Reminder

Get your charity donations in before Thursday if you itemize on your taxes for it to count against 2008 income.

Go to www.charitynavigator.org to check out the financials of any one that you are interested in. (yes, piss-poor grammar - so shoot me).

As for me, I support:
1. Women's rights, so I contribute to Women for Women International
2. Education, so we send $$ to our alma mater (DH and I went to the same school)
3. The local food bank will get some cash, but they also get some of my weekends.
4. Goodwill gets my kids' outgrown stuff
5. DD wants to contribute to the local Humane Society as well. I'll match her contribution to help teach her about giving.
6. The local PBS station (love the Red-Green show!)

Charities have been hit hard with the Wall Street nuclear bomb. Please, remember someone!

Merry Christmas!

DD woke up at 4:17 am (why, oh why am I cursed with kids who wake up early?).

Presents unwrapped before 7 am. Kids loved the gifts. DS is wearing his new Star Wars sweatshirt. DD still has yet to beat me at Othello...I may have a few years of experience on her playing it. ;)

Christmas dinner was in the oven by 7:30 am: made the pie first (blueberry, and of COURSE a homemade crust!), prime rib roast was in the oven by 8, green bean casserole (not the usual one, this one is cheesy and spicy) started in the crockpot at 9, and the potatoes were being boiled at 11. This year, I did NOT overcook the prime rib - got it out when it was 135 degrees (missed last year, it ended up being medium-well. pooey)

Dinner is now finished, bellies are full. Second glass of wine being consumed. Pie is waiting for the bellies to empty somewhat. Whipping cream is in the fridge, awaiting its time to shine.

Best present: news that a partner has agreed to terms and the contract is in the mail to her. She can start in March. Woo Hoo! I can last 2 more months of near continuous call - I'm paying another doc in town to take a few days/month...I have to get away from the hospital. I even have 4 consecutive days off starting today!

Life is looking up...

Baby, It's Cold Out

That was the headline of the local newspaper on the day I was born. February in Michigan tends to be like that.

Sure fits today, though. We're hovering around 0 degrees here, freezing our toukas off. At least we haven't lost power. My office lost power on Friday, so we canceled the afternoon.

I'm hunkering down at home, drinking coffee and trying to get motivated to wrap presents. Today is normally a surgery day for me, but no one wants surgery this week - although I operated every single day last week. This day is a gift of free time, which is a rarity for me. Next week, I have a ton of surgeries before the new year - December is always a busy month for the OR, people want to have surgery before they have to meet the deductible again. January is always a slow surgery month. Because of that, I usually try to get a vacation then.

Not looking forward to driving to Michigan later in the week.

I hate winter. Why did I stay in a fly-over state, when I could have moved into the south? I hate cold, I hate snow, I hate ice.

12-11

Today would have been my dad's 60th birthday. He died a little over 3 years ago from stage 4 lung cancer (quote of the disease -"I went to the ER thinking I had pneumonia, left it with cancer!"). Cancer is a shitty way to die, BTW. I know, I've seen it both professionally and personally.

So I'm feeling a little philosophical today. I did some Christmas cards today - looking through my address book (the old-fashioned kind, where names are crossed out). I'm basically the matriarch now in my dad's family - I'm the oldest cousin not in jail. All of my grandparents are dead, my dad and his only sister are dead. There isn't much for me to go to in terms of the older generations.

My mom is still alive. Not healthy, but still alive. She's an only child. Two of her aunts/uncles are alive, albeit in the end stage of Alzheimer's. I doubt if they remember much at all. Many of the adults in my life as a child are now just memories. I look through my wedding album and many of the folks there are gone. Aunts, uncles, adult family friends. Gone.

Egads, I should have another glass of wine. I'm getting too depressing for myself!

Traveling and other stuff

1. Knee braces set off the security alarms in airports.
2. I did not put my liquids in a bag...and didn't get stopped either coming or going (all I had was toothpaste - no make-up, shampoo or anything like that).
3. Why is it that when I land, I'm at the far end of concourse A and my connecting flight is at the far end of concourse D? Every single time.
4. Having my cell phone turned OFF is a beautiful thing.
5. ABOG uses a very nice hotel. We definitely paid for it.
6. Guiness is a very good thing after taking the orals.
7. There is no better bed than your own.
8. Kids love the cheesy T-shirts that you can buy in airports.
9. Two days of no email is a very long time.
10. I'm so glad to be home.

Boards

Keep all appendages crossed...taking orals this week. :(

Causing trouble

Sometimes, you just need to know who to contact. I had a patient the other day that I was very distinctly unhappy about her treatment from another doctor. I was talking to the nurse-manager of L&D, who encouraged me to email that doc's boss.

So I did. And I spontaneously decided to cc the higher-ups in admin. The next day, I was rounding on L&D. The nurse-manager came up to me and said with a smirk "Look at the hornet's nest you stirred up!"

Amazing what the cc line of email can do.

Is your mouth watering...

This is just a few of the 48 dozen cookies made last weekend during a cookie baking marathon.

Yum!

A Letter to whiny patients

Dear PIA,

No, I do not want you to have a miscarriage. However, since you are now in your third trimester, that would be difficult. No, I am NOT going to write an off-work note for you because the factory is "too cold." Put on another layer, dammit, and quit trying to get out of work.

No, your boss asking you to lift 10 pounds is not unreasonable. Here's a copy of the ACOG guidelines for working in pregnancy. YOU ARE NOT DISABLED!!! Quit trying to be a drain on society and go to work.

Yes, you should live in a place with water, electricity, and heat. At your last appointment (2 months ago, since you've missed multiple ones), we gave you the phone numbers of agencies around here that can help. You have not done a thing to help yourself. I'm sorry you're being evicted tomorrow, but I did give you the number of the local women's shelter last time. I can't help those who won't help themselves. And it isn't the caseworker's fault your documentation isn't in order. Grow up and show some responsibility for your own actions.

Oh, and those ciggies in your pocket can pay for the bus ride here. Don't tell me you don't have money to pay for that when you smoke a couple of packs per day.

FYI, if the L&D nurses fight over who will be "lucky" enough to have you as a patient, that is not a good sign. Stop being a whiny twit. You are not the first, nor the last woman to give birth.

Sincerely,
Your OB

Ramblings

5 pound dermoids are cool...the link is obviously not mine, but it was cool. My path report showed that it included mature brain, thyroid, adipose tissues.

2 ectopics in 1 week are plenty.

delivering twins is amazing.

people say the strangest things when under the influence of anesthesia.

I seriously dislike vaginal hysterectomies.

Actually, I HATE M-F vaginal hysterectomies. I do 'em because the recovery time is shorter for the patient, but I do loathe them.

I need to clean - I'm hosting Thanksgiving. :(

Woo-Hoo, it's now 7 AM and I am off-call for the first time in 2+ months!

Another One Bites the Dust

Another OB in town announced his retirement. Our hospital can (based on deliveries and population of service area) support 10 OB-Gyns. With this retirement, we'll be down to 4. Just 4. When I arrived 3 years ago, I was the 7th doc. We're dropping like flies here!

Rural areas are drowning. I'm on track to do 350 deliveries in 2009. A busy practice in the city would do 150-175. There are always more patients, more people who need help. Those of us who remain are hustling fast and hard. And there is no relief in sight...I am booked months out for new patients, for surgeries, for anything! Good luck getting a pap smear booked!

We're a small and close-knit department. We all have the haggard look in our eyes, the perpetual fatigue in our bones. Other docs look at us with pity, knowing that you can almost always see an OB's car in the doc's parking lot. I know what call rooms get cell reception and what ones don't. I'm interviewing for someone to join me, but it's a tough sell. Rural, work hard, call Q2, interesting patient population. Sounds like a great life, eh?

Of course, if I had been smart, I would have done a cushier specialty. But I wouldn't love my work if I had...

Vote

Just do it. I did today...waited over an hour.

And dammit all, this is the first election where technically I'm old enough to run for POTUS.

:(

Having fun

Ahh, Halloween. When kids can have fun and Mom can steal her favorite candy from the pumpkin. ;)

I'm particularly fond of Reese's.

Funny as hell

Long...about ten and a half minutes. But well worth it.

Ch-ch-ch-changes

Well, this summer has been eventful. I left my old private practice and opened up a solo practice as a hospital employee. Part of the contract involves supervising Gyn portion of the free clinic here in town.

I'm having so much fun! Working my tail off, lots of people to be seen. A lot of pathology, uteruses weighing over a kilo, a 5 pound dermoid, seeing OB patients for the first time a week before the EDC (scan done early in the ER, so dates are good). It's a lot like residency, but a lot more fun. Even in rural areas, we have the crack inductions of labor. ;)

And to top it off, another Gyn in town in leaving. I heard from a friend who works in his office...he is writing a letter to give to the hospital. That just means more work for those who remain, which is dwindling fast.

Primary care is in trouble. OB-Gyn is not far behind. The number of new graduates going into either is falling. And you wonder why it can take months to get into a Gyn...it's because we're overwhelmed with the amount of work that needs to be done. And I can only see so many patients per hour and work only so many hours per week.

If you don't...

Want to deal with post-op complications, then don't operate.

Drilled into me by my mentor, a wonderful Gyn-Onc. Brilliant surgeon, nice man, excellent with patients, and now my friend.

Had a bad one recently, ended up in ICU with double digits worth of blood products. Somehow managed to avoid DIC...

At least she left the hospital alive.

And it hurts us too. I hate when bad stuff happens. Surgeons have a rep for acting more than thinking, but we do think. I've reviewed over and over in my head what I did, what steps happened. Had some sleepless nights thinking. And this time, I can honestly say "bad luck." Aberrant anatomy in a procedure requiring a blind pass with a sharp object.

I was reviewing it with the chief of anesthesiology (who happened to be my gas-passer for that day) and he told me the same thing. And he complimented me for the quick action I took, getting vascular surgery in as fast as I recognized the problem. I was brooding and he basically slapped me out of it - "The denominator is fixed, and you are constantly increasing your numerator. Sooner or later something will happen. It's just a numbers game."

I understand that intellectually. Still doesn't make me feel better. I aim for perfection and this type of event hurts.

But I'm a doctor. And a surgeon. So I will have to get over it - or at least act like I'm over it - because I have other patients to care for. We have to take a deep breath and do it again, for the next patient. Because there is always a next patient. It's a strange sort of optimism.

I HATE!!!!!!!

When I agree to do an early case on my day off and the patient DOESN'T EVEN SHOW!!!!!!!!!!


grrrrrrrrrrrrrr...............................

Guess what happened to me today. ;)

Congrats Joe

I grew up in small town Michigan. I can remember the Bad Boys in their glory days. I hated the Bulls and the Lakers. I owned the t-shirts proclaiming the supremacy of the Pistons. My sister adored Isaiah, I wanted to rebound like Dennis. I can remember being pissed when Adrian Dantley was traded.

And there was Joe. Rock steady. Distinctly unflashy. But you could count on him. Always. And now he kept the promise to himself.

Now that I'm older, I can appreciate him a lot more than I did as a teen.

New drug

We were talking the other day at the office, the FP doc, PA, and myself. We're going to patent:

Oxypercodineralnax.

I'm trying to figure out how much per pill the market will bear.

We'll be rich. ;)

Doc as patient

I fully admit I'm a lousy patient.

Worse than lousy.

At least I get CME credit for my issues.

But last month, something that has been bothering me for a year was finally getting to the point where I can't take it (and my self-treatment is helping less and less), so I called my doctor. She got me in, did some tests, and said "Which surgeon do you want to go to? And you're going to mess up your stomach with all of that Motrin."

Wry grin on my face. "I was afraid you would say that. Dr. X. And that's why I buy the economy sized bottle of antacid!" Got a laugh out of my PCP.

So the appointment for Dr. X is made...I deliberately chose him because A. he's good and B. he's conservative...I might be able to postpone the OR for myself. Which he's agreeable to right now, but he just smiled and said "We'll try it." It reminded me of my mother, for some reason.

At this point, I'll do anything to make walking and standing nonpainful. I want to wake up and not need my Motrin hit. I want to be able to not limp out of the OR. But I don't have the ability to be down and out for a long period of time. I just can't.

Classic doctor's (and mom's) thoughts...can't get sick...think of others...just keep working. We don't think of ourselves until we absolutely have to do so.

Random thoughts about musicals

I love musicals. Love. Them. Listened to many while driving this weekend to a conference.

Some nominations for various categories:

Best intro: Phantom of the Opera, Andrew Lloyd Webber. The overture playing as the chandelier rises...

Best song, lyrics: You Got to Be Carefully Taught from South Pacific. A primer on how hatred arises.

Least Appreciated: Chess, Tim Rice and the dudes from ABBA. Outdated plot, but interesting musically. Also extremely pessimistic.

Best misintepretation of a song from a Musical: Whitney and Cissy Houston "I Know Him So Well" from Chess. It's obvious that they do not know the source.

Favorite Character: Judas from Jesus Christ Superstar. Interesting character, propels plot, some cool songs. I usually sing this character when I listen to JCS.

Best song, music: All I Ask of You from Phantom. Lush and romantic (my style) and very hummable.

Favorite memory: Taking my DD to her first one...she was great! And now I have someone who loves them as much as I do (she goes to sleep listening to Phantom).

Ponderings

As an OB, we are involved in the single most intimate and amazing experience most people have - childbirth. There is a huge amount of trust placed in us - we are allowed to see and touch areas most people aren't. I am the first person to reach out and touch a new person as the baby is pushed towards extrauterine existence. I guide the shoulders out and in the same movement swing the baby onto Mom's belly - just inches from where he resided hours earlier.

And as a doc in a small town, we frequently care for the whole family. Sisters who are pregnant at the same time. New cousins. We hysterectomize the soon-to-be grandmother during her child's pregnancy (in time to allow her to help with the newborn). A new patient will come in and say "You delivered so-and-so's baby. She's my cousin/sister/friend/neighbor." It's an interconnecting web of humanity and I am merely one strand.

And I've been here in town long enough to start doing repeaters. That is the true mark of trust - letting you be there again. Allowing you to enter a sacred time again. Trusting in your ability to do a c-section - again.

This is why I still do what I do, despite whining about call, despite the hours, despite the crazy patients. Because there is still lots of beautiful things about being an OB.

Resolution

That I will never again blog about how good of an OR week I'm having, since that immediately pisses off the OR Gods.


Lots of swearing was done in the OR yesterday.

ETA: I must have really pissed off the OR Gods, as emergent surgeries are raining down upon me.

Female OBs

Nowadays, the majority of OB-Gyns in training are female (last stats I saw were 75% female). It's the way of the future. Many women feel (rightly or wrongly) that a woman would understand better.

Guess what! Female OBs are harder asses than the men! We've been there. Many of us were pregnant in residency. So we don't put up with the victim act. We waddled around at 38 weeks, working 15 hour days, helping to move patients to the stretcher. So quit your bitching, because we *DO* know what it is like...and it is possible to do it.

Quote of the week

"I can't have one of those diseases. I'm macnogmous."

I swear, comedy gold is there for the picking in doctor's offices around the country.

Jinxing myself

2 great OR weeks in a row. Every case started on time. No complications. No unexpected findings. No equipment malfunctions. The laparoscopic hyst on a very large lady stayed laparoscopic. My fastest vag hyst ever (24 minutes!). The worst thing that happened was I dropped an instrument on the floor during the laparoscopic hyst and had to wait for a new one to be thrown onto the field.

One laparoscopy had such beautiful anatomy, it looked like a textbook. The ureter was peristalsing gently next to the great vessels. The appendix rested nearby. Two textbook tubes and ovaries. No findings to explain her pain, but beautiful anatomy.

We had 80s rock going in the background yesterday. Styx, Whitesnake, all of the cheesy stuff from my high school years. Today, it was an all female room, so we were debating the merits of the male swimmers vs the male gymnasts.

Pregnancy Haiku

Courtesy of my DH.


Ankles are swelling.
Whales at sea are envious.
Ten more weeks to go.


:)

From Ramona

The Big Read reckons that the average adult has only read 6 of the top 100 books they’ve printed.”

1) Bold: I have read.
2) Underline: Books I love.

3) Reprint this list in your own blog so we can try and track down these people who’ve read 6 and force books upon them ;-)

1. Pride and Prejudice - Jane Austen

2. The Lord of the Rings - JRR Tolkien

3. Jane Eyre - Charlotte Bronte

4. The Harry Potter Series - JK Rowling

5. To Kill a Mockingbird - Harper Lee

6. The Bible

7 . Wuthering Heights - Emily Bronte

8. Nineteen Eighty Four - George Orwell

9. His Dark Materials – Phillip Pullman

10. Great Expectations – Charles Dickens

11. Little Women - Louisa M Alcott

12. Tess of the D’Urbervilles - Thomas Hardy

13. Catch 22 - Joseph Heller

14 . The Complete works of Shakespeare (Like Purplesque and Ramona I've tried, and failed. Evidently I'm uncouth)

15. Rebecca - Daphne Du Maurier

16. The Hobbit --J.R.R. Tolkien

17. Birdsong – Sebastian Faulks

18. Catcher in the Rye - JD Salinger

19. The Time Traveler's Wife

20. Middlemarch - George Eliot

21. Gone With The Wind - Margaret Mitchell

22. The Great Gatsby - F Scott Fitzgerald

23. Bleak House - Charles Dickens

24. War and Peace - Leo Tolstoy

25. The Hitch Hiker’s Guide to the Galaxy - Douglas Adams

26. Brideshead Revisited – Evelyn Waugh

27. Crime and Punishment - Fyodor Dostoyevsky

28. Grapes of Wrath - John Steinbeck

29. Alice in Wonderland - Lewis Carroll

30 . The Wind in the Willows - Kenneth Grahame

31. Anna Karenina - Leo Tolstoy

32. David Copperfield – Charles Dickens

33. Chronicles of Narnia - CS Lewis - hated LWW, why would I toture myself with the sequels?

34 . Emma - Jane Austen

35. Persuasion - Jane Austen

36. The Lion, The Witch and The Wardrobe - CS Lewis

37. The Kite Runner - Khaled Hosseini

38. Captain Corelli’s Mandolin - Louis De Bernieres

39. Memoirs of a Geisha - Arthur Golden

40. Winnie the Pooh - AA Milne

41. Animal Farm - George Orwell

42. The Da Vinci Code - Dan Brown

43. One Hundred Years of Solitude - Gabriel Garcia Marquez

44. A Prayer for Owen Meaney - John Irving

45. The Woman in White - Wilkie Collins

46. Anne of Green Gables - LM Montgomery

47. Far From The Madding Crowd - Thomas Hardy

48. The Handmaid’s Tale - Margaret Atwood

49. Lord of the Flies – William Golding

50. Atonement - Ian McEwan

51. Life of Pi - Yann Martel

52. Dune- Frank Herbert

53. Cold Comfort Farm - Stella Gibbons

54. Sense and Sensibility - Jane Austen

55. A Suitable Boy - Vikram Seth

56. The Shadow of the Wind - Carlos Ruiz Zafon

57. A Tale Of Two Cities - Charles Dickens

59. The Curious Incident of the Dog in the Night-time - Mark Haddon

60. Love In The Time Of Cholera - Gabriel Garcia Marquez

61. Of Mice and Men - John Steinbeck

62. Lolita - Vladimir Nabokov

63. The Secret History - Donna Tartt

64. The Lovely Bones - Alice Sebold

65. Count of Monte Cristo - Alexandre Dumas

66. On The Road - Jack Kerouac

67. Jude the Obscure - Thomas Hardy

68. Bridget Jones’s Diary - Helen Fielding

69. Midnight’s Children - Salman Rushdie

70. Moby Dick – Herman Melville

71. Oliver Twist - Charles Dickens

72. Dracula - Bram Stoker

73. The Secret Garden - Frances Hodgson Burnett

74. Notes From A Small Island - Bill Bryson

75. Ulysses - James Joyce

76. The Bell Jar - Sylvia Plath

77. Swallows and Amazons

78. Germinal - Emile Zola

79. Vanity Fair - William Makepeace Thackeray

80. Possession - AS Byatt

81. A Christmas Carol - Charles Dickens

82 Cloud Atlas - David Mitchell

83. The Color Purple - Alice Walker

84. The Remains of the Day - Kazuo Ishiguro

85. Madame Bovary - Gustave Flaubert

86. A Fine Balance - Rohinton Mistry

87. Charlotte’s Web - EB White How could you not love this book?

88. The Five People You Meet In Heaven – Mitch Albom

89. Adventures of Sherlock Holmes - Sir Arthur Conan Doyle

90. The Faraway Tree Collection – Enid Blyton

91. Heart of Darkness - Joseph Conrad

92. The Little Prince – Antoine de St. Exupery

93. The Wasp Factory – Iain Banks

94. Watership Down - Richard Adams

95. A Confederacy of Dunces – John Kennedy Toole

96. A Town like Alice- Nevil Shute

97. The Three Musketeers - Alexandre Dumas

98. Hamlet- William Shakespeare

99. Charlie and the Chocolate Factory - Roald Dahl

100. Les Miserables – Victor Hugo

Happy 10th Anniversary

I love you sweetie. You have been my friend, partner, and true love. You are a great husband and a loving father. You make me want to be better than what I am now. 19 years ago, we exchanged class rings and now look at us. I am truly a lucky person to have you in my life.

Thank you

Great delivery day

3 deliveries today. Total time spent pushing with the patients (I push with my patients, I don't have the nurses start pushing them, so this is a true total time pushing): 12 minutes.

YES!

Have I mentioned that I love multips?

Done!

Take THAT ABOG! I am done, done, DONE!!!!

Neener!

I HATE ABOG!!!!!!!!!!!!!!

AAAAAAAAAAAAAAAAAARRRRRRRRRRRRRRRRRRRRRRRRRGGGGGGGGGGGGGGGGGGGGGGHHHHHHHHHHHHHHHH!!!!!!!!!!!!!!



My head is spinning from entering 210 deliveries and about 140 surgeries from last year.

I'm beginning to think board certification isn't worth it. And now there is continual recertification, which, amazingly enough, the established docs are grandfathered out of needing to do.

Garump!

Did I mention how much I loathe ABOG?

Tattoo, Tattoo!!!

Watched a documentary last night on tatts. Interesting.

As a doctor, you see lots of tatts on people. Some are truly works of art and some...well...should be regretted. I STILL remember a tramp stamp (a tatt on the small of your back) on a patient when I was a med student. "Exit only" with an arrow pointing down. Sigh. Just recently I saw a beautiful tatt - footprints with her kids' names on her foot.

Just remember ladies, that young, flat abdomen you have now will not be that way later. Most women get stretch marks and those make tatts look ugly. And please don't put one right down by the pubic hairline - it's a bitch to sew skin when there is a tatt to match up.

And also, if you have lots of tatts, no fair whining about needles and injections. You will have ZERO credibility. Trust me.

The most amazing thing

Even though I have literally seen thousands of births, it still amazes me.

The woman is pushing and at first, just a smidgen of head is visible if I'm separating the labia. Then after some more pushing, the head is seen without my assistance (at this point, I'm frequently styling the hair into a ponytail/mohawk). Then a few more pushes, and she's crowning.

And then it's done. Once the baby crowns, it's pretty quick. But it's so cool to see the head come out, turn, and then the rest of the body follows.

Just beautiful.

RIP

Not understanding, part infinity

Why do patients allow their children to be brats at the doctor's office? Today was the day for bratty kids; the front staff were at the point of wanting to explain parenting to people.

One woman had 4 kids with her in the exam room. The toddler had (stinkily) loaded up his drawers (and NO, she did not change him) and was running around opening drawers and cabinets. The older children interrupted me every time I was trying to get a question out. My head was pounding at the end of the day.

Now I remember why I didn't go into peds. :)

At least all of the newborns were being good (as well as being adorable creatures who needed kisses on their heads).

Sometimes, I just don't understand

So yesterday, we took the kids to Chuck E. Cheese as a reward for good behavior during the school year. We had fun, the kids had fun, this is what we had in mind. I learned that I suck at video racing.

But I don't understand other parents.

Exhibit A: allowing a young kid to wander alone (he looked to be about 2-3). Now, the place does have the security mark but still! Come on people! PARENT YOUR KIDS! Toddlers need to be supervised.

Exhibit B: 30 something mom. Wearing booty shorts that said "Saddle up"...over what looked like butt implants. I swear, her ass was triangular. Now, I am not a fashionista (Stacy and Clinton would have a good laugh at my wardrobe of mom jeans and t-shirts) but even I realize that particular outfit is just so....wrong.

Maybe I'm just getting old.

I'm not the only one!

obgynkenobi.blogspot.com/2008/06/seriously-people.html

40 weeks

Is a loooooooooooooooooong time to be pregnant! I can't believe that my mean OB won't induce me when I've shown up on L&D 4 times in the last 3 days. I mean, I am SOOOO uncomfortable - it's hot outside! You can't expect me to exist with this pressure too - it hurts to walk. And I'm having contractions every 20 minutes!!! And I get up to pee 3 times every night - I'm not sleeping well. Maybe if I refuse to leave L&D after the 4th time, I'll get induced.

Hmm, cussing out the nurse makes me feel better. And perhaps threatening to go to a different practice after delivery will make them jump and do my bidding! Naw, let's just pitch such a huge fit that security is called.

gah. Some people just shouldn't breed. But I do so hope she makes good on her threat to leave the practice. ;)

Constant learning

So I'm filling out my infectious disease report for last month. I had a post-op infection in a patient, cultures grew out a bug I had never heard of before! Staph Lugdenens. (I think that is how it's spelled, I'm at home)

So I did some research...discovered in 1988 and most commonly found in inguinal (hmmmm) sites as a carriage bug. Fortunately, antibiotic resistance is low. Frequently confused with S. Aureus.

And the patient is doing fine after antibiotics.

Half-full

DH is changing my half-full wine glass to an all full one. ;)

But what I was really going to post about is outlook. Deborah Peel would have you think that bitching and moaning on a blog is unprofessional. Doctors shouldn't feel that way about their patients.

BULLSHIT!

Anyone who deals with the public on a regular basis needs an outlet. There are a lot of nutty people out there, and we see them on a daily basis. You know, my sister bitched about customers when she waitressed, I grew to loathe some clients when I was a secretary, teachers I know whine about their students. Sartre was right when he proclaimed that hell is other people.

But we wouldn't be doctoring without a love of what we do. And there are lots of patients whom I absolutely adore. You just don't need a release when you deal with those folks. Fortunately, these folks are the silent majority of patients.

But bitching is fun. ;)

Happy Birthday Burpy-Brain

8 years ago today, we met you, our wonderful daughter. Time sure has flown by and you're now marching on towards the teen years.

Wow.

(Burpy-Brain is the family nickname for DD...she can belch better than anyone I know)

Ok Folks,

Repeat after me:

The pharmacy closes at 9 pm. The CLOSEST 24 hour pharmacy is about 90 minutes away.

I am on call tonight. I had 5 pages between 20:55 and 21:05 for meds. Several from people DISCHARGED FROM THE FRICKEN HOSPITAL TODAY!!!!!!!!!!!!!! Who didn't bother to fill their pain meds and now are hurting.



aurgh!

The pain

As a mom, I don't think I could deal with this.

Do you think I could market this?

So after the umteenth vagitch of the day, I decided that Diflucan should be dispensed like candy. Pez candies was my inspiration...I could do a Diflucan Pez dispenser.

It needs to be anatomically correct...with the little pill coming out of the vagina. And to gulp it down, just push on the bladder for a squirt of water out of the urethra! Maybe I could put yellow food dye in there for complete accuracy...

Somehow, I don't think this would be a best-seller... ;)

Not what you want to hear

Rose was an old nurse. She had been working on L&D literally longer than I had been alive. You learned early on (if you were a smart intern) to do what she told you to do. It was just easier that way for all involved.

I'm back in the call room, relaxing. Easy call night so far, no major issues going on. I was even watching TV. Then my phone rang.

Rose knew where I was and that calling would be faster than paging. "I can't get heart tones on a 23 weeker who came in with abdominal pain."

That sentence ended that calm night. I walk the 30 yards to triage to find her, the patient and the patient's father there. I wheeled the ultrasound machine into the tiny space and plugged it in. Actually there was a heartbeat...but I couldn't quite get all of the fetus in view abdominally. The heart was basically on top of her pubic bone.

Mentally groaning, I go to check her cervix. Gloves are on and my left hand separates the labia to find...butt cheeks.

Fuck. Fuck. Fuckety-fuck-fuck. My resident and the in-house attending are going to love this. Did I mention the word FUCK went through my mind? Because it did.

Wheel her back to the delivery room and page my senior resident, the attending, and NICU for delivery. Wheel her out - 23 weeks even...not even an extra day. Aint nuthin good going to come out of this.

Quick history to NICU doctor: 23 weeks, butt on perineum. And we deliver the butt, the body.......................but no head is coming.

FUCK!

Eventually, we end up cutting the cervix to allow the head to finally deliver. A live (sorta) baby. Fortunately, she died the next day.

Even if there is nothing we can do, it still sucks.

Happy 0th Birthday

Hope Mary. May you live up to your name.

Bad equation

Nauseated doctor + ((obese patient^hygiene issues)*needs a pelvic exam) = not a pretty sight.

Vacation thoughts

Things important to KIDS on vacation:
1. Hotel swimming pool
2. Hotel elevator
3. Hotel ice machine

Things important to PARENTS on vacation:
1. Local museums
2. Historical sites
3. Does the restaurant serve alcohol? (we WERE in Utah...)


Other thoughts:
The hotel bar closed at 11 pm. Last call was 10:45. :(

Damn, Utah has a lot of mountains. Here in flyover country, we're not used to drastic elevation changes! Walking SLC's zoo was a challenge - up and down and up and down... It was truly a beautiful state, even when we took a wrong turn and went down a mountain road riding the brakes as hard as we could.

The Great Salt Lake is fricken' HUGE!

Great kid quotes:
Upon hearing that the breakfast buffet was served between 6 and 9; DD said "Great cuz I'm 7!" I started crying, I was laughing so hard at that one.

Amazing article

Go here for a great link to what death and dying can mean.

As someone who has been the primary caretaker in a home hospice situation (for my father), I find these pictures beautiful and amazing.

Death is not the enemy, it is the natural consequence of living.

The OR

There is very little that compares to a good OR day. The one where every patient is thin, all of the instruments work without needing to jigger this-n-that, the anatomy is normal, and the patient has a virgin belly. You have your CD player going, you are running on time, and the conversation between the nurses, CRNA, assist, and me are teasing in nature. It is honestly a hell of a lot of fun, although it can be physically draining. And if everything goes right, the patient improves quickly post-operatively and feels much better. And THAT'S why we love to operate.

The above paragraph is a dream...most patients are fluffy (to be polite), the damn bovie machine is acting up again, we're hours behind schedule, I forgot my CDs, and conversation consists of me and the assist swearing because of distorted anatomy and our legs/back/shoulders ache. It's still a lot of fun, even when I'm bitching and moaning about why I hate vaginal surgery.

My OR day this week was more like the second day...it beat me up! But I'm still operating tomorrow...

Ruminations

I was reading the internet this weekend while waiting for a delivery. And I can't link to it, because I can't remember how I got to the article (love clicking through links!), but there was an op-ed piece on Clinton and female support. The gist of the piece was that women should vote for her because she is a woman.


ARRRRRRRRRRRRGGGGGGGGGGGGGGGGHHHHHHHHHHHHHHHHH!!!!!!!!!!!!!!!!!


I am a woman. I even think of myself as a feminist. But I refuse to vote for someone JUST BECAUSE we share the same gender. Hell, feminism to me means that I DON'T take into account gender to make decisions. I don't care if a candidate for POTUS has a vagina or a penis. I don't care what color of skin s/he may have. I just care that I agree with their positions more than the other candidates.

You know, 40+ years ago, MLK dreamed a dream for his kids. I want my kids also to be judged for the depth of their character, not their external characteristics. I have a daughter and a son. And I hope that in the future, they are judged by their work.

Sadly, that day is not here yet. My daughter is growing up in a world that still is immersed in a double standard. It is better than in my grandmother's day. Hopefully it will be better someday. I will say, I am happy that I am seeing a time where serious candidates for POTUS reflect a wide variety of backgrounds, including the fact that Obama is the son of an immigrant from Kenya.

And for those who think all is hunky-dory, there's still underlying attitudes that women can't do things. I just have to think about the attending who told me to my face when I was a resident that women don't belong in operating rooms.

E&R's Mom

Wow

Here's a reply to the hatred spewing idiot. Who says teens are apathetic? Good job, young man.

Why kids rock

1. I can watch Tom and Jerry without feeling guilty.
2. Snowball fights!
3. I get to reread the cool books from when I was a kid (we're working on a Wrinkle in Time right now...)
4. They give me an excuse to run through the sprinklers in the summer.
5. They give the best hugs and kisses.
6. They are an amazing amalgram of me and DH.

OB-Gyn in trouble

I love being an Ob-Gyn. It was the only rotation in med school that I really truly could see myself doing as a job. Having said that, as time passes, I see more and more the dark underbelly...how things are going to get bad before they get better (sorta like residency, if you think about it).

Solo Ob-Gyns are a dying breed. It's not the call - it's the overhead! Even my practice (3 docs, a CNM, and 2 PAs), the numbers are now starting not to work. We've been looking at the numbers, and there's little to pare. I practice in a "red alert" state, so our malpractice insurance is a large expense. We docs actually pay ourselves less than the mean and median, so cutting there (although possible) is not a viable option for long. We have a great staff, but they're running close to maximum output. We're considering eliminating the match on the 401K, but that won't help a lot. I do make a profit, albeit barely.

I could add more hours. I value time with my kids and husband. I could squeeze in more patients. But I like my schedule as is - 30 minutes with a new patient is not a luxury with EMR, it's a necessity (especially those who come in with a long list of meds). (EMR is a whole 'nother rant)

So I'm at an impasse. I'm technically not a partner in the practice, I'm employed. My contract will be up in the summer. They would like to keep me but the writing is on the wall. Do I go to the hospital and become employed? Do I move back to where I trained, as they are looking (I've seen the ads in the Green Journal)? I talked to one of my former attendings, he said they would love to have me back on faculty. I haven't burned any bridges anywhere. I've talked to the Chief of Staff here, they would be interested.

Lots to think about. And I need to get moving, so I have a contract in place and a plan.

Question

Am I a horrible person for hoping that a certain pain-in-the-ass patient no-shows for her appointment?

We could have TOLD you that

http://news.yahoo.com/s/ap/20080212/ap_on_he_me/fewer_docs;_ylt=Alhcj1ZB3HddrZw5krgbE8qs0NUE


Fewer American grads going into primary care. DUH!!!! Why on earth would you - low reimbursement, long hours, lots more hassles than a specialist?

Don't get me wrong - a good PC doctor is worth his/her weight in gold, maybe even platinum. But many American medical school grads agree and they are voting with their feet by going into specialties. (and BTW, my specialty is having similar issues with getting people to train as one - more on the rant later)

Heck, pretty soon, all American grads will be either path, derm, rads, ortho, or anesthesia. ;)

Heal Thyself

I'm an Ob-Gyn. Many women (rightly or wrongly) come to me for their only care. I am a specialist, but we'll let that one point slide for now.

I'm like my patients. Getting older, a pound or two heavier each year. I can chart it. It's depressing.

So what do I tell my patients : Exercise. Eat right. Do the preventative stuff.

I decided to start walking the walk (so to speak, it's more like biking the bike, but you get the picture). I've even started lifting weights.

And I'm down a few pounds. My arms look a little bit better, more toned.

Hope it helps.

WTF?

If you admitted for severe abdominal pain, you are OK to be discharged if your nurse catches you in the shower "soaping up" with your boyfriend.

WTF?

Gripes

1. If YOU page ME to a phone number, I had better not get your god-damned voicemail. I just hang-up, since it's obvious it's not important enough for you to talk to me. I may or may not try to call again in 10 minutes.

2. If you come to me to establish as a patient since your previous doctor retired...and you tell the secretary that the purpose of your visit is to renew your meds...and you didn't bother to get records...you better damn well KNOW YOUR MEDICINES AND THE DOSES!

grrrrr.