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.

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.

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. ;)

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.

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...

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?!?!??!?!?!?!?!?!?!?!

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...

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?

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.

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).

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.

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.

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.

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.

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.

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?

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.

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.

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.