At 5:15 a.m., I am awakened from my sound sleep by the beeping of my alarm. Quickly, I shower and get dressed then walk down the hall to get my five-year old daughter ready. By 6:40, I have dropped her off at daycare and am heading down Douglas to the hospital.
A little before seven, I arrive on the post-partum side of the OB floor and log into the computer to start seeing postpartum patients with the two other OB residents on this month. Today, three of the six that need to be seen are being discharged. After notes and discharge paperwork is completed, the post-call resident signs out to me what is going on the Labor side of the floor. We have two elective pitocin inductions that arrived this morning, the post-call resident has one of his continuity OB patients in labor, and a patient in the PACU is here for cerclage placement. The post-call resident is finishing up the H&P on one of the inductions, so I see other patient and complete her H&P. By 8:30, we head down to the cafeteria for breakfast and discuss preterm labor while we eat.
After breakfast, I check on the resident labor patient and introduce myself to the other patient here for induction that I did not meet earlier this morning. I encourage the resident’s continuity patient to get up and walk around the unit to see if we can improve her contraction pattern. The plan for the patient is discussed with her primary resident and the attending on for the day. Around 11, the patient in placed back on the monitor. Unfortunately, her contraction pattern has not improved, so I place an IUPC. After 10 minutes, I calculate the Montevideo units and update the attending. She is only measuring 80 MVU, so I start pitocin.
While I was busy with the resident labor patient, the private OB taking care of the two patients here for induction came in and broke both patients’ water. One has clear fluid and the other has meconium-stained fluid. NICU is notified of the one with mec staining and they will be present at delivery.
While writing my labor notes, I notice a triage been registered that I have not been paged about, YET. I read up on her and stop by the triage area to check in with the nurse before going downstairs to grab some lunch. She tells me the patient has not felt baby move and is here for a non-stress test. During lunch, I am paged and informed that the nurses cannot get fetal heart tones and the patient is telling them she has not felt her baby move in a week. We order a STAT ultrasound. I eat my lunch and return to the floor. It’s time to check on the resident patient again. She has not changed since my last check and is 7cm dilated. I update the attending who has been covering all morning and the one who will be taking over.
The ultrasound tech pages me and confirms the 34-week fetal demise. I call the attending on for the patient’s group who instructs me to order blood work. Thankfully, he will be in to see her in the next hour to deliver the terrible news. I have never had to tell a patient anything so horrible and did not want to have to today. Sad now, I sit at the computer outside the patient labor rooms and check my clinic messages.
The nurse comes out of the resident patient room and tells me she is feeling a lot of pelvic pressure. She is complete on my cervical exam. As I put on my shoe covers, the attending that was covering this morning is called. The attending arrives quickly and we do some practice pushes. The patient only speaks Spanish. Even though an interpreter is in the room translating, the patient is having a hard time following the directions regarding how she is to push. We wait for her contraction to pass and do a practice push without a contraction. We put the plan into action with the next contraction. She moves the baby really well with the practice push so the nurse breaks down the bed and I gown up for delivery. Within ten minutes, I am holding the baby and place her on her mother’s abdomen. She did great pushing and did not even tear. Once the placenta is delivered, I clean up my mess and go to examine the baby along with the attending. The baby has an intermittent hip click on the right that will need to be watched. I put post-partum orders in for the mother and newborn orders in for the baby, then complete an H&P on the baby and write a delivery note.
Next, I head over to the triage area to check on the fetal demise. As I arrive, her OB is coming out of her room. He has already spoken with the patient who is obviously quite upset. He updates me on the plan, goes over some teaching points and we go over the orders together as I place them in the computer.
As I finish the orders, I am paged to the labor side of the floor as one of the inductions is now complete. I rush to her room and find her very comfortable with her epidural. She has no urge to push, so I have time to place an IUPC in the other induction patient whose contractions we are not picking up very well. I quickly return to the room of the patient who is complete and am ready if I am needed. Her OB arrives shortly. The baby is down pretty low, so we both gown up. Even though this is the first time I have worked with this OB, she allows me the honor of doing the delivery. The patient has a small first-degree laceration which the OB repairs. I offer to do the delivery note and put in the postpartum orders for the doctor. After I finish, I am paged by one of the other residents. He came by to drop off his pager and sign out a few things to me, since I am covering him while he is on vacation next week.
It is now 4:25 p.m. I go check on the fetal demise who has now been moved to a labor room. She has a history of epilepsy and I need to clarify her seizure medications. Luckily she has her medication bottles with her so I can order the correct medication in the correct dose. I check on the other induction that is stuck at 5 cm and head down to the cafeteria to get dinner. An hour later, I am called by the nurse who reports that the last induction is now 9/100/0. The patient is comfortable and not feeling an urge to push. The OB is on her way in. It is the same OB that I delivered with earlier, so she again allows me to do the delivery. We have a little bit of shoulder dystocia and employ McRoberts maneuver to assist in delivery of the anterior shoulder. I repair the patient’s 1st degree tear while the OB watches me. After completing the delivery note and placing the post-partum order, there is a lot of commotion by one of the windows. A huge thunderstorm is going on outside and the wind is blowing hard. The power goes out but the back up generator quickly kicks in. We all run around the floor closing shades and plugging equipment into the "red" outlets.
Around 7:20 p.m., I go to the call room to watch TV and find out what is going on with the storm. I call my husband who reports that the power is out there. At 8:30, I lie down and try to sleep. My pager goes off at 9 p.m. The patient that I delivered at 6:30 is still in pain after taking Motrin and one darvocet. I order a second dose of darvocet and lie back down. I quickly fall back to sleep and am awakened at 11 p.m. by the same nurse reporting that the patient is still in pain. I order a one-time dose of Nubian and change her scheduled medication to Norco then crawl back in bed. The nurse awakens me at 2:30 a.m. to clarify the Norco order, which I quickly do and return to sleep. At 4 a.m., I am paged yet again for the same patient. I go speak with the patient and examine her. She is having crampy lower abdominal pain that feels like it radiates into her thighs and legs. Her fundus is firm and her lochia is within normal limits. I am concerned since I have not been able to control her pain and do not want to miss anything, so I page her OB. I would think I would have more bleeding if the patient had retained tissue. The OB reassures me that I am not missing anything. I order tordol and nubain for the patient. While I am up, I check in with the nurses regarding the fetal demise patient and they inform me that she delivered a little after midnight. Again I return to sleep. My alarm goes off at 6:50 a.m. I get up and get ready before the next resident comes on for their 7 a.m. shift.
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