already knows who you are because you come in EVERY SINGLE NIGHT for the last 2 weeks. Sometimes twice in one night.

And the L&D nurses, upon paging me ask "Can you guess who's here?" When the night nurses know who you are, it is NOT a good sign.

39 weeks can't come soon enough. Because the reason for your induction is our sanity.

Friday, July 17, 2009

Don't get mad

When I won't see you because you showed up at 4:40 for your 3:30 appointment.

On a Friday afternoon.

People are still good

Emily, my cousin's daughter is getting her wish granted. Iron Chef Morimoto is cooking her a meal and skyping her this week.

I love the Food Network and Iron Chef...my love for them has just gone up immensely.

The L&D nurses are being very overprotective of me right now...love them dearly.

Wednesday, July 15, 2009

Memories

So I asked my hubby the other day "What happened that turned me into this raving, bitchy person?" And he reminded me of a page I got a few years back...I had completely forgotten about this one. But it's a good one.


It's 1:12 am. I am home, in my bed, asleep. Like a normal person. My pager goes off. It's the operator with a phone call. Yawn, please transfer me to it.

"Hi there, I'm Dr. Wantstosleep. How can I help you?"

"I dropped my pills in the toilet."

"You dropped them into the toilet? What kind of pills?"

"Birth control pills."

"Still in the packet?"

"Yes."

"Well, get them out, wipe the back with some alcohol and take them."

"That's gross. Can't you call in a refill?"

"Do you have refills left on the prescription?"

"Yes."

"Call the pharmacy yourself and get the refill filled sooner."

"Medicaid won't pay for it."

"Buy it yourself or check in the morning to the clinic."

"Can't you get me some samples now? I need it for my cysts"

"I AM AT HOME, IN BED SLEEPING. I AM NOT DRIVING INTO THE HOSPITAL SO YOU CAN GET SOME SAMPLES AT SOME UNGODLY HOUR IN THE MORNING!"

"Oh, I thought you were working at the hospital."

My husband is shaking, he is laughing so hard at my half of the conversation. It took me over 20 minutes to get this dingbat off the phone.

Friday, July 10, 2009

Levels of crazy

Been thinking about this for awhile. I now have the "ER's Mom Official Guidelines for Assigning Levels of Crazy".

1. Normal. They exist, even constitute the majority of patients. They make poor blog fodder however, so you wouldn't know that that they even exist from reading any medical blog.
2. Crazy. These are the "fun crazy" folks. A little off, but you don't cringe when you see them on the schedule.
3. Bat-shit crazy. Your stomach drops a little when you see the name on the schedule.
4. Fucking Nuts. These folks seem intent on driving YOU nuts too.
5. Mouth agape and head shaking. You are lost for words upon meeting these folks. Fortunately, they are rare.

Tuesday, July 7, 2009

Battered and Bruised

Is what my family is feeling lately. Emily got her stem cell transplant last month. And yesterday, we got news that her ALL reoccurred. 1 week after she turned 14. This is now her 5th relapse.

My mom has yet to complete a cycle of chemo her cycles of Gemzaar and cisplatin are in groups of 3. She is very intolerant of cisplatin - or more accurately the amount of IVF needed - so it was switched to carboplatin. At any rate, she has had 2 doses (not rounds, DOSES) of chemo. It's now been 8 weeks. She goes Thursday for another dose...assuming it doesn't get scrubbed for whatever reason (last time was thrombocytopenia, time before was for neutropenia/sepsis, lather rinse repeat).

AURGH!

Monday, July 6, 2009

20 years

Grandma. You are remembered.

Tuesday, June 30, 2009

Senseless

IUFDs after the age of viability.

Preemies who are going to be gorked thanks to their mothers' drug habits.

Teens shot at the bus stop.

Son/brother/nephew/cousin of my coworkers/friends/patients dead.

God, I hate open-casket viewings.

Monday, June 29, 2009

You know you are a PITA

When the ER doc, upon getting through to me says "She's driving us all nuts."

Yes, we will see her tomorrow. But all of her issues are supratentorial, so we won't be able to help much. :(

Wednesday, June 24, 2009

How to make the answering service drone laugh.

Cell phone goes off. It's around 8 pm (thank goodness). Caller ID reveals the ever dreaded answering service.

"Hello?"

"Hello doctor. This is Dawn at the call center. I have a call for you."

"OK."

"Patient Ida Dunce calls stating her period started today..."

"Why the hell do I care?!" interrupting her spiel on the reason for the call. She started laughing.

"I don't know. Do you want me to connect her?"

"Not really, but go ahead."

I only wish some of these stories were made up, but I'm not that good of a storyteller.

Saturday, June 20, 2009

My family has superpowers

My mom and sister have the superpower to call exactly 10 minutes after I have laid down for the first time in 40+ hours. It's inevitable. It happened yesterday. Again. And then they get irritated with me for not being spritely and willing to talk.

My kids have the superpower to whine exactly when I am on my last ounce of reserve from dealing with needy people and the generalized craziness of my life right now.

My husband has the superpower to always make me feel better, even when my world is crashing.

I like the last superpower the best. ;)

Friday, June 19, 2009

New quote of the day

So I'm getting ready to pap a lady, who isn't too keen on me being down there. Actually, she's terrified. So she asks me to talk while I'm examining her to distract her.

Me : "I'm really good at talking to butts."

We both burst out laughing.

Wednesday, June 17, 2009

Happy Time-Out Day!

So said the signs posted about the doc's lounge in the OR.

Bleah.

I had a pre-op nurse ask me today if I wanted to mark the patient. "No" was my answer...I was doing a D&C and didn't think marking the cervix would be a good idea in the pre-op area. Hell, I probably couldn't SEE it in the pre-op area!

One of these days, I'm going to mark an abdomen (pre-laparoscopy) with the words : Camera here, dipshit. I told this to our hospital's risk manager and after her laughter died down, she told me to stop being difficult.

Now, I think timeouts are a good idea to remind us what we are doing. However, the new craze of MARKING every single incision is insane. Every surgery is unique. I should be able to reserve the right to THINK and ACT on the basis of my skills, knowledge, and unique factors any patient may bring to the table. The majority of my cases are laparoscopies. Sometimes I need 2 incisions. Sometimes 3. Bad cases get 4. I've done tubal ligations where I couldn't place the usual suprapubic port...it ended up being a left-sided port due to her uterus being scarred to the anterior abdominal wall. I changed my surgery intraoperatively from my usual way to something unusual.

Now, I'm not against marking incisions in cases where laterality/location is important. When I choose to get my knee fixed, I damn well want the RIGHT knee (literally and figuratively) operated upon. Neuro better operate on the correct level. But in cases like laparoscopies, c-sections, or where you're doing the same thing to both sides (ie, bilateral tubal ligation, tubes in ears, tonsilectomies...) does it truly help to mark? Or is it yet another blip on the computer to mark off?

I'm threatening a true temper tantrum if they start requiring marking the incision site for c-sections...

Saturday, June 13, 2009

Enough!

My 3rd ectopic in less than 2 months.

Stop it!!!!!!!!!!!!

Implant in the correct place, dammit!

Friday, June 12, 2009

PSA

A yeast infection is NOT a medical emergency.

You do NOT need to go to L&D at 1 am for it.

There ARE over-the-counter medicines for it. Trying them first is NOT a bad idea.

Doctors are really bitchy at 1:23 am when paged by the L&D nurse about this.

I'm starting to think I need to screen patients on common sense.

Saturday, June 6, 2009

Fun times

At least Mecca is closer to me than home is, which means I can run up every day I'm not on call.

So Mom's over anti-coagulated (again), this time with a retroperitoneal bleed. She's gotten 4 units of PRBCs and some platelets (since they're down to 30). She's also acting like she's infected, although the source is nebulous. So Vanco and Zosyn are on board.

The whole team rounded when I was there...med students, intern, resident, God. Made me smile internally. Thank god it's June! I said that outloud and Mom and her cousin asked "Why?" July 1st is the start of the new academic year...and interns are worse than clueless! They are clueless AND have the ability to write orders!

Coincidentally, her cousin was there because her niece (my second cousin) is getting her bone marrow transplant next week. Usually we do a family reunion every August at a park on Lake Michigan. I suggested the reunion site near the Mecca, where we could play spin the bottle to see who gets admitted to the onc floor at Mecca next. Gallows humor at its finest. I followed my cousin to see Emily and her mom.

Emily's mom (also my mom's cousin) is about 10 years older than me and was one of my favorite babysitters as a kid. She is just one of those people who exudes generosity and caring. I was shocked to see how she has aged in the last year. I can't imagine the hell she has been through. And yet, she still makes you feel like everything you are saying is the most important thing in the world to her. Truly a beautiful person.

I made sure to hug my kids extra hard when I got home last night.

Going back today.

Friday, June 5, 2009

Huh?

You know that saying that states there is no such thing as a dumb question? That person was an idiot for saying that. Here's proof:

Patients husband, in the post-operative conference room. I'm there telling him that the vag hyst went well. His question:

So, um, where will my cum go if she doesn't have a uterus?

Wednesday, June 3, 2009

Readmitted

Pelvic abscess. Being shipped to the mecca as I type. I'm on call tomorrow. I have instructed DH to go up there tomorrow and scout out what's going on. My sister is somewhat clueless when she calls.

I think I'm going to enjoy a lot of wine tonight to numb myself.

Whatever happened to "2009 is going to be fine."?

Tuesday, June 2, 2009

Moods

It's been a rough few months...between working my ass off, my mom getting sick, various appliances all deciding to die at once in my house (I think they're unionized and striking). I'm finding myself listening to a lot of punk/hard rock lately with some later Beatles thrown in.

It makes for a strange mix in the OR. The punk and rock seem to cover the anger that I'm feeling at the world. The dandelions in my garden beds can attest to that anger. But the Beatles...not angry. Their songs that I'm drawn to are more wistful, more longing for connection. Let It Be is even more on the road to acceptance. (yes, I've been reading Kubler-Ross)

My usual assist is getting sick of American Idiot. ;)

Monday, June 1, 2009

Validation

Sometimes, it seems like all we hear is the whining and complaining of people whom we can NEVER make happy. (Usually because we are withholding narcs, but that's another story). And although I don't do this for praise, an attagirl every now and then is appreciated. But they are few and far between. Just knowing that some people recognize the effort that you put forth to care for and about them...it makes a lot of the daily crap a little more bearable.

Well, I got two today! A box of dark chocolates from a patient at her postpartum visit with a very nice note. And then a call from the patient advocate at the hospital. Usually those calls mean someone is pissed off and let Press-Gainey know it. But not this time! A patient took the time to write this long, handwritten letter about her birth experience and how wonderful it was, how caring we all were to her and her stillborn child, and how she will never go anywhere else for her care.

So even though I'm delirious from lack of sleep, I'm feeling good. Stupid, I know, but it doesn't take much.

Monday, May 25, 2009

Happy 9th

You are the light of our lives. Happy 9th birthday, sweetie.

Sunday, May 24, 2009

W.W.Y.D?

My least favorite question from a patient. What would you do?

I don't know.

I'm not dodging, it's the truth. I don't know. I don't have xxx diagnosis. I have a pretty high pain tolerance. I'm terrified of having surgery (still have every part including my tonsils!)...or of the loss of control implicit in surgery.

I hate answering.

Friday, May 22, 2009

Eww times two

1. Tampons were NOT designed to be left in for 4 weeks.

2. What is your pessary doing in a place where your dog can eat it? Inquiring minds want to know!


All together now: EWWWWWWWWWWWWWWW!!!!!!!!!!!!!!!!!!!!!!!!!

Wednesday, May 20, 2009

Overheard in the OR

Circulating Nurse to Anesthesiologist: "Did you take your meds today? Because you're hyper."

Needless to say, a lot of ribbing/goofing off/ jokes were flying today. And not all was aimed at me! :)

Monday, May 11, 2009

Happy Birthday!

You're still older than me!

;)
Luv ya!

Sunday, May 10, 2009

RIP Chuck.

Chuck Daly, mastermind of the greatest basketball team in Michigan's mind, passed on.

I grew up loving this man's teams. As an adult, I still can't believe that he got Lambeer, Rodman, et al to listen to him!

Saturday, May 9, 2009

It stops hurting when you stop hitting your head!

I can see how patients hate us. If it wasn't for the fact that I have an MD, I would be so damn confused by now.

Mom's urologist, RadOnc, and MedOnc have 3 entirely different ideas as to what needs to be done. As for me, I tend to agree with the urologist, having seen the films and knowing her past surgical misadventures. He wants neoadjuvant chemo/radiation before surgery. RadOnc is questioning why surgery isn't being done first, since that is the usual case in ureteral cancer. MedOnc wants the 5 cm pelvic nodes sampled before starting chemo, since "It might not be cancer." Hell, it might not, but then I would also be the goddamned Queen of England too. What looks like a duck and quacks like a duck...probably is a duck.

So next week she has an appointment with those who live in the rarified air of the ivory tower. I have called some contacts at that school and quizzed them. Fortunately, the appointment is on my off day, so I'll be there.

AURGH!

Friday, May 8, 2009

Wish us luck

Going to the oncologist today. I'm going to have to leave in a few minutes to make it on time, even though her appointment is early afternoon.

Sunday, May 3, 2009

I would divorce my hubby...

and hang out with my ortho but I love my DH too much.

However, since my visit (and deep joint injection) on Friday, I have been painfree for the first time in over a year! The injection hurt more than contractions, but I would do that every week if it keeps me feeling like this. I'm not limping! I can put my weight on my right leg! I'm going to be daring in the OR and weight bear on it, so I can use my left leg for the foot pedals in my LSHs. My back will appreciate the more ergonomic position.

Funny story: so I get another set of knee X-rays. He comes into the room, throws them up on the lightbox and starts talking. Now, I'm OB. The knee X-ray looks like some bones. He's going on about joint space and how it looks good and then he asks "You see?"

My response : "I'm OB-Gyn. I can read a knee X-ray as well as radiology can read a pelvic ultrasound."

Got a laugh out of him.

Wednesday, April 29, 2009

Advice for newbies

Went to a conference today at my old stomping grounds. My interns are graduating!

I guess that means I'm old.

Here's some advice, hard-earned by me but free for you:

1.Be nice. This directly leads to
2. Your nurse makes or breaks you. I have been fortunate in this respect. Michelle, then Kim, then Jen have rocked.
3. The learning curve the first year of attendingship is steeper than internship.
4. Go to a coding/billing conference.
5. Don't go on a spending spree right away. I know, that first check is burning a hole in your pocket but trust me. Shovel money into savings.
6. Bring in a treat to the L&D nurses the first week you work. Remember, they have your back!
7. Get an MP3 player so YOUR music is playing in the OR. Even if everyone else hates it. ;)
8. Meet and greet the IM, FP, and peds docs.
9. Download some games onto your phone. Useful for whiling away time before a delivery.
10. Take some time off before starting.
11. Do NOT, under any circumstances, be a princess.
12. Yelling frequently means people ignore your yelling. Save it for the important stuff. I want people to KNOW when I'm pissed...and how to fix it.
13. Look at your billings monthly.
14. Be quiet the first few months as you figure out the politics of the hospital.
15. If L&D is swamped and nurses don't get lunch, spring for pizza delivery.
16. Treat your office staff humanely and they will reciprocate.
17. Learn which patients never, never get double-booked.

Did I miss any?

Tuesday, April 28, 2009

I was wrong

Ureteral cancer.

Now I need to go look stuff up on emedicine/up to date/nih.

Monday, April 27, 2009

OK, OK

So I'm going to ortho later this week. Only because I told my awesome nurse the story about running into him in the elevator. She then called their office and told me either I could choose the time or she would.

Harumph! Outmaneuvered! I admitted defeat and scheduled my own damn appointment, thankyouverymuch.

Not the first time she's made appointments for me...last time she was worried enough to schedule an appointment, I ended up having pneumonia. I'm just not good at figuring out when I need to get things looked at.

Still no word on Mom's biopsy. :(

Wednesday, April 22, 2009

Waiting

So my mom (finally) got the CT-guided biopsy yesterday of her pelvic mass. I am willing to lay odds on an adenocarcinoma originating from the colon - she had a TAH/BSO back in the early 90s. I however, have not told her that. Yanking away hope seems unnecessarily cruel. She's already gone through a lot in the last 6 weeks. She's pissed that urology isn't too keen on stenting her ureter but is keeping her perc since it's working well.

And now we wait. Because of what I do, I know that pathology usually takes 3-4 business days to process, diagnose, and transcribe. Which means that the wait will probably last until after the weekend for her.

And if I'm right, we - meaning me, my sister, and my mom - will have to figure out what to do. I live a long drive away. I can't manage this via phone. I've been pushing for her to move in (ohdeargodwhatamIthinking!) with me - we have plenty of room.

I worry about my kids - my daughter's kidnergarten year was scarred by our caring for my father in home hospice (stage 4 lung). My son is that age now. DD remembers some. The boy was only 1 at the time, so he doesn't but he certainly would recall anything from now forward. I don't worry about them seeing the completion of the circle of life, but rather the fact that caring for someone very ill involves restricting other activities and paying attention to them.

It's tough - I've read about the "sandwich" generation - caring for kids and parents. I'm in a cage - caring for kids, parent, and patients. I've been ignoring me. I ran into ortho today at the hospital and he asked about my knee. I admitted that it was bad and I need to get into see him for the next step. I'm not sure when I have the time to do that!

Friday, April 17, 2009

To the love of my life

20 years ago, you gave me your class ring.

Twenty. Years. Ago. We were young and stupid, two teenieboppers "in love". But with you, we've weathered a lot and my love has blossomed even more. I can honestly say that I love you more now than I did back then.

I love you with all of my heart. I admire what a kind and great man you are. I'm thankful our children have such a great role model for a father. I love laughing with you.

Here's to a long future together.

Love you, always and forever.

Against the odds

4th, (yes, FOURTH) set of spontaneous triplets diagnosed yesterday since I started practicing here 2 1/2 years ago.

What is in the water!?!?!?!?!?!?!?

Sunday, April 12, 2009

Notes about calling your doctor

1. Menstrual cramps ARE NOT, nor ever will be, a medical emergency. Waking me up at 5:30 am (20 minutes after I went to bed from a delivery) is not appreciated in any way, shape, or form.

2. Please listen when I give instructions on what I chart as "labor precautions". Every week from 36 on, I give my little spiel on when to go to L&D. Please listen so you don't wake me up at midnight with a complaint of hourly contractions.

3. On Easter Sunday, don't be surprised when I tell you that the pharmacy is likely to be closed. I'll call in something for your UTI, but it won't help until tomorrow.

4. And don't call me after the pharmacy has already closed for the day...no matter what, it WILL wait until the morning. You're not sick enough to be admitted for the UTI/URI/1 bout of vomiting.

Hope this helps!

Wednesday, April 8, 2009

The optimism of a crocus

Spring is in the air. Today is my scheduled OR day, and I was done dictating my last case before it was supposed to start! Hours ahead of schedule! Great OR day! Listened to the Beatles in the OR, did 2 hysts in 78 minutes total time (anesthesia was impressed).

So I drove home (woo hoo, home before 2 pm!), changed out of my scrubs and started to tend my front raised beds. The folks who had the house before us were master gardeners. I'm not, but I try.

Crocuses are in full bloom now. Purple, yellow, white flowers greeting us and reminding us that life is always continuing. Flowers that come out despite the cold and the snow. Small and delicate.

Daffodils are just starting to bloom. So are my brunneria. My tulips haven't. The hyacinths are considering it. The bee balm, balloon flowers, sedum, irises, and daylillies have the greens showing. The roses put up a good fight, but I trimmed them back (and have the scratches to prove it).

Pulling up dandelions is very satisfying when you get the whole bloody taproot.

Tuesday, April 7, 2009

More randomness

Mom is out of the hospital now...after rewriting Harrison's. ;) DVT, PE, GI bleed, pelvic mass, ARF, hydronephrosis...and she's still refusing to come and be with me. UGH! ***head banging against wall***

Didn't make it up to Dad's grave. Maybe next time.

Just want a q-word call weekend, so I can get things done around the house. I've been away for so long, that my house is an official disaster zone. Plus, spring is in the air and my gardens need tending. I don't rake in the fall (hey, the leaves are mulching the ground!), so spring has a lot of clean-up.

The L&D nurses laugh every time I tell them more of my shitty month. Because I am a shit-magnet. Really.

My car died while in Michigan. Now I have to decide if I'm going to get a new car (mine's 8 years old) or try to repair it and gimp it along for a few more years. My contract actually states that I need a functioning car...I'm currently driving a rental.

Why do I always get the sickest patients? Or the bat-shit crazy ones? My newest nutcase is a heroin addict asking for Percs for her dysmenorrhea. Nope, try some Motrin. She didn't like that answer.

Dogs totally rock.

I have an awesome hubby who is an amazingly patient and kind man.

Never ask "What ELSE can go wrong?" Because something will.

Don't like the "monetize" tab on Blogspot. This is where I vent, gather some thoughts, brag about 2 wonderful kidlets. Then again, money isn't an incentive for me, which is why I like where I'm at - the local hospital is wonderful at letting me be a DOCTOR and not care about the business side. It's why I went to medical school.

I have some wonderful friends as well...keeping me laughing and handing me tissues when I need it.

Saturday, March 28, 2009

Lots of random thoughts

I'm in Michigan, caring for my mom this weekend. She's back in the hospital, with a complication of the PE she had a few weeks ago. It's very interesting, being on this side. I know too much. Sometimes, I think it would be easier to be my sister, the teacher. And I'm sure my mom's doctors are sick of me. No one is taking ownership of her, we have IM, urology, general surgery, vascular surgery, interventional radiology, and who knows who else rounding on her. It's pretty bad when I know my way around the back ways of a hospital that I don't work at! I'm pushing to get her out, because from what I can see, she doesn't need to be inhouse any longer. But too many cooks are in the pot right now, and I'm trying to orchestrate cooperation. I may push her to come to my house for a week or so. It's easier to manage her locally, but my sister is clueless...so I can't be of much help from long distance. My office manager is hollering at me to take time off, but it's not time yet.

Semi-private rooms suck. The hospital I work at has 100% private rooms and it's nice. My mom's roommate is a LOL with dementia and pneumonia. I've been hitting the call button for her when she's screaming "Help me, Help me!" over and over again. She also asks what day it is about every 30 minutes or so. We've taking to answering her so she doesn't repeat the question in 30 seconds. The current day of the week is becoming a running joke in our family. I promised Mom that I would unplug her if she ever was like that. That's why my sister is her medical POA. ;)

My mom's cat Ginger is sweet, but lonely right now, since she's been alone most of the month (mom hasn't done so hot). She has been obnoxiously cuddly.

I miss my kids. But I'll see them tomorrow.

We'll be back next weekend - we're billing it as an early Easter for the kids (I'm on call Easter weekend). They'll get to see their cousins and all grandparents. I'll be able to check up on Mom. I may try to go up to my Dad's gravesite...haven't been there since the burial.

I'm only a little crazy. OK, a lot crazy. Wait, I've always been crazy, now I'm crazy and stressed. :)

My prom picture with DH (yes, I married my high school sweetie) is on the wall here in the computer room (formerly my sister's room). Neither one of us have grey hair in the picture and I'm a hell of a lot thinner! I only wish I knew then how cute I was...I look at those pictures now and go "Damn! I was hot!" Now I'm a dumpy mom-jeans wearing overworked wife.

I am so sick of reading trashy magazines and women's magazines I could scream. I've been in OR/procedure waiting rooms too often this month. I bought Twilight to read - I can see why teenieboppers love it - They in LOVE! It's FORBIDDEN! He saves her! He's DANGEROUS! Although I do admit, I would totally have the posters plastered in my room if I was 20 years younger. Robert Pattison is hawt! (to quote teens)

I have great in-laws. Just had to throw that in there.

What doesn't kill me will make me stronger...