Monday, December 28, 2009


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.


Grumpy, M.D. said...

Yes. We all have our share of cases go bad. And when it happens, it's awful.

The key thing is knowing how to move on for the other patients who are still depending on us.

rlbates said...

Moving on is sometimes hard to do, but necessary.

Grumpy, M.D. said...

I thought you'd like this, from ER Stories today.

Dragonfly said...

I've always thought that of all the specialties that involve surgery, OBGYN has the highest stakes. Neurosurgery, etc are always billed that way but with OBGYN you have mother and foetus, so much can go wrong, but there is also so much potential.
Am really enjoying your blog btw.