Labor & Delivery Nights

The OB/Gyn office week was cut short by Thanksgiving. I don't think I missed that much and was able to study my rotation book during the family trip to San Diego for the Holiday.

Things changed a lot this week for Labor & Delivery nights. The first night, Monday 7pm to 7am, was with the worst attending I've been with yet. She was a decent Doc technically, but a stuck-up b**** to the nursing staff, a sourpuss to patients and non-existent as a preceptor. It was the worst rotation shift I had to that point. I had to chase her around and get my bearings of the busiest L & D ward in the SW USA! They deliver 8500+ babies a year at Banner Desert. So she was worthless, but I managed to pick up a few things on my own, watch a C-Section and attend a few deliveries.

Unfortunately I had her again on Thursday night (7pm - 7am). That night was dead so I read a lot and tried to stay out of her way so she could get her "precious" sleep. She didn't have the courtesy to let me know about the one delivery of the night on our service so I did absolutely nothing! That was just about my most worthless 12 hours in medical school and I had to stay up through the night for it.

Tuesday was much better. I scrubbed for two C-Sections and got to cut sutures, hold retractors, etc. I was a little more involved in deliveries and saw some interesting cases. Wednesday was even better with an awesome attending. He let me catch three babies, deliver the placentas and get even more involved in a C-Section. It was a tricky one with fibroids and a lot of bleeding so I learned a lot. Even though I was tired driving an hour and a half through Phoenix rush hour traffic at 7am, I felt awesome having helped with those deliveries. The downer is that I left at 7:10am and learned later that the attending lost a mom shortly afterwards when she bled to death from a placenta accreta. The baby was delivered at 8am, but the Code for the 28 yo mom was called at 11am. The entire staff was shaken up and I heard the attending took it really hard.

Thursday was the let-down I already mentioned, but Friday made up for it. I was with one of PPA's (Phoenix Paranetology Assoc) attendings and she was terrific. We were extremely busy and she didn't get any sleep, but she was still the most gracious attending I've seen at Banner yet. The nurses love her too. I read maybe two paragraphs the whole night but loved it. I caught three babies, wrote lots of notes and started to perform some sutures on my own to repair torn vaginal walls. I need a lot more practice on suturing and started working on my catching technique so I can do single-handed someday.

I learned that the Doc hardly gets to see the baby at all. You deliver his/her head, bulb suction the goop, rotate the shoulders, deliver the body and cradle him/her, clamp the cord, cut the cord and hand the baby off to mom or the nursery folk for a high risk case. You get a few seconds at most to look at the baby when s/he is usually covered with goop and still blue. Then, with amniotic fluid running down your leg, you get to stare at a new mom's privates for an hour or so trying to deliver her placenta and repair any lacerations while the nurses, parents and anyone else present enjoy the infant.

In fact, one of the babies I delivered last night was given a clinical diagnosis of Down's by the nurse that took him from me based on facial features alone. Neither my attending or I had time to notice any of the findings as we were dealing with the placenta, lacerations and cleaning mom up. Afterwards, we spoke to the visibly upset parents (dad had seen his son in the nursery when the nurse talked to him). The attending was great and I appreciated her bedside manner. We had the advantage of having a nurse nearby that had raised a 10 yo daughter with Down's. She talked to the family for quite awhile and gave them lots of information on support groups, web sites, etc. However, we warned the patients the chromosomal studies would take 10-14 days and the baby may be just fine. The weird thing is the baby had pericardial effusions (usually associated with a viral infection) and a level II ultrasound. None of the usual "soft" findings like missing nasal bones, thick nuchal fold, short femur, heart/GI problems, etc. showed up.

All in all a great week some of the highest highs and lowest lows I've experienced thusfar in med school. I can see the attraction of OB/Gyn for male and female Docs (healthy patients, procedural, gracious parents and continuity of care). It is something that I will definitely consider incorporating into a rural practice. But the concerns of uncontrolled hours, malpractice costs and legal liability are pretty discouraging. Two more weeks to go though and I have to study up on three Gyn surgeries on Monday.

My parting thought is remembering the rural IM/FM doc from Texas I met on a flight coming back from Seattle. He mentioned doing a crash C-Section in one hour and nine minutes. This is how long it took the ambulance he was in to get the 120 miles to the nearest hospital with L & D services. At this point I can't fathom ever having the courage, knowledge and skill to do that. As a classmate told me; "your knees get weak after an intense delivery" - with all the resources of one of the busiest L & D departments in the country a few feet away.